Disparities in pharmacotherapy for alcohol use disorder in the context of universal health care: a Swedish register study

Abstract

Background and aims: Pharmacotherapy can be an important part of the continuum of care for alcohol use disorder (AUD). The Swedish universal health-care system emphasizes provision of care to marginalized groups. The primary aim was to test associations of neighborhood deprivation and disadvantaged social status with receipt of AUD pharmacotherapy in this context.

Design: Data from linked population registers were used to follow an open cohort over 7 years.

Setting: Sweden.

Participants: Alcohol-related ICD-10 codes reported for all hospitalizations in the Swedish Hospital Discharge Register and all clinic/office visits in the Outpatient Care Register between 2005 and 2012 were used to identify 62 549 cases with AUD.

Measurements: The primary outcome was any AUD pharmacotherapy (naltrexone, disulfiram, acamprosate, nalmefene) picked up by patients between 2005 and 2012 (versus none), based on the Swedish Prescribed Drug Register. Neighborhood deprivation was defined using aggregated data from the Total Population Register; indicators of disadvantaged social status (income, education, country of origin) also came from this source.

Findings: Approximately half the cases (53.7%) picked up one or more AUD pharmacotherapy prescriptions. In adjusted models, people living in neighborhoods with moderate [odds ratio (OR) = 0.90, 95% confidence interval (CI) = 0.86, 0.95] or high levels of deprivation (OR = 0.75, 95% CI = 0.70, 0.79) compared with low deprivation, those with lower incomes (for example, lowest quartile: OR = 0.70, 95% CI = 0.66, 0.73 compared with highest) and less education (for example, < 10 years: OR = 0.82, 95% CI = 0.78, 0.85 compared with 12+ years) and people born outside Sweden (OR = 0.74, 95% CI = 0.71, 0.78 compared with Swedish-born) were significantly less likely to pick up a prescription for AUD pharmacotherapy during the study period.

Conclusions: There appear to be socio-economic disparities in the receipt of pharmacotherapy for alcohol use disorder in Sweden.

Keywords: Alcohol use disorder; Sweden; neighborhood deprivation; pharmacotherapy; socio-economic disparities; treatment disparities.