Background
Methods
Study settings
Measurements
Exposure variables and covariates
Outcome measures of perceived access and barriers to care
Statistical analysis
Results
Descriptive statistics
Characteristics of the participants
All | DU-a | DU+a | HD- | HD+ | |
---|---|---|---|---|---|
Age (years) mean (sd) | n = 6387 | 4984 | 1403 | 4261 | 1889 |
39.6(12.2) | 38.3(12.4) | 43.8(10.5) | 38.8(12.6) | 41.2 (11.3) | |
Gender n (%) | |||||
Men | 4557 (71.3) | 3316 (66.5) | 1241 (88.5) | 2824 (66.3) | 1567 (83.0) |
Women | 1830 (28.7) | 1668 (33.5) | 162 (11.5) | 1437 (33.7) | 322 (17.0) |
Race n (%) | |||||
Hispanic/Latino | 2475 (38.8) | 1736 (34.8) | 739 (52.7) | 1514 (35.5) | 931 (49.3) |
Black/African American | 3651 (57.2) | 3118 (62.6) | 533 (38) | 2556 (60) | 898 (47.5) |
White/Asian | 107 (1.7) | 24 (0.5) | 83 (5.9) | 83 (1.9) | 21 (1.1) |
Other | 154 (2.4) | 106 (2.1) | 48 (3.4) | 108 (2.5) | 39 (2.1) |
HIV status n (%) | |||||
Negative | 5509 (86.3) | 4594 (92.2) | 915 (65.2) | 3721 (87.3) | 1663 (88.0) |
Positive | 878 (13.7) | 390 (7.8) | 488 (34.8) | 540 (12.7) | 226 (12.0) |
Hazardous drinkingb n (%) | |||||
No | 4261 (69.3) | 3531 (73.7) | 730 (53.7) | ||
Yes | 1889 (30.7) | 1259 (26.3) | 630 (46.3) | ||
Education n (%) | |||||
Less than high school | 2217 (34.8) | 1755 (35.3) | 462 (33) | 1439 (33.8) | 691 (36.6) |
High school/some college | 3901 (61.2) | 3034 (61) | 867 (61.8) | 2637 (62) | 1129 (59.9) |
College degree or higher | 256 (4) | 183 (3.7) | 73 (5.2) | 178 (4.2) | 66 (3.5) |
Social supportc n (%) | |||||
No | 1763 (35.3) | 1317 (33) | 446 (44.6) | 1107 (32.6) | 612 (41.5) |
Yes | 3232 (64.7) | 2679 (67) | 553 (55.4) | 2290 (67.4) | 864 (58.5) |
Access to care
All | Substance use patterns | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
no DU and no HDa | DU only | HD only | DU and HD | |||||||
Perceived Access to Care |
n
| % |
n
| % |
n
| % |
n
| % |
n
| % |
If I need medical care, I can get admitted without any trouble (% disagree) | 3548 | 11.4 | 2325 | 11.6 | 319 | 11 | 620 | 11 | 152 | 7.2 |
It is hard for me to get medical care in an emergency (% agree) | 3554 | 19.8 | 2329 | 18.8 | 319 | 19.4 | 620 | 22.7* | 152 | 21.1 |
I have easy access to the medical specialists that I need. (% disagree) | 3546 | 26.9 | 2326 | 26.4 | 319 | 16.3** | 619 | 30.4 | 152 | 18.4* |
I am able to get medical care whenever I need it (% disagree) | 3557 | 12.7 | 2332 | 11.1 | 319 | 12.5 | 622 | 14 | 152 | 14.5 |
Places where I can get medical care are very conveniently located (% disagree) | 3552 | 13.7 | 2328 | 12 | 319 | 17.2** | 621 | 14.7 | 152 | 19.1* |
Sometimes I go without the medical care I need because it is too expensive (% agree) | 3551 | 28.6 | 2326 | 27.7 | 319 | 25.7 | 622 | 31.7 | 152 | 23 |
