Individual and structural barriers to chronic disease screening among illicit drug users in New York City population, 2009-2011

Background: Heart disease and diabetes commonly afflict marginalized populations. As the pharmacy roll expands to include prevention services, we aim to identify healthcare access barriers associated with lack of annual chronic disease screening (blood pressure, glucose and cholesterol) among a pharmacy-based sample of illicit drug users in New York City.

Methods: Injection drug user (IDU) customers, their peers, and walk-in customers were recruited by IDU peers and pharmacy staff from low-income neighborhoods for a pharmacy-based study. An ACASI survey ascertained disease/screening history, and perceptions of individual (i.e. not sick/not necessary or drug use) and structural barriers to care (i.e. no money/insurance, no transportation, or not knowing where to go). Adjusted associations were calculated using logistic regression.

Results: Of 667 participants recruited, 310 (46%) reported illicit drug use and mean age of 43.3 years. Of these, 27% reported daily drug use, 72.3% male, 51.3% Latino/a, 29.3% Black, 80.3% had health insurance, and 58.9% reported annual chronic disease screening. After adjustment, not reporting annual screening was associated with no regular doctor (AOR=0.37), not having a prior high cholesterol diagnosis (AOR=0.47), feeling screening was unnecessary (AOR=2.94), and feeling no money/insurance (AOR=3.24) and drug use (AOR=3.04) interfered with access to screening.

Conclusion: These data suggest that, while health insurance coverage has risen among drug users, payment for healthcare remains a structural barrier. Individual drug use and perception of need for preventive care could be incorporated within services currently targeting drug users (e.g. drug treatment, HIV testing, and pharmacy syringe access programs) and warrants investigation.