Inequalities in primary care quality in patients with alcohol use disorder: a register-based study
S Drexler, I Keskimäki, E Virolainen, M SatokangasAbstract
Background
Globally, harmful alcohol use accounts for 4.7% of the disease burden and 2.6 million deaths with societal cost reaching up to 2.6% of national GDPs. Moreover, people with alcohol use disorder (AUD) often receive insufficient healthcare for their addiction and comorbidities, despite available evidence-based interventions for AUD in primary care. Thus, we aimed to assess primary care quality among people with AUD in Finland. We used hospitalizations for ambulatory care–sensitive conditions (ACSCs), which are both costly (∼4.730€) and potentially avoidable with adequate primary care. To mitigate the impact of varying patient engagement on ACSCs, we focused on persistent frequent attenders (pFAs) of primary care.
Methods
This is a population-wide, register-based cohort study. We defined pFAs as individuals who were annually among the 10% of users with the highest frequency of primary care visits over a three-year period (2021–2023). We estimated incidence rate ratios of ACSCs in 2024 between pFAs with and without AUD using mixed-effects Poisson regressions adjusted for individual sex, age, comorbidities, socioeconomic status, and regions.
Results
We identified 87,576 pFAs, whereof 3,864 (4.4%) had AUD. The age-standardized ACSC rate per 10,000 person years was 1,068 in the AUD group and 441 in non-AUD group. After adjusting for sociodemographics and comorbidities, the risk of ACSCs was 82% higher in the AUD group (95% CI: 1.61–2.05, p < 0.001). Selected contrasts showed that within the AUD group 1) women had a 32% higher risk for ACSCs (1.20–1.41, p < 0.006) compared to men, and 2) no significant differences emerged between high- and low-income quintiles.
Conclusions
Our results suggest that Finnish primary care poorly meets the needs of people with AUD, especially of women, though with limited income inequalities. We recommend providers to treat AUD similarly to other conditions (i.e. regular check-ups, advice, prescription of interventions or medication).