Healthcare utilization among adults with co-occurring substance use and mental health disorders (2019-2023): A study based on All of Us program.
cross_sectional · Level IV
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- Record sourced from PubMed, PMID 42607584.
- Also identified by DOI 10.1016/j.drugalcdep.2026.113316.
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Abstract
Co-occurring substance use and mental health disorders (COD) are common, yet healthcare utilization patterns remain understudied. This study examined healthcare utilization patterns and sociodemographic and structural correlates among adults with COD in the All of Us Research Program (2019-2023). Electronic health record data from the All of Us Research Program were analyzed for adults with COD. Healthcare utilization outcomes were assessed from 2019 to 2023 and categorized into counseling and therapy, medication/somatic services, telehealth services, and other supportive services. Multivariable logistic regression examined sociodemographic and structural correlates of healthcare utilization, including interaction effects between income, disability status, and insurance type. Among 11,238 participants, 32.9% received at least one documented substance use disorder- or mental health disorder-related healthcare service. Counseling and therapy accounted for the largest share of encounters, while telehealth utilization surged during the COVID-19 pandemic. Healthcare utilization increased with age (≥65 years: aOR=2.24, 95% CI:1.86-2.70) and was lower among female participants (aOR=0.72, 95% CI:0.67-0.79). Significant interaction effects indicated that the relationship between insurance coverage and healthcare utilization varied across income and disability subgroups. Participants with higher income combined with private or multiple insurance coverage demonstrated some of the highest odds of healthcare utilization. Healthcare utilization among adults with COD remained low and reflected persistent structural inequities across income, disability, and insurance subgroups. Findings highlight the importance of strengthening integrated healthcare services, improving equitable access to care, and sustaining telehealth infrastructure to support long-term engagement in care.