Factors mediating the relationship between gender and healthcare utilization among drug users

Background: Drug users have evidenced gender differences in healthcare utilization. However, the factors contributing to these differences remain under-studied. This study examined factors mediating the relationship between gender and healthcare utilization (HCU).

Methods: 1,799 Puerto Rican heroin and/or cocaine users (1,374 males; 425 females) were recruited in NYC and Puerto Rico in 1998-2003. HCU (prior 12 months) was measured by: 1) use of mental health services; and 2) use of medical services. Ever been abused (sexual and physical), depression, having chronic medical problems, and having an IDU sex partner were used as potential mediators. Correlations and logistic regression analyses were examined for mediation tests.

Results: Mean age 42. Gender (male=1; female=2) was significantly (p<.05) related to sexual and physical abuse (r=.42; r=.41, respectively), depression (r=.15), having chronic medical problems (r=.12), and having an IDU sex partner (r=.14). Gender was also significantly related to use of mental health services (OR=1.66, p<.001) and use of medical services (OR=1.51, p<.001). A series of mediation tests found that both sexual abuse and physical abuse mediated gender effects on use of mental health services (when abuse was added to the model, the gender effects became not significant [p=ns]). Depression and having chronic medical problems partially mediated the relationship between gender and use of mental health services. Sexual and physical abuse also partially mediated the relationship between gender and use of medical services. No other mediation effects were found.

Discussion: Sexual and physical abuse experience mediated gender-HCU relationships, indicating the importance of addressing abuse experiences in this population. The findings also indicate an on-going need for mental and other health services for drug users who were victims of abuse.