Predictors of the degree of drug treatment coverage for injection drug users in 94 metropolitan areas in the United States of America
Predictors of the degree of drug treatment coverage for injection drug users in 94 metropolitan areas in the United States of America
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DOI：
10.1016/j.drugpo.2006.10.004
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发表时间：
2007-12-01
影响因子：
4.4
通讯作者：
Jarlais, Don C. Des
中科院分区：
文献类型：
--
作者：
Friedman, Samuel R.;Tempalski, Barbara;Jarlais, Don C. Des
目的：此前的一项研究得出结论，在美国96个大都市统计区，药物治疗覆盖率（定义为注射吸毒者接受药物治疗的百分比）从1%到39%不等（中位数为9%）。在这里，我们确定哪些大都市区的特点与药物治疗coverage.Methods：我们进行了二次分析的官方数据，包括注射吸毒者的数量在治疗和其他变量，为94个大的美国MSA。我们使用之前描述的方法估计了这些大都市地区的注射吸毒者数量。我们使用滞后的横截面分析，其中的自变量，选择社区行动理论的基础上，之前的因变量（药物治疗覆盖率）的时间。预测因素确定使用普通最小二乘多元回归，并确认了强大的regression.Results：较高的药物治疗覆盖率的独立预测因素注射器：存在的组织，支持治疗（非标准化β = 1.64; 95% CI .59至2.69）;教育支出人均在MSA（非标准化β = 1.64; 95% CI .59至2.69）。12岁; 95%置信区间-0.34至2.69）;接受治疗的非注射吸毒者所占百分比较低（非标准化β = -0.18; 95% CI -0.24至-0.12）;非西班牙裔白色人的比例较高（非标准化beta = 0.14; 95% CI 0.08至0.20）;大都市地区政府的人均长期债务较低（非标准化β = -0.93; 95%CI-1.51 to -0.35）。在注射吸毒者治疗覆盖率不足的情况下，流行病学需求指标（注射吸毒者中艾滋病的人均程度）并不能预测治疗覆盖率，并且非注射器对治疗槽的竞争可能减少注射器对治疗的使用。大都会财政限制了治疗范围。政治变量（种族结构、支持药物治疗的组织的存在以及预算优先事项）可能是注射者治疗覆盖率的重要决定因素。虽然如果我们使用纵向设计，对这些结果的信心会更高，但这些结果表明，迫切需要进一步的研究和行动来解决治疗扩展的结构，政治和其他障碍。(C)2006年由Elsevier B. V.出版
Aims: A prior study concluded that drug treatment coverage, defined as the percentage of injection drug users in drug treatment, varied from 1 percent to 39 percent (median 9 percent) in 96 metropolitan statistical areas (MSAs) in the United States. Here, we determine which metropolitan area characteristics are associated with drug treatment coverage.Methods: We conducted secondary analysis of official data, including the number of injection drug users in treatment and other variables, for 94 large US MSAs. We estimated the number of injection drug users in these metropolitan areas using previously described methods. We used lagged cross-sectional analyses where the independent variables, chosen on the basis of a Theory of Community Action, preceded the dependent variable (drug treatment coverage) in time. Predictors were determined using ordinary least squares multiple regression and confirmed with robust regression.Results: Independent predictors of higher drug treatment coverage for injectors were: presence of organisations that support treatment (unstandardized beta= 1.64; 95 percent CI .59 to 2.69); education expenditures per capita in the MSA (unstandardized beta=. 12; 95 percent CI -.34 to 2.69); lower percentage of drug users in treatment who are non-injection drug users (unstandardized beta= -0.18; 95 percent CI -0.24 to -0.12); higher percentage of the population who are non-Hispanic White (unstandardized beta = .14; 95 percent CI .08 to .20); lower per capita long-term debt of governments in the metropolitan area (unstandardized beta= -0.93; 95 percent CI -1.51 to -0.35).Conclusions: In conditions of scarce treatment coverage for drug injectors, an indicator of epidemiologic need (the per capita extent of AIDS among injection drug users) does not predict treatment coverage, and competition for treatment slots by non-injectors may reduce injectors' access to treatment. Metropolitan finances limit treatment coverage. Political variables (racial structures, the presence of organisations that support drug treatment, and budget priorities) may be important determinants of treatment coverage for injectors. Although confidence in these results would be higher if we had used a longitudinal design, these results suggest that further research and action that address structural, political, and other barriers to treatment expansion are sorely needed. (C) 2006 Published by Elsevier B.V.