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Universidad Central del Caribe Determinants of Health Care Use Among Puerto Rican Drug Users in Puerto Rico and New York City.

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Presentation on theme: "Universidad Central del Caribe Determinants of Health Care Use Among Puerto Rican Drug Users in Puerto Rico and New York City."— Presentation transcript:

1 Universidad Central del Caribe http://cbattc.uccaribe.edu Determinants of Health Care Use Among Puerto Rican Drug Users in Puerto Rico and New York City To be published in: Clinical Infectious Diseases Journal To be published in: Clinical Infectious Diseases Journal

2 http://cbattc.uccaribe.edu Authors Rafaela R. Robles Tomás D. Matos Héctor M. Colón Sherry Deren Juan Carlos Reyes Jonny Andía C. Amalia Marrero Hardeo Sahai Rafaela R. Robles Tomás D. Matos Héctor M. Colón Sherry Deren Juan Carlos Reyes Jonny Andía C. Amalia Marrero Hardeo Sahai

3 http://cbattc.uccaribe.edu Center for Addiction Studies, Universidad Central del Caribe School of Medicine, Bayamón, PR Institute for AIDS Research, National Development and Research Institutes, Inc., New York, NY Center for Addiction Studies, Universidad Central del Caribe School of Medicine, Bayamón, PR Institute for AIDS Research, National Development and Research Institutes, Inc., New York, NY

4 http://cbattc.uccaribe.edu Support for this study was provided by a grant from the National Institute on Drug Abuse at the National Institutes of Health (Grant #R01 DA10425)

5 Table 1. Sociodemographic, health-related, and drug-use behavior characteristics at baseline, by study site. Puerto Rico (n=334) NY City (n=617) Number (%) p value Sociodemographic Characteristics Gender Male261 (78.1)428 (69.4) Female73 (21.9)189 (30.6)0.002 Age 18-24 years47 (14.1)11 (1.8) 25-34 years136 (40.8)175 (28.4) 35 or more years150 (45.0)431 (69.9)<0.001 Mean / SD * 33.5 / 8.338.6 / 7.50.020 * Standard Deviation

6 Table 1. Sociodemographic, health-related, and drug-use behavior characteristics at baseline, by study site. Puerto Rico (n=334) NY City (n=617) Number (%) p value Sociodemographic Characteristics Education Less than high school182 (54.5)390 (63.1) High school or more152 (45.5)228 (36.9)0.006 Living with sex partner (yes)53 (15.9)175 (28.3)<0.001 Living with children (yes)74 (22.2)155 (25.1)0.177 Living with parents (yes)145 (43.4)84 (13.6)<0.001 Homeless (yes)59 (17.7)114 (18.4)0.419 Employed (yes)34 (10.2)81 (13.1)0.111

7 Table 1. Sociodemographic, health-related, and drug-use behavior characteristics at baseline, by study site. Puerto Rico (n=334) NY City (n=617) Number (%) p value Health-Related Characteristics Health insurance (yes)127 (38.0)444 (71.8)<0.001 Perception of health Excellent/good161 (48.3)367 (59.7) Fair/poor172 (51.7)248 (40.3)<0.001 Chronic physical health problems (yes)80 (24.0)308 (50.2)<0.001 HIV positive (test results)65 (20.8)143 (25.6)0.064 Previously diagnosed HIV/AIDS (yes)44 (13.2)108 (17.5)0.050 Previously diagnosed tuberculosis (yes)6 (1.8)77 (12.5)<0.001 Previously diagnosed hepatitis B/C (yes)78 (23.4)137 (22.2)0.367 Previously diagnosed STD (yes)46 (13.8)182 (29.4)<0.001 Probable case of depression-last 2 weeks (yes)199 (59.6)341 (55.5)0.129 Physical health services-last year (yes)29 (8.7)423 (68.4)<0.001 Mental health services-last year (yes)16 (4.8)106 (17.2)<0.001 Drug treatment - last year (yes)186 (55.7)490 (79.3)<0.001

8 Table 1. Sociodemographic, health-related, and drug-use behavior characteristics at baseline, by study site. Puerto Rico (n=334) NY City (n=617) Number (%) p value Drug-Use Behavior Characteristics Number of non injected drugs used (last 30 days) 065 (19.5)39 (6.3) 175 (22.5)91 (14.7) 276 (22.8)137 (22.2) 3 or more118 (35.3)351 (56.8)<0.001 Mean / SD2.0 / 1.63.0 / 1.90.047

9 Table 1. Sociodemographic, health-related, and drug-use behavior characteristics at baseline, by study site. Puerto Rico (n=334) NY City (n=617) Number (%) p value Drug-Use Behavior Characteristics Number of injected drugs used (last 30 days) 081 (24.3)205 (33.2) 153 (15.9)182 (29.4) 289 (26.6)102 (16.5) 3 or more111 (33.2)129 (20.9)<0.001 Mean / SD1.7 /1.21.3 / 1.10.110 Number of injections (last 30 days) Mean / SD 172.0 / 140.173.6 / 95.2<0.001 * Standard Deviation

10 Table 2. Health services utilization during six months prior to follow-up, by study site. Physical health services Inpatient medical services (yes) 10 (3.0)115 (18.6)0.14 (0.07, 0.26) <0.001 Outpatient medical services (yes) 18 (5.4)401 (65.0) 0.03 (0.02, 0.05)<0.001 HIV medications * (yes) 14 (21.5)74 (51.7)0.26(0.13, 0.50)<0.001 Puerto Rico (n=334) NY City (n=617) Number (%) OR(95% CI)p

