加拿大 HIV 感染者药物使用相关健康社会决定因素模式：潜在类别分析。
Patterns of social determinants of health associated with drug use among women living with HIV in Canada: a latent class analysis.
机构信息
Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada.
Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
出版信息
Addiction. 2019 Jul;114(7):1214-1224. doi: 10.1111/add.14566. Epub 2019 Mar 12.
BACKGROUND AND AIMS
Identifying typologies of social determinants of health (SDoH) vulnerability influencing drug use practices among women living with HIV (WLWH) can help to address associated harms. This research aimed to explore the association of SDoH clusters with drug use among WLWH.
DESIGN
Latent class analysis (LCA) was used to identify the distinct clusters of SDoH. Inverse probability weighting (IPW) was employed to account for confounding and potential selection bias. Associations were analyzed using generalized linear model with log link and Poisson distribution, and then weighted risk ratio (RR) and 95% confidence intervals (CI) were reported.
SETTING AND PARTICIPANTS
Data from 1422 WLWH recruited at time-point 1 of the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS, 2013-15), with 1252 participants at 18 months follow-up (time-point 2).
MEASUREMENTS
Drug use was defined as use of illicit/non-prescribed opioids/stimulants in the past 6 months. SDoH indicators included: race discrimination, gender discrimination, HIV stigma, social support, access to care, food security, income level, employment status, education, housing status and histories of recent sex work and incarceration.
FINDINGS
LCA identified four SDoH classes: no/least SDoH adversities (6.6%), discrimination/stigma (17.7%), economic hardship (30.8%) and most SDoH adversities (45.0%). Drug use was reported by 17.5% and 17.2% at time-points 1 and 2, respectively. WLWH with no/least SDoH adversities were less likely to report drug use than those in economic hardship class (weighted RR = 0.13; 95% CIs = 0.03, 0.63), discrimination/stigma class (weighted RR = 0.15; 95% CIs = 0.03, 0.78), and most SDoH adversities class (weighted RR = 0.13; 95% CIs = 0.03, 0.58).
CONCLUSIONS
Social determinants of health vulnerabilities are associated with greater likelihood of drug use, underscoring the significance of addressing interlinked social determinants and drug use through the course of HIV care and treatment.
背景和目的
确定影响 HIV 感染者（PLWH）药物使用行为的健康社会决定因素（SDoH）脆弱性的类型，有助于解决相关危害。本研究旨在探讨 SDoH 聚类与 PLWH 药物使用之间的关联。
设计
使用潜在类别分析（LCA）来识别 SDoH 的不同聚类。采用逆概率加权（IPW）来考虑混杂因素和潜在选择偏差。使用对数链接和泊松分布的广义线性模型分析关联，然后报告加权风险比（RR）和 95%置信区间（CI）。
设置和参与者
数据来自加拿大 HIV 女性性健康和生殖健康队列研究（CHIWOS，2013-15 年）的 1422 名 PLWH，其中 1252 名在 18 个月随访（时间点 2）时报告了药物使用情况。
测量方法
药物使用定义为过去 6 个月内使用非法/非处方阿片类药物/兴奋剂。SDoH 指标包括：种族歧视、性别歧视、HIV 耻辱感、社会支持、获得医疗保健、食品安全、收入水平、就业状况、教育、住房状况以及近期性工作和监禁史。
结果
LCA 确定了四个 SDoH 类别：无/最少 SDoH 逆境（6.6%）、歧视/耻辱（17.7%）、经济困难（30.8%）和最多 SDoH 逆境（45.0%）。分别在时间点 1 和 2 报告了 17.5%和 17.2%的药物使用情况。与经济困难类别的患者相比，无/最少 SDoH 逆境类别的患者报告药物使用的可能性较低（加权 RR=0.13；95%CI=0.03，0.63），歧视/耻辱类别的患者（加权 RR=0.15；95%CI=0.03，0.78）和最多 SDoH 逆境类别的患者（加权 RR=0.13；95%CI=0.03，0.58）。
结论
健康社会决定因素的脆弱性与药物使用的可能性增加有关，这强调了通过 HIV 护理和治疗过程解决相互关联的社会决定因素和药物使用的重要性。
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