Racial/Ethnic and Rural Differences in Alcohol Use, Care, and Related Outcomes among VA Patients Living with HIV

Thesis (Ph.D.)--University of Washington, 2017-08Alcohol use is common and particularly risky for people living with HIV (PLWH). Certain subpopulations of PLWH, such as racial/ethnic minorities and rural PLWH, may be at particularly increased risk of adverse alcohol-related outcomes. This dissertation describes differences in alcohol-related mortality risk across racial/ethnic groups (Aim 1), patterns of alcohol use across rurality (Aim 2), and the receipt of alcohol related care across both rurality and race/ethnicity (Aims 3a and 3b). In Aim 1, we found that PLWH from all racial/ethnic groups have increased mortality risk at higher-risk, relative to lower-risk drinkers. White patients have increased mortality risk relative to black patients at higher-risk levels of drinking, and black patients have increased mortality risk relative to white patients at lower-levels of drinking. In Aim 2, we found that patterns of alcohol use vary across rurality among PLWH. Urban PLWH appear to be more likely to report any alcohol use, although this association varies across region and by neighborhood poverty level. Among drinkers, PLWH from small rural communities may be more likely to drink at higher-risk levels. In Aims 3a and 3b, we identified differences in receipt of alcohol related care across both rurality and race/ethnicity among PLWH. Large rural PLWH are more likely to receive brief interventions overall, in the Midwest, and the South, but may be less likely than urban PLWH in the Northeast. Urban patients are more likely than large or small rural patients to receive specialty addictions treatment. Black PLWH were more likely to receive specialty addictions treatment. There were no differences across rurality or race/ethnicity in receipt of AUD medications. In this dissertation, we document differences in alcohol use, care, and outcomes among PLWH across rurality and race/ethnicity. Specifically, black PLWH have increased mortality risk at lower levels of drinking but more likely to receipt specialty addictions treatment than Hispanic and white patients. Additionally, rural PLWH may be more likely to drink at higher risk levels of drinking, but are less likely to receive specialty addictions treatment. These differences highlight important areas for future interventions