11 Table 2. Health services utilization during six months prior to follow-up, by study site. Puerto Rico (n=334) NY City (n=617) Number (%) OR(95% CI)p Mental health services (yes) 9 (2.7)110 (17.8)0.13(0.06, 0.26)<0.001 Drug use related services Methadone (yes) 15 (4.5)391 (63.3)0.03(0.02, 0.05)<0.001 Outpatient (yes) 7 (2.1)13 (2.1)1.00(0.39, 2.52)0.599 Inpatient (yes) 60 (18.0)23 (3.7)5.67(3.43, 9.35)<0.001 Drug treatment in jail (yes) 17 (5.1)76 (12.3)0.38(0.22, 0.66)<0.001

12 Table 4. Factors associated with utilization of drug treatment services during last six months using hierarchical multiple logistic regression. Model 1 * Model 2 Study Site East Harlem, NY1.00 Bayamón, PR0.20(0.15, 0.26)<.0010.19(0.14, 0.26)<.001 Predisposing Factors Gender Male 1.00 Female 1.11(0.81, 1.53).516 OR(95% CI)pOR(95% CI)p * Deviance (D): Model 1: D=155.33, p=<.001. Model 2: D=153.84, p=.828. Model 3: D=109.48, p=<.001

13 Table 4. Factors associated with utilization of drug treatment services during last six months using hierarchical multiple logistic regression. Model 3Model 4 Study Site East Harlem, NY1.00 Bayamón, PR0.19(0.13, 0.27)<.0010.26(0.17, 0.40)<.001 Predisposing Factors Gender Male 1.00 Female 1.34 (0.95, 1.90) 1.11(0.86, 1.87).237 OR(95% CI)pOR(95% CI)p.096 * Deviance (D): Model 1: D=155.33, p=<.001. Model 2: D=153.84, p=.828. Model 3: D=109.48, p=<.001

14 Table 4. Factors associated with utilization of drug treatment services during last six months using hierarchical multiple logistic regression. Model 1Model 2 Predisposing Factors Age Education Less than high school High school or more OR(95% CI)pOR(95% CI)p 18-24 25-34 35 or more 1.00 1.01(0.54, 1.86).989 1.17(0.86, 1.60).321 1.00 (0.75, 1.34).992 * Deviance (D): Model 1: D=155.33, p=<.001. Model 2: D=153.84, p=.828. Model 3: D=109.48, p=<.001

15 Table 4. Factors associated with utilization of drug treatment services during last six months using hierarchical multiple logistic regression. Model 3Model 4 Predisposing Factors Age Education Less than high school High school or more OR(95% CI)pOR(95% CI)p 18-24 25-34 35 or more 1.00 0.96(0.51, 1.83).908 1.10(0.79, 1.52).580 1.00 0.92(0.68, 1.25).601 1.00 0.85(0.43, 1.68).645 1.11(0.78, 1.58).548 1.00 0.93(0.67, 1.29).680 * Deviance (D): Model 1: D=155.33, p=<.001. Model 2: D=153.84, p=.828. Model 3: D=109.48, p=<.001

16 Table 4. Factors associated with utilization of drug treatment services during last six months using hierarchical multiple logistic regression. Model 3Model 4 Need Factors Probable case of depression – CESD (yes) Injection Frequency OR(95% CI)pOR(95% CI)p 1.28(0.94, 1.73).115 1.00 0.42(0.28, 0.64).001 1.20(0.77, 1.88).428 1.19(0.76, 1.87).445 0 1 daily 2- 3 daily 4 or more daily 1.31(0.94, 1.73).106 1.00 0.51(0.32, 0.80).003 1.03(0.65, 1.70).834 1.14(0.70, 1.84).598 * Deviance (D): Model 1: D=155.33, p=<.001. Model 2: D=153.84, p=.828. Model 3: D=109.48, p=<.001

17 Table 4. Factors associated with utilization of drug treatment services during last six months using hierarchical multiple logistic regression. Model 3Model 4 Enabling Factors Health Insurance (yes) Employed (yes) OR(95% CI)pOR(95% CI)p 1.52(1.08, 2.14).016 0.99(0.61, 1.60).954 1.07(0.71, 1.61).757 1.22(0.83, 1.81).315 1.08(0.71, 1.66).715 1.050.66, 1.66).831 Living w/ sex partner (yes) Living w/ children (yes) Living w/ parents (yes) Homeless (yes) * Deviance (D): Model 1: D=155.33, p=<.001. Model 2: D=153.84, p=.828. Model 3: D=109.48, p=<.001

18 Table 4. Factors associated with utilization of drug treatment services during last six months using hierarchical multiple logistic regression. Model 3Model 4 Enabling Factors Physical health services – last year (yes) Mental health services – last year (yes) OR(95% CI)pOR(95% CI)p 1.14(0.77, 1.70).506 0.82(0.51, 1.34).428 4.97(3.50, 7.05)<.001 1.03(0.46, 2.27).952 Drug treatment – last year (yes) HIV medications (yes) * Deviance (D): Model 1: D=155.33, p=<.001. Model 2: D=153.84, p=.828. Model 3: D=109.48, p=<.001

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