OBJECTIVE Studies show that racially and ethnically minoritized veterans have a higher prevalence of alcohol use disorder (AUD) than White veterans. The investigators examined whether the relationship between self-reported race and ethnicity and AUD diagnosis remains after adjusting for alcohol consumption, and if so, whether it varies by self-reported alcohol consumption. METHODS The sample included 700,012 Black, White, and Hispanic veterans enrolled in the Million Veteran Program. Alcohol consumption was defined as an individual's maximum score on the consumption subscale of the Alcohol Use Disorders Identification Test (AUDIT-C), a screen for unhealthy alcohol use. A diagnosis of AUD, the primary outcome, was defined by the presence of relevant ICD-9 or ICD-10 codes in electronic health records. Logistic regression with interactions was used to assess the association between race and ethnicity and AUD as a function of maximum AUDIT-C score. RESULTS Black and Hispanic veterans were more likely than White veterans to have an AUD diagnosis despite similar levels of alcohol consumption. The difference was greatest between Black and White men; at all but the lowest and highest levels of alcohol consumption, Black men had 23%-109% greater odds of an AUD diagnosis. The findings were unchanged after adjustment for alcohol consumption, alcohol-related disorders, and other potential confounders. CONCLUSIONS The large discrepancy in the prevalence of AUD across groups despite a similar distribution of alcohol consumption levels suggests that there is racial and ethnic bias, with Black and Hispanic veterans more likely than White veterans to receive an AUD diagnosis. Efforts are needed to reduce bias in the diagnostic process to address racialized differences in AUD diagnosis.

中文翻译：

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退伍军人酒精使用障碍诊断中的种族和民族偏见。

目标 研究表明，种族和族裔少数的退伍军人酒精使用障碍 (AUD) 的患病率高于白人退伍军人。研究人员检查了自我报告的种族和族裔与 AUD 诊断之间的关系在调整饮酒量后是否仍然存在，如果是这样，它是否因自我报告的饮酒量而异。方法 样本包括参加百万退伍军人计划的 700,012 名黑人、白人和西班牙裔退伍军人。饮酒量被定义为个人在酒精使用障碍识别测试 (AUDIT-C) 的消费子量表上的最高分，这是一种不健康饮酒的筛查。AUD 的诊断是主要结果，其定义为电子健康记录中是否存在相关的 ICD-9 或 ICD-10 代码。使用具有交互作用的逻辑回归来评估种族和民族与 AUD 之间的关联，作为最大 AUDIT-C 分数的函数。结果 尽管饮酒水平相似，但黑人和西班牙裔退伍军人比白人退伍军人更有可能诊断出澳元。黑人和白人之间的差异最大。除了最低和最高饮酒水平外，黑人男性患 AUD 的几率高出 23%-109%。在对饮酒、酒精相关疾病和其他潜在混杂因素进行调整后，研究结果没有改变。结论 尽管酒精消费水平分布相似，但不同群体的澳元流行率存在巨大差异表明存在种族和民族偏见，黑人和西班牙裔退伍军人比白人退伍军人更有可能接受澳元诊断。需要努力减少诊断过程中的偏倚，以解决 AUD 诊断中的种族差异。