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Recent Incarceration Linked to Cutaneous Injection-Related Infections Among Active Injection Drug Users in a Canadian Setting

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Abstract

Cutaneous injection-related infections (CIRI), such as abscesses and cellulitis, are the cause of a substantial burden of morbidity and mortality among injection drug users (IDU). The possible contribution of exposure to correctional environments to CIRI risk has not been fully investigated. Thus, we sought to test the possible relationship between incarceration and CIRI using data from a community-based sample of IDU. Data for these analyses was from the Scientific Evaluation of Supervised Injecting (SEOSI) cohort, linked with administrative records of a local ED in Vancouver, Canada. Using longitudinal analysis we assessed the relationship between the number of ED visits for CIRI care and recent incarceration in a multivariate model including information on possible confounders. Between June 2004 and December 2006, 901 individuals were eligible for our analysis. Of these, 214 (9.6%) visited the ED for CIRI care at least once during the study period. The incidence of ED care for CIRI was 72.9 per 100 person years. In a multivariate model, recent incarceration was associated with a greater number of ED visits for CIRI care (adjusted relative rate = 1.56, 95% confidence interval: 1.31–1.85, P < 0.001). The need for ED treatment for CIRI was common among a sample of local IDU. Exposure to correctional environments was an independent risk factor for visiting the ED for CIRI care, suggesting improvements in infection control in local prisons is urgently needed.

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Acknowledgments

The authors wish to thank the participants in SEOSI and the staff at Insite, the Portland Hotel Society, and Vancouver Coastal Health (Chris Buchner, David Marsh and Heather Hay.) We also thank all current and past SEOSI staff. We would also like to thank Deborah Graham, Leslie Rae, Caitlin Johnston, Steven Kain and Calvin Lai for their research assistance. Viviane Dias Lima and Karissa Johnstone contributed statistical expertise. The evaluation of the SIF was originally made possible through a financial contribution from Health Canada, although the views expressed here do not reflect the official policies of Health Canada. The evaluation is currently supported by the Canadian Institutes of Health Research (grants HPR-85526 and RAA-79918) and Vancouver Coastal Health. TK, MT and ELS are supported by the Michael Smith Foundation for Health Research; TK, ELS and M-JM are supported by the Canadian Institutes of Health Research.

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Authors and Affiliations

  1. British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada

    M.-J. Milloy, Evan Wood, Mark Tyndall, Julio Montaner & Thomas Kerr

  2. School of Population and Public Health, University of British Columbia, Vancouver, Canada

    M.-J. Milloy

  3. Department of Infection Prevention and Control, Providence Health Care, Vancouver, Canada

    Elisa Lloyd-Smith

  4. Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, Canada

    Eric Grafstein

  5. Faculty of Medicine, University of British Columbia, Vancouver, Canada

    Evan Wood, Eric Grafstein, Mark Tyndall, Julio Montaner & Thomas Kerr

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  1. M.-J. Milloy
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  2. Evan Wood
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  7. Thomas Kerr
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Correspondence to Thomas Kerr.

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Milloy, MJ., Wood, E., Lloyd-Smith, E. et al. Recent Incarceration Linked to Cutaneous Injection-Related Infections Among Active Injection Drug Users in a Canadian Setting. J Community Health 35, 660–666 (2010). https://doi.org/10.1007/s10900-010-9269-y

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  • DOI: https://doi.org/10.1007/s10900-010-9269-y

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