Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, BC, Canada.
British Columbia Centre on Substance Use (BCCSU), Vancouver, BC, Canada.
Subst Use Misuse. 2021;56(12):1837-1845. doi: 10.1080/10826084.2021.1958849. Epub 2021 Aug 11.
People who use illicit drugs (PWUD) experience various adverse health outcomes leading to increased healthcare service utilization. PWUD are also a highly mobile population which poses challenges to healthcare delivery. The objective of this study was to identify migration patterns from the Downtown Eastside (DTES), an urban illicit drug scene in Vancouver and to estimate the impact of different migration patterns on two outcomes: a) emergency department (ED) visits and b) ED visits resulting in inpatient admission among PWUD.
Three prospective cohorts of PWUD in Vancouver were linked with regional ED data. We defined the optimal number of trajectory groups that best represented distinct patterns of migration from Vancouver's DTES using a latent class growth analysis. Then, generalized estimating equations were used to estimate the effect of migration patterns on the two ED outcomes.
Four distinct migration trajectory patterns were identified among the 1210 included participants: PWUD who consistently lived in the DTES, those who migrated out of DTES early, those who migrated out of DTES late, and those who frequently revisited the DTES. Participants who frequently revisited the DTES had higher odds of an ED visit (adjusted odds ratio = 1.62; 95% confidence interval: 1.28-2.06). There was no significant association between migration patterns and inpatient admission.
We found that PWUD who frequently revisited the DTES were more likely to have utilized the ED, suggesting that there may be a subgroup of PWUD who are at increased risk of experiencing negative health outcomes.Supplemental data for this article is available online at 10.1080/10826084.2021.1958849.
使用非法药物的人（PWUD）会经历各种不良健康后果，导致医疗保健服务利用增加。PWUD 也是一个流动性很强的群体，这给医疗保健服务的提供带来了挑战。本研究的目的是确定从温哥华市区非法毒品区（DTES）的移民模式，并估计不同移民模式对两个结果的影响：a）急诊部（ED）就诊和 b）ED 就诊导致 PWUD 住院。
在温哥华，三个前瞻性的 PWUD 队列与区域 ED 数据相关联。我们使用潜在类别增长分析确定了最佳数量的轨迹组，这些轨迹组可以最好地代表从温哥华 DTES 迁移的不同模式。然后，使用广义估计方程估计迁移模式对两个 ED 结果的影响。
在 1210 名纳入的参与者中确定了四个不同的迁移轨迹模式：一直居住在 DTES 的 PWUD、早期迁出 DTES 的 PWUD、晚期迁出 DTES 的 PWUD 和频繁返回 DTES 的 PWUD。频繁返回 DTES 的参与者 ED 就诊的可能性更高（调整后的优势比=1.62；95%置信区间：1.28-2.06）。迁移模式与住院治疗之间没有显著关联。
我们发现，频繁返回 DTES 的 PWUD 更有可能使用 ED，这表明可能有一个 PWUD 亚组面临更高的负面健康结果风险。本文的补充数据可在 10.1080/10826084.2021.1958849. 在线获取。
