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

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.

Keywords:

• Stigma
• discrimination
• people who inject drugs
• substance use
• emergency department utilization

Acknowledgements

We thank the ALIVE study participants and ALIVE study staff, without whom this work would not have been possible.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This study was supported by the National Institute on Drug Abuse (NIDA) (U01DA036297 [GDK, SHM]). The study was also supported by the Johns Hopkins University Center for AIDS Research (CFAR), an NIH funded program (10P30AI094189), which is supported by the following NIH Institutes: NIAID, NCI, NICHD, NHLBI, NIDA, NIA, NIGMS, NIDDK, NIMHD. ELE is supported by the National Institutes of Health, National Institute on Drug Abuse (NIDA) (T32DA031099; PIs: Hasin & Martins). EUP was supported by NIDA (F31DA054849) and the National Institute of Allergy and Infectious Diseases (NIAID) (T32AI102623). The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report, or the decision to submit for publication; thus, the content of this manuscript is solely the responsibility of the authors and does not necessarily represent the views of the funding organizations.