Health Services Research (OnlineEarly Articles). 17 August 2007

Racial Disparities in Completion Rates from Publicly Funded Alcohol Treatment: Economic Resources Explain More Than Demographics and Addiction Severity

• Jerry O. Jacobson¹ E-mail: jerry.jacobson@cdc.hhs.gov
• ¹Central America and Panama, Centers for Disease Control and Prevention, Universidad del Valle, 18 Av. 11-37, VH III, Edificio GAP, Zona 15, CP 01015, Ciudad de Guatemala, Guatemala, ^*,
• Paul L. Robinson²
• ²University of Medicine and Science, Lynwood, CA, , and
• Ricky N. Bluthenthal³
• ³RAND Corporation, Santa Monica, CA

• ¹Central America and Panama, Centers for Disease Control and Prevention, Universidad del Valle, 18 Av. 11-37, VH III, Edificio GAP, Zona 15, CP 01015, Ciudad de Guatemala, Guatemala, ²University of Medicine and Science, Lynwood, CA, ³RAND Corporation, Santa Monica, CA

Abstract

Objectives.

To assess racial and ethnic differences in rates of completion from publicly funded alcohol treatment programs, and to estimate the extent to which any identified racial differences in completion rates are related to differences in patient characteristics.

Data Sources.

Administrative intake and discharge records from all publicly funded outpatient and residential alcohol treatment recovery programs in Los Angeles County (LAC) during 1998–2000. Study participants (N=10,591) are African American, Hispanic, and white patients discharged from these programs, ages 18 or older, who reported alcohol as their primary substance abuse problem.

Study Design.

Bivariate tests identified racial and ethnic differences in rates of treatment completion and patient characteristics. Logistic regression models assessed the contribution of differences in patient characteristics to differences in completion.

Principal Findings.

Significantly lower completion rates by African Americans (17.5 percent) relative to whites (26.7 percent) (odds ratio [OR]=0.58, 95 percent confidence interval [CI]: 0.50–0.68) are partially explained (40 percent) by differences in patient characteristics in outpatient care (adjusted OR=0.75, 95 percent CI: 0.63–0.90), mostly by indicators of economic resources (i.e., employment, homelessness, and Medi-Cal beneficiary). In residential care, only 7 percent of differences in completion (30.7 versus 46.1 percent) could be explained by the patient-level measures available (OR=0.52, 95 percent CI: 0.45–0.59; AOR=0.55, 95 percent CI: 0.47–0.65). Differences in completion rates between Hispanic and white patients were not detected.

Conclusions.

Large differences in rates of outpatient and residential alcohol treatment completion between African American and white patients at publicly funded programs in LAC, the nation's second largest, publicly funded alcohol and drug treatment system, are partially because of economic differences among patients, but remain largely unexplained. These racial disparities merit additional investigation and the attention of health professionals.