母亲药物过量：在加拿大一个边缘化女性的纵向队列研究中，儿童被带走与意外药物过量之间的关系。
Overdose among mothers: The association between child removal and unintentional drug overdose in a longitudinal cohort of marginalised women in Canada.
机构信息
Centre for Gender & Sexual Health Equity, 1081 Burrard Street, Vancouver BC, Canada; Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 -37 Wellington Square, Oxford OX1 2ER; University of British Columbia, School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC Canada V6T 2B5.
Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 -37 Wellington Square, Oxford OX1 2ER.
出版信息
Int J Drug Policy. 2021 May;91:102977. doi: 10.1016/j.drugpo.2020.102977. Epub 2020 Oct 29.
BACKGROUND
Accidental overdose is a major public health concern in North America with research primarily focused on cisgender men. Little is known about the burden of overdose among marginalised women, particularly in the context of child custody loss. This study aims to examine the prevalence of overdose and the association with child removal in a cohort of marginalised women.
METHODS
This study draws on a merged dataset (2010-2018) of two community-based longitudinal cohorts of over 1000 marginalised women in Canada recruited using time-location sampling. After restricting to women who had ever had a live birth, bivariate and multivariable logistic regression using generalised estimating equations (GEE) were used to examine the association between child removal and overdose. Joint effects of child removal and Indigeneity were also investigated.
RESULTS
Of the 696 women who reported ever having a live birth, 39.7% (n = 276) reported child removal at baseline. Unintended, non-fatal overdose rates were high, with 35.1% (n = 244) of women reporting ever having an overdose. Using bivariate GEE analyses, having a child apprehended and being Indigenous were positively correlated with overdose. Using multivariable GEE, child removal increased the odds of overdose by 55% (AOR: 1.55; 95% CI 1.01-2.39) after adjusting for education and Indigenous ancestry. Using multivariable joint-effects analysis, Indigenous women who had experienced child removal had over twice the odds of an unintended overdose than non-Indigenous women who had not lost custody after adjusting for education, food insecurity, and sex work (AOR: 2.09; 95% CI 1.15-3.79).
CONCLUSION
This analysis suggests that, after controlling for known confounders, women who have a child removed experience higher odds of overdose, and these odds are highest among Indigenous women. The high prevalence of overdose in this cohort suggests the need for further strategies to prevent overdose among pregnant and parenting women.
背景
意外用药过量是北美的一个主要公共卫生问题，研究主要集中在跨性别男性身上。对于边缘化女性的用药过量负担知之甚少，特别是在失去儿童监护权的情况下。本研究旨在检查一个边缘化女性队列中的用药过量发生率及其与儿童被带走之间的关联。
方法
本研究利用加拿大两个基于社区的纵向队列（2010-2018 年）的合并数据集，这些队列通过时间定位抽样招募了超过 1000 名边缘化女性。在限制为曾经有过活产的女性后，使用广义估计方程（GEE）进行了两变量和多变量逻辑回归，以检查儿童被带走和用药过量之间的关联。还调查了儿童被带走和本土性的联合效应。
结果
在报告曾经有过活产的 696 名女性中，39.7%（n=276）在基线时报告了儿童被带走。非故意、非致命性用药过量率很高，有 35.1%（n=244）的女性报告曾有过用药过量。使用两变量 GEE 分析，儿童被带走和本土性与用药过量呈正相关。使用多变量 GEE，在调整教育和本土血统后，儿童被带走使用药过量的几率增加了 55%（调整后的优势比：1.55；95%置信区间 1.01-2.39）。使用多变量联合效应分析，在调整教育、食物不安全和性工作后，经历过儿童被带走的本土女性用药过量的几率是非失去监护权的非本土女性的两倍多（调整后的优势比：2.09；95%置信区间 1.15-3.79）。
结论
本分析表明，在控制已知混杂因素后，失去儿童监护权的女性用药过量的几率更高，而在本土女性中，这一几率最高。该队列中用药过量的高患病率表明需要进一步采取策略，以防止孕妇和哺乳期女性用药过量。
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