Proportion of alcohol use disorder diagnoses in electronic health records documented with stigmatized descriptors: a comparison across race, ethnicity, and sex

Objectives In a sample of patients with diagnosed alcohol use disorder (AUD), we examined the prevalence of both stigmatizing (eg, “alcohol abuse”) and highly stigmatizing, non-medical descriptors (eg, “alcoholic”) documented in electronic health records (EHRs). We also assessed whether the use of these terms—entered by clinicians when documenting AUD using search tools and picklists—varied across patient subgroups within a regional health system. Study Design Cross-sectional study. Measurements This study used EHR data from AUD diagnoses documented (January 3, 2015-May 5, 2023) for adult primary care patients identified as Asian, Black, Latine, or White. Four researchers classified AUD descriptors used to diagnose AUD as “stigmatizing” or “highly stigmatizing.” Stigmatizing AUD descriptors were terms that carry negative connotations, imply blame, moral failing, or character flaws. Highly stigmatizing AUD descriptors were non-standard medical terms with strong negative connotations. Results Among 61 886 AUD diagnoses (18 068 patients: 3.5% Asian, 5.0% Black, 5.9% Latine, 85.6% White; 40.5% women), stigmatizing descriptors were used in 88.5% and highly stigmatizing in 18.6% of diagnoses. Differences across intersectional subgroups were minimal. Conclusion Most AUD descriptors were stigmatizing (1 in 5 highly stigmatizing), with men showing slightly higher prevalence than women.