Johns Hopkins University, Bloomberg School of Public Health, Department of Mental Health, 615 N. Wolfe St, Baltimore, MD 21205, United States of America; Us Helping Us, People Into Living, Inc., 3636 Georgia Ave NW, Washington, D.C. 20010, United States of America.
Johns Hopkins University, Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe St, Baltimore, MD 21205, United States of America.
J Subst Abuse Treat. 2022 Nov;142:108806. doi: 10.1016/j.jsat.2022.108806. Epub 2022 May 20.
Aging people who inject drugs (PWID) have complex health needs. Health care management could be complicated by persistent substance use, multiple health challenges, and inconsistent access to care. However, we know little about the relationship between chronic multimorbidity and health care engagement in this population. The purpose of this study is to characterize patterns and correlates of chronic disease multimorbidity among PWID.
We conducted a latent class analysis (LCA) using data from the AIDS Linked to the IntraVenous Experience (ALIVE) Study, a community-based observational cohort, to determine classes of multimorbid chronic diseases. We then conducted regressions to determine factors associated with class membership and the impact of each multimorbid class on health events and utilization.
Of 1387 individuals included, the majority were male (67%) and Black (81%), with a mean age of 53 years. We identified four classes of multimorbidity: Low Multimorbidity (54%), and Low Multimorbidity Including Psychiatric Comorbidity (26%), Multimorbidity (12%), and Multimorbidity Including Psychiatric Comorbidity (7%). Female sex, baseline age, and receipt of disability were factors significantly associated with membership in all three classes compared to the Low Multimorbidity class. Additionally, PWID in these three classes were significantly more likely to utilize emergency room and outpatient health care. Membership in both classes with psychiatric comorbidity was associated with significantly higher adjusted odds of receiving medication for opioid use disorder.
Holistic health care systems can best address the needs of aging PWID with integrated care that provides harm reduction, substance use and mental health treatment together, and wrap around services.
老龄化的药物注射者（PWID）有复杂的健康需求。由于持续的物质使用、多种健康挑战以及医疗服务的不一致获取，医疗保健管理可能会变得复杂。然而，我们对该人群中慢性多种疾病与医疗保健参与之间的关系知之甚少。本研究的目的是描述 PWID 中慢性多疾病的模式和相关性。
我们使用 AIDS Linked to the IntraVenous Experience (ALIVE) 研究的数据进行潜在类别分析（LCA），这是一项基于社区的观察性队列研究，以确定多慢性疾病的类别。然后，我们进行回归分析，以确定与类别成员资格相关的因素，以及每个多疾病类别对健康事件和利用的影响。
在纳入的 1387 名个体中，大多数为男性（67%）和黑人（81%），平均年龄为 53 岁。我们确定了四类多疾病：低多疾病（54%）、低多疾病伴精神病合并症（26%）、多疾病（12%）和多疾病伴精神病合并症（7%）。与低多疾病类别相比，女性、基线年龄和残疾的获得是所有三个类别中成员资格的显著相关因素。此外，与低多疾病类别相比，这三个类别的 PWID 更有可能使用急诊室和门诊医疗保健。伴精神病合并症的两个类别中的成员资格与接受阿片类药物使用障碍药物治疗的调整后优势比显著升高相关。
综合医疗保健系统可以通过提供减少伤害、物质使用和心理健康治疗相结合的综合护理，并提供全面服务，最好地满足老龄化 PWID 的需求。
