Migration Patterns from an Open Illicit Drug Scene and Emergency Department Visits among People Who Use Illicit Drugs in Vancouver, Canada,Substance Use & Misuse

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Migration Patterns from an Open Illicit Drug Scene and Emergency Department Visits among People Who Use Illicit Drugs in Vancouver, Canada
Substance Use & Misuse ( IF 2 ) Pub Date : 2021-08-11 , DOI: 10.1080/10826084.2021.1958849
Saif-El-Din El-Akkad ₁ , Kanna Hayashi _{2,

3} , Huiru Dong ₂ , Andrew Day ₄ , Rachael McKendry ₄ , Gaganpreet Kaur ₁ , Rolando Barrios ₅ , Kora Debeck _{2,

6} , M-J Milloy _{1,

2} , Lianping Ti _{1,

2}

Affiliation

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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

中文翻译：

加拿大温哥华非法药物使用者的公开非法药物现场和急诊科就诊的迁移模式

摘要

背景

使用非法药物 (PWUD) 的人会经历各种不良健康后果，从而导致医疗保健服务利用率增加。PWUD 也是一个高度流动的人群，这对医疗保健服务提出了挑战。本研究的目的是确定温哥华市区东区 (DTES) 的迁移模式，并估计不同迁移模式对两个结果的影响：a) 急诊科 (ED) 就诊和 b) ED访问导致 PWUD 住院。

方法

温哥华的三个 PWUD 前瞻性队列与区域 ED 数据相关联。我们使用潜在类别增长分析定义了最能代表温哥华 DTES 不同迁移模式的轨迹组的最佳数量。然后，使用广义估计方程来估计迁移模式对两个 ED 结果的影响。

结果

在 1210 名参与者中确定了四种不同的迁移轨迹模式：一直居住在 DTES 的 PWUD、早期迁移出 DTES 的人、晚迁移出 DTES 的人以及经常重新访问 DTES 的人。经常重访 DTES 的参与者有更高的 ED 就诊几率（调整优势比 = 1.62；95% 置信区间：1.28-2.06）。迁移模式与住院患者之间没有显着关联。