Abstract

Immiseration as a risk factor for health risk and outcomes among people who inject drugs in Los Angeles, CA and Denver, CO in 2021

Jesse Goldshear, PhD(c) MPH¹, Karen Corsi, ScD, MPH², Kelsey Simpson, PhD(c), MA¹, Patricia Wilkins², Karina Dominguez, MPH¹, Eric Kovalsky², Lindsey Richardson, D.Phil, M.Phil³, Ricky Bluthenthal, PhD¹ (1)Keck Medicine of University of Southern California, Population and Public Health Sciences, (2)University of Colorado Denver School of Medicine, Department of Psychiatry , (3)University of British Columbia, Department of Sociology

APHA 2022 Annual Meeting and Expo

Background: Immiseration among people who inject drugs (PWID) is high, with increasing houselessness, food insecurity, and exposure to violence. Yet few studies examine how immiseration affects health risk among this population.

Methods: Community-recruited PWID in Los Angeles and Denver were interviewed about drug use patterns, health risks, and indicators of immiseration (n=356) in 2021/22. Immiseration was calculated based on the summed score of five indicators each with four response options. Indicators were difficulty finding shelter, food, clothes, restrooms, and places to wash in the last 3 months. Total scores were reclassified into terciles representing high, medium and low immiseration. We examined whether immiseration scores were associated with rushed injections, syringe sharing, and nonfatal overdose using multivariate regression.

Results: Participants reported some difficulty finding shelter (54%), finding food (54%), finding clothing (50%), finding a place to wash (61%), and finding a restroom (60%). Participants with low immiseration had 0.32 the odds of receptive syringe sharing (95% CI=0.16, 0.65) and 0.23 the odds of nonfatal overdose (95% CI=0.11, 0.49), as compared to high immiseration while controlling for confounders in each model. Participants with medium immiseration had 0.39 the odds of nonfatal overdose (95% CI=0.21, 0.75) as compared to high immiseration while controlling for confounders.

Conclusion: Among urban PWID, lower levels of immiseration (as indicated by difficulty finding shelter, food, clothes, restrooms, and places to wash) were significantly associated with reduced odds of several health risks and outcomes. Public health policy should be oriented towards providing shelter and access to basic necessities.