TOPLINE:

The socioeconomic position (SEP) significantly influenced the effectiveness of pharmacotherapy for alcohol use disorder (AUD) in Sweden, with medications showing benefits only among individuals with a high SEP. An analysis of 148,626 patients revealed that the use of pharmacotherapy reduced the risk for AUD-related hospitalisation by 17% in the high SEP group but had no significant effect in the low and middle SEP groups.

METHODOLOGY:

• Researchers conducted a prospective register-based cohort study in Sweden, including 148,626 individuals aged 16-64 years with a first-time diagnosis of AUD between 2005 and 2019.
• The SEP was determined using the highest educational attainment (years of education), and participants were categorised as having a low (≤ 9 years), middle (10-12 years), or high (> 12 years) SEP.
• Demographic characteristics showed male predominance across groups (71.8% in the low, 68.2% in the middle, and 61.2% in the high SEP groups), with the mean age ranging from 47.9 to 49.9 years.
• The primary outcome was AUD-related hospitalisation (an inpatient stay of at least 24 hours), and the exposure was time-varying use of four pharmacotherapies (acamprosate, disulfiram, nalmefene, and naltrexone) for AUD.
• Researchers used statistical models to calculate the subdistribution hazard ratio (SHR), adjusting for sociodemographic and other factors and the use of other psychiatric medications; individuals with a low SEP who did not use any pharmacotherapy comprised the reference group.

TAKEAWAY:

• A higher proportion of individuals with a high SEP (52.5%) than of those with a low SEP (41.5%) used pharmacotherapy for AUD.
• In the fully adjusted model, the use of pharmacotherapy was associated with a lower risk for AUD-related hospitalisation (SHR, 0.83; 95% CI, 0.77-0.90) only in the high SEP group vs the reference group.
• SHRs for pharmacotherapy users in the low SEP (SHR, 1.02) and middle SEP (SHR, 1.01) groups were not significantly different from that in the reference group.
• Additive interaction analysis suggested that about 10% of the reduction in the risk for AUD-related hospitalisation in the high SEP group was attributable to the interaction between the use of pharmacotherapy and SEP.

IN PRACTICE:

"Using any type of AUD pharmacotherapy was associated with a lower risk of hospitalisation only among individuals in high SEP. This underscores the importance of variations in treatment access across social strata that lead to disparities in health outcomes," the authors wrote. 

"Potential differences in the use of psychosocial treatments for AUD by itself or in combination with pharmacotherapy across socio-economic strata should be explored further," they added.

SOURCE:

The study was led by Devy L. Elling, Karolinska Institutet, Stockholm, Sweden. It was published online on November 6 in Addiction.

LIMITATIONS:

The study faced potential selection bias as individuals with incomplete information on SEP, particularly those born outside Sweden, were excluded. The use of data from a prescription drug register possibly introduced the risk for exposure misclassification. The study was limited to four specific pharmacotherapies and may have misclassified individuals using other medications. Additionally, data on individuals who received direct administration of pharmacotherapy in healthcare centres and emergency rooms or during hospital stays may have been missed.

DISCLOSURES:

This study was funded by the Swedish Alcohol Retail Monopoly Alcohol Research Council. Several investigators reported receiving funding, research grants, honoraria, or support in other forms and serving as testifying experts or consultants for several pharmaceutical and research organisations. Full details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.