Drug Use-Related Discrimination in Healthcare Settings and Subsequent Emergency Department Utilization in a Prospective Cohort Study of People With a History of Injection Drug Use
Year: 2024
Type: article
Abstract: BACKGROUND: People with a history of injection drug use face discrimination in healthcare settings that may impede their use of routine care, leading to greater reliance on the emergency department (ED) for addressing health concerns. The relationship between discrimination in healthcare settings and subsequent ED utilization has not been established in this population. METHODS: This analysis used longitudinal data collected between January 2014 and March 2020 from participants of the ALIVE (AIDS Linked to the IntraVenous Experience) study, a community-based observational cohort study of people with a history of injection drug use in Baltimore, Maryland. Logistic regressions with generalized estimating equations were used to estimate associations between drug use-related discrimination in healthcare settings and subsequent ED utilization for the sample overall and six subgroups based on race, sex, and HIV status. RESULTS: 1,342 participants contributed data from 7,289 semiannual study visits. Participants were predominately Black (82%), mostly male (66%), and 33% were living with HIV. Drug use-related discrimination in healthcare settings (reported at 6% of study visits) was positively associated with any subsequent ED use (OR = 1.40, 95% CI: 1.15-1.72). Positive associations persisted after adjusting for covariates, including past sixth-month ED use and drug use, among the overall sample (aOR = 1.28, 95% CI: 1.04-1.59) and among some subgroups. CONCLUSIONS: Drug use-related discrimination in healthcare settings was associated with greater subsequent ED utilization in this sample. Further exploration of mechanisms driving this relationship may help improve care and optimize healthcare engagement for people with a history of injection drug use.
Source: Substance Use & Misuse
Institutions: Johns Hopkins University, Columbia University
Language: English
Topic: HIV, Drug Use, Sexual Risk
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Johns Hopkins University, National Institute of Development Administration, National Institutes of Health, Center for AIDS Research, University of Washington, Center for AIDS Research, Johns Hopkins University, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute on Drug Abuse, National Cancer Institute, National Institute of General Medical Sciences, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute on Minority Health and Health Disparities
Awards: G1089032987, G1592026562, G2553518400, G5814311522, G7670853268, G8520666786, G9000123959, G9000129047, G9000281406, AIDS Linked to the IntraVenous Experience (ALIVE) Study, The Johns Hopkins Center for AIDS Research (JHU CFAR), Johns Hopkins HIV Epidemiology and Prevention Sciences Training Program
OpenAlex ID: W4393118138