Socioeconomic differences in the real-world effectiveness of pharmacotherapy of alcohol-related health problems

Background: Alcohol-related health problems continue to be a major public health issue, yet they remain to be undertreated. Despite recommendations, the use of pharmacotherapy, especially among individuals with lower levels of socioeconomic position (SEP), is still limited. This study aims to examine the real-world effectiveness of pharmacotherapy for the prevention of alcohol-related health problems and to investigate SEP differences in the effectiveness of these pharmacotherapies.
Methods: A longitudinal cohort study was conducted including all individuals who received a first-time alcohol-related diagnosis in Sweden between 2005 and 2019 (N=162,848 individuals). Information on sociodemographic characteristics (sex, age, and education), type of pharmacotherapy (disulfiram, acamprosate, naltrexone, nalmefene, or any combination of these), alcohol-related hospitalization and mortality, use of other medications, and other mental health diagnoses were obtained from nationwide registers. The use of pharmacotherapy was estimated using the ‘tablet per day’ method. Alcohol-related health problems were defined as having an underlying or contributing diagnosis related to alcohol based on the Swedish version of the ICD-10 codes. Individuals were followed from first-time diagnosis to death, emigration, or end of data linkage (31 December 2020). Cox regression models were conducted to examine the association between pharmacotherapy effectiveness and alcohol-related hospitalization and mortality. SEP differences in the effectiveness of these pharmacotherapies will be investigated through interaction analyses, where never-users of pharmacotherapy with the lowest education level serve as the reference group.
Results: Preliminary results showed that acamprosate (hazard ratio [HR]: 0.69; 95% confidence intervals [CI]: 0.60, 0.80), naltrexone (HR: 0.74; 95% CI: 0.60, 0.92), and disulfiram (HR: 0.77; 95% CI: 0.68, 0.88), were associated with lower hazard for alcohol-related mortality when used as monotherapy compared to never-users of pharmacotherapy. Due to the few number of events, individuals who were prescribed nalmefene or a combination of pharmacotherapies were excluded from this analysis. The association of pharmacotherapy effectiveness and alcohol-related hospitalization, as well as socioeconomic differences for both outcomes, are now being examined. The results from all the analyses will be presented at the conference.
Conclusions: Pharmacotherapy for alcohol-related health problems is associated with a reduced risk of alcohol-related mortality and should be considered as a part of regular treatment options within alcohol use disorder care. Understanding potential differences in treatment effectiveness could contribute to the reduction of health inequalities regarding alcohol-related harms.