Racial and Ethnic Bias Contribute to Provider Diagnosis of Alcohol Use Disorder in Veteran Populations

In the US, Black and Hispanic veterans are more likely than White veterans to be diagnosed with alcohol use disorder (AUD) by Veterans Health Administration (VHA) healthcare providers. Researchers analyzed data from >700,000 veterans to examine racial and ethnic differences in the association between self-reported alcohol consumption and provider-generated AUD diagnosis. Alcohol consumption was measured via the Alcohol Use Disorders Identification Test (AUDIT-C), with a possible score range of 0–12 (higher scores indicating a greater likelihood of AUD).

• Among the 638,204 men, for any given AUDIT-C score, Black veterans were more likely to receive an AUD diagnosis compared with White veterans. In general, for a given AUDIT-C score, Hispanic veterans were less likely than Black veterans and more likely than White veterans to receive an AUD diagnosis.
• Among the 61,808 women, Black veterans were more likely than Hispanic or White veterans to receive an AUD diagnosis at almost every alcohol consumption level, with significant differences noted for AUDIT-C scores of 2, 4, 5, 6, and 7.

Comments: These results suggest that for a given level of reported alcohol consumption, VHA healthcare providers are more likely to diagnose a Black or Hispanic person with AUD than a White person. Identifying the causes of this bias and mitigating them are important next steps for improving diagnosis—and subsequent treatment—for persons with AUD.

Carrie Mintz, MD

Reference: Vickers-Smith R, Justice AC, Becker WC, et al. Racial and ethnic bias in the diagnosis of alcohol use disorder in veterans. Am J Psychiatry. 2023;180(6):426–436.