Race, Ethnicity, and Language Differences in Inpatient Discharge Prescriptions for Alcohol Use Disorder at an...

Disparities exist in alcohol use disorder (AUD) diagnosis, morbidity, and mortality based on patient demographics. Medications for alcohol use disorder (MAUD) have been demonstrated to improve AUD outcomes, and multiple agents are approved for this indication by the Food and Drug Administration (FDA). Hospitalizations are opportunities for MAUD prescribing. This study identifies race, ethnicity, and language-based differences in discharge MAUD prescribing at an academic medical center.

This was a retrospective cohort study of adult hospitalizations with alcohol withdrawal syndrome from 2016 to 2024 at an academic medical center with an addiction consult service. Patients without an encounter in the health system within the preceding 12 months were excluded. We determined the prevalence of prescriptions for FDA-approved MAUD (oral and injectable naltrexone, acamprosate, disulfiram) on discharge and identified variables associated with discharge MAUD in generalized linear models.

There were 5551 hospitalizations representing 2564 unique patients, with 77% of hospitalizations including an evaluation by the addiction consult service. Prevalence of discharge MAUD prescriptions was 35%. Adjusted for covariates, increased rates of discharge MAUD prescriptions were associated with Hispanic ethnicity (aRR: 1.23, 95% CI: 1.06-1.42, vs. White non-Hispanic), Black non-Hispanic race/ethnicity (aRR: 1.25, 95% CI: 1.06-1.48, vs. White non-Hispanic), and non-English language preference (aRR: 1.35, 95% CI: 1.17-1.54, vs. English preference).

These findings suggest that structured hospital-based addiction services may help mitigate disparities in AUD treatment by expanding equitable access to MAUD among racial, ethnic, and language minority patients.