title: Sociodemographic and access-related correlates of health-care utilization among African American injection drug users: The BESURE study.
abstract: Persons who inject drugs (PWID) may have less access to, and utilization of, health-care services, and African American PWID may be less likely than other racial groups to utilize health care in the United States. The present study evaluated the prevalence of health-care utilization (HCU) among a cohort of African American PWID in Baltimore. Data were from the 2012 Baltimore National HIV Behavioral Surveillance study. Participants were adult PWID and recruited using respondent-driven sampling (RDS). They completed a comprehensive sociobehavioral survey and voluntary HIV test with trained study interviewers. Analyses included descriptive and bivariate statistics to examine the prevalence of HCU, defined as seeing a health-care provider in the past year. Poisson regression assessed correlates of HCU. Participants were 61% male; 23% self-reported HIV seropositivity. Nearly 90% reported unemployment and/or disability; HCU prevalence was 85%. Significant negative correlates of HCU included age and higher injection frequency; positive correlates included previous incarceration and moderate financial stability. Interaction analyses showed unemployed publicly insured individuals had 30% higher HCU than unemployed and uninsured individuals (χ2= 2.52; p < .05). There is a need to improve health-care utilization among PWID. High prevalence of disability was still found, despite insurance coverage and access to care in this population. While the recent Affordable Care Act has increased health-care coverage and access, our results suggest that is only a first step to improving health outcomes among PWID; targeted intervention to integrate these individuals is still needed.
authors.affiliation: a Brigham and Women's Hospital , Boston , Massachusetts.
authors.forename: Allysha C
authors.initials: AC
authors.lastname: Maragh-Bass
authors.affiliation: b Johns Hopkins University , Baltimore , Maryland.
authors.forename: Christine
authors.initials: C
authors.lastname: Powell
authors.affiliation: b Johns Hopkins University , Baltimore , Maryland.
authors.forename: Ju
authors.initials: J
authors.lastname: Park
authors.affiliation: c Maryland Department of Health and Mental Hygiene , Baltimore , Maryland.
authors.forename: Colin
authors.initials: C
authors.lastname: Flynn
authors.affiliation: d Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland.
authors.forename: Danielle
authors.initials: D
authors.lastname: German
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015142:Baltimore / Q000453:epidemiology; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D055815:Young Adult
keywords: African Americans; HIV/AIDS; health disparities; health-care utilization; injection drug use