Liebschutz J M, Mulvey K P, Samet J H
Section of General Internal Medicine, Boston Medical Center, University School of Medicine, Mass., USA.
Arch Intern Med. 1997 May 26;157(10):1093-7.
Although women with a history of victimization are known to have increased somatic symptoms, health care utilization, and substance abuse, the health effects of victimization on substance-abusing women are uncertain.
To examine whether a history of victimization among substance-abusing women is associated with more medical problems or emergency department visits.
Interview data were collected from 2322 women seeking publicly funded addiction treatment from September 1992 to January 1996. We compared women with a lifetime history of physical or sexual abuse with those without such a history by bivariate and multivariable analyses. Variables included episodic medical disease, chronic medical disease, recent emergency department visits, substance abuse characteristics, and demographic data.
The prevalence of victimization was 42%. In bivariate analyses, the following variables had significant association with victimization histories: episodic medical disease, recent emergency department visit, chronic medical disease, primary care physician's awareness of substance abuse history, ethnicity, and lower income. Alcohol and crack cocaine users had higher prevalence of victimization compared with heroin or noncrack cocaine users (P = .001). In the logistic regression, the following variables remained independently and significantly associated with victimization: episodic medical disease (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.70-2.73), physician awareness of substance abuse (OR, 1.78; 95% CI, 1.42-2.23), emergency department visit (OR, 1.57; 95% CI, 1.22-2.03), chronic medical disease (OR, 1.51; 95% CI, 1.19-1.92), and lower income.
Victimization in urban, poor, substance-abusing women is associated with more medical disease and health care utilization. Interventions that focus on the interconnected problems these women face may more effectively affect this challenging population.
尽管有受害经历的女性已知会出现更多躯体症状、医疗保健利用率增加以及药物滥用问题，但受害经历对药物滥用女性健康的影响尚不确定。
研究药物滥用女性的受害经历是否与更多的医疗问题或急诊就诊次数相关。
收集了1992年9月至1996年1月期间2322名寻求公共资助成瘾治疗的女性的访谈数据。我们通过双变量和多变量分析，将有身体或性虐待终生史的女性与没有此类病史的女性进行了比较。变量包括发作性疾病、慢性疾病、近期急诊就诊次数、药物滥用特征和人口统计学数据。
受害率为42%。在双变量分析中，以下变量与受害史有显著关联：发作性疾病、近期急诊就诊、慢性疾病、初级保健医生对药物滥用史的知晓情况、种族和低收入。与海洛因或非快克可卡因使用者相比，酒精和快克可卡因使用者的受害率更高（P = 0.001）。在逻辑回归中，以下变量仍与受害独立且显著相关：发作性疾病（优势比[OR]，2.15；95%置信区间[CI]，1.70 - 2.73）、医生对药物滥用的知晓情况（OR，1.78；95% CI，1.42 - 2.23）、急诊就诊（OR，1.57；95% CI，1.22 - 2.03）、慢性疾病（OR，1.51；95% CI，1.19 - 1.92）和低收入。
城市中贫困的药物滥用女性的受害经历与更多的疾病和医疗保健利用率相关。关注这些女性所面临的相互关联问题的干预措施可能会更有效地影响这一具有挑战性的人群。
