Sexually and gender-diverse people have higher proportions of AUD diagnoses

Key takeaways:

• A greater proportion of patients identifying as sexually diverse had alcohol use disorder diagnoses compared with heterosexuals — 6.0% vs. 2.6%.
• SGD patients also were more likely to receive AUD treatment.

A greater proportion of sexually and gender-diverse patients had alcohol use disorder diagnoses and care utilization compared with heterosexual and cisgender patients, a recent study found.

“We conducted this study because although the existing literature documents disparities in alcohol use disorder (AUD) diagnoses between sexually and gender diverse (SGD) and non-SGD populations, we did not have a good understanding of how SGD communities are accessing AUD care,” Michal J. McDowell, MD, MPH, a resident in psychiatry at Massachusetts General Hospital, told Healio. “Our hope was to better understand treatment access through this study.”

To do this, the researchers conducted a cohort study with electronic health record system data from a federally qualified health center.

The cohort consisted of 3,607 patients who had an ICD-9 or ICD-10 codes for an AUD diagnosis and any clinic visit from January 2013 through June 2021.

A total of 1,991 patients identified as SGD, and 430 had a gender-diverse identity.

The researchers found that for sexual orientation, “when taken together and split into a binary (straight heterosexual vs. all sexually diverse patients), 2.6% vs. 6% of patients had AUD diagnoses,” McDowell said. “For gender identity, when taken together and split into a binary (cisgender vs. all gender-diverse patients), 4.4% vs. 5.5% had AUD diagnoses.”

McDowell and colleagues highlighted significant differences between the different gender groups regarding health care utilization.

For example, heterosexual patients had the lowest proportion of pharmacotherapy (19.6%), group therapy (13.2%) and individual psychotherapy (40.8%) visits, whereas bisexual patients had the lowest proportion of primary care visits for AUD (38.9%) compared with other gender groups.

“This may indicate a greater comfort for sexually diverse patients to utilize AUD care through behavioral health rather than primary care,” the researchers wrote in the Journal of Clinical Psychiatry.

McDowell and colleagues added this may also come from a greater need for mental health in SGD populations.

Among all patients, 16.3% were prescribed psychotherapy, with oral naltrexone being the most frequent treatment. Overall, 16.1% of SGD patients received oral naltrexone, compared with 9.8% of heterosexual patients.

The researchers pointed out this difference in treatment could be due to the heterosexual group having the lowest proportion of health care visit utilization, in combination with SGD populations having greater access.

McDowell noted one implication for primary care physicians “is that SGD communities may find that seeking AUD care within behavioral health to be more accessible than seeking AUD care through their primary care provider.”

“If an SGD patient is struggling to adhere to addiction care in their primary care setting, PCPs may consider any steps that can be taken to make their office setting more welcoming to SGD patients, as well as making a referral to psychiatry for the patient,” he said.