Black and Hispanic veterans are more likely to be given a diagnosis of alcohol use disorder (AUD) than White veterans despite similar levels of alcohol consumption, according to a report published today in AJP in Advance. The racial discrepancy in diagnosis was evident for both men and women but was greatest for Black men who in some cases had a greater than 100% chance of having a diagnosis of AUD than White male veterans.
“The absence of other factors to explain this discrepancy strongly suggests the presence of racial and ethnic biases in the diagnosis of AUD by VA practitioners,” wrote Rachel Vickers-Smith, Ph.D., of the Mental Illness Research, Education, and Clinical Center at Veterans Integrated Service Network 4 in Philadelphia and colleagues.
The researchers examined the association between levels of alcohol consumption and diagnoses of AUD among 700,012 veterans enrolled in the Million Veteran Program, a longitudinal cohort study that began enrolling veterans in 2011. The sample included 638,204 men (74% identified as White, 19% as Black, and 7% as Hispanic) and 61,808 women (62% identified as White, 30% as Black, and 8% as Hispanic).
Alcohol consumption was defined as an individual’s maximum score on the consumption subscale of the Alcohol Use Disorders Identification Test (AUDIT-C), a screen for unhealthy alcohol use. The AUDIT-C includes three questions:
- How often do you have a drink containing alcohol?
- How many standard drinks containing alcohol do you have on a typical day?
- How often do you have six or more drinks on one occasion?
These responses are scored from 0 to 4 points and summed for a total AUDIT-C score of 0 to 12 points. (AUDIT-C scores ≥3 for women and ≥4 for men reflect unhealthy alcohol use.) A diagnosis of AUD was indicated by the presence of relevant ICD-9 or ICD-10 codes in the participants’ electronic health records.
Vickers-Smith and colleagues focused their analysis on the highest AUDIT-C recorded score (maximum AUDIT-C score) for each participant. Most veterans in the sample had AUDIT-C scores that indicated a low overall level of risk for harmful drinking.
At every maximum AUDIT-C score, White men were less likely than Black men to receive an AUD diagnosis; at maximum AUDIT-C scores of 1 to 10, Black men had 23% to 109% greater odds of an AUD diagnosis than White men. The greatest difference was at an AUDIT-C score of 4, where White men were approximately one-third as likely to have an AUD diagnosis as Black men. Although Hispanic men had a lower frequency of AUD diagnosis than Black men across all AUDIT-C scores, the frequency was generally higher than that among White men, with the greatest difference also at an AUDIT-C score of 4.
“The prevalence of disorders associated with persistent heavy drinking (e.g., alcoholic cirrhosis and hepatitis), whose diagnoses generally rely on objective measures (e.g., laboratory values and ultrasound findings), was similar across the three groups, which suggests that the greater likelihood of an AUD diagnosis among Black and Hispanic veterans was likely not due to different levels of alcohol consumption,” Vickers-Smith and colleagues wrote. “Black women were [also] more likely than Hispanic and White women to receive an AUD diagnosis, despite having a similar distribution of alcohol consumption and prevalence of alcohol-related disorders among the groups.”
For related information, see the Psychiatric News articles “Consult Cases Demonstrate Result of Implicit Racial Bias” and “Impact of Culture, Race, Social Determinants Reflected Throughout New DSM-5-TR.”
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