Barriers to care
All | Substance use patterns | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
no DU and no HDa | DU only | HD only | DU and HD | |||||||
Barriers to care: “Think of the last time you did not get the medical treatment recommended for you” |
n
| % |
n
| % |
n
| % |
n
| % |
n
| % |
I was unable to pay for medical care (% agree) | 3448 | 27.9 | 2388 | 25.7 | 263 | 27** | 632 | 34.8** | 126 | 32.5** |
I did not have transportation to medical care (% agree) | 3476 | 26.4 | 2386 | 23 | 287 | 34.5** | 632 | 32.1** | 134 | 42.5** |
The clinic’s hours of operation were inconvenient for me (% agree) | 3474 | 18.2 | 2386 | 16 | 287 | 22.3** | 631 | 21.6** | 134 | 27.6** |
I did not have child care (% agree) | 3444 | 10.2 | 2361 | 9.8 | 287 | 8.7 | 627 | 11.3 | 131 | 10.7 |
I was treated poorly at a clinic in the past (% agree) | 3481 | 16 | 2390 | 13.7 | 287 | 17.8** | 632 | 21.4** | 134 | 24.6** |
I do not trust doctors (% agree) | 3468 | 12.9 | 2383 | 11.3 | 286 | 17.1** | 628 | 14.6* | 134 | 20.9** |
Uninsured (%) | 6342 | 16.5 | 3512 | 15.9 | 720 | 12.9 | 1254 | 17.1 | 622 | 20.4** |
Multivariable regression models
Perceived access to carea | Barriers to carea | |||
---|---|---|---|---|
Better condition | Higher score | Lower score | ||
β (95%CI) |
p
| β (95%CI) |
s
| |
HIV-negative | n = 2895 | n = 2832 | ||
Illicit drug use (yes) | −1.42 (−2.38 to −0.45) | < 0.01 | 0.49 (0.19 to 0.79) | < 0.01 |
Hazardous drinking (yes) | −0.34 (−0.78 to 0.11) | 0.14 | 0.31 (0.18 to 0.45) | < 0.01 |
Social support | 0.18 (0.15 to 0.22) | < 0.01 | − 0.05 (− 0.06 to − 0.04) | < 0.01 |
HIV-positive | n = 263 | n = 253 | ||
Illicit drug use (yes) | 1.89 (0.56 to 3.22) | 0.01 | − 0.01 (− 0.39 to 0.38) | 0.97 |
Hazardous drinking (yes) | 0.18 (− 0.96 to 1.32) | 0.75 | −0.03 (− 0.43 to 0.37) | 0.86 |
Social supporta | 0.18 (0.09 to 0.28) | < 0.01 | −0.02 (− 0.05 to 0.01) | 0.15 |
Mediation analysis
Perceived access to care | Barriers to care | |||
---|---|---|---|---|
Better condition | Higher score | Lower score | ||
Illicit drug use | ||||
ACME | −0.17 (− 0.35 to 0) | 0.06 | 0.05 (− 0.01 to 0.1) | 0.07 |
ADE | − 1.42 (− 2.33 to − 0.37) | < 0.01 | 0.49 (0.13 to 0.86) | 0.02 |
Total effects | − 1.59 (− 2.58 to − 0.53) | < 0.01 | 0.54 (0.18 to 0.92) | 0.01 |
Proportion mediated | 0.11 (0 to 0.32) | 0.07 | 0.09 (− 0.02 to 0.3) | 0.08 |
Hazardous drinking | ||||
ACME | −0.24 (− 0.35 to − 0.15) | < 0.01 | 0.06 (0.04 to 0.09) | < 0.01 |
ADE | −0.34 (− 0.78 to 0.11) | 0.18 | 0.31 (0.17 to 0.45) | < 0.01 |
Total effects | −0.58 (− 1.03 to − 0.13) | 0.01 | 0.38 (0.23 to 0.51) | < 0.01 |
Proportion mediated | 0.42 (0.2 to 1.61) | 0.01 | 0.16 (0.09 to 0.29) | < 0.01 |