Inequities in Alcohol Screening of Primary Care Patients with Chronic Conditions

Abstract

Routine alcohol screening of people with chronic health conditions that are exacerbated by alcohol can help to prevent morbidity and mortality. The U.S. Affordable Care Act and other recent health reforms expanded insurance coverage and supported alcohol screening in primary care. This study assessed increases in alcohol screening following health reform and insurance-related and racial and ethnic disparities in screening. Data are from the 2013 to 2019 National Surveys on Drug Use and Health for adults with alcohol-related chronic conditions who received primary care in the past year (N=46,014). The outcome was receipt of alcohol screening (yes/no) in which a healthcare provider inquired whether, how often, or how much the respondent drank, or about having alcohol-related problems. Multivariable logistic regression models assessed temporal changes in screening overall and by insurance type and race/ethnicity, adjusting for demographics, health conditions, and primary care utilization. Statistical analysis was performed in 2023. Alcohol screening prevalence rose from 69% to 77% from 2013 through 2019, with a notable increase in 2014-2015 for both Medicaid-insured and privately-insured patients. Black and Asian American patients were generally less likely to be screened than White patients. Importantly, racial disparities in screening were found among privately-insured patients, patients with hypertension, patients with heart disease, and patients with diabetes who drink alcohol. Alcohol screening of primary care patients with chronic conditions increased following health reform, but persistent disparities among patients with private insurance and specific chronic conditions underscore the need to address drivers of unequal preventive care.