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Patterns of Socioeconomic Marginalization among People Who Use Drugs: A Gender-Stratified Repeated Measures Latent Class Analysis

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Abstract

Socioeconomic factors are important correlates of drug use behaviors and health-related outcomes in people who use drugs (PWUD) residing in urban areas. However, less is known about the complex overlapping nature of socioeconomic conditions and their association with a range of individual, drug use, and health-related factors in men and women who use drugs. Data were obtained from two community-recruited prospective cohorts of PWUD. Using a gender-stratified approach, we conducted repeated measures latent class analyses (RMLCA) to identify discrete latent socioeconomic subgroups. Multivariable generalized estimating equations were then used to identify correlates of class membership. Between June 2014 and December 2018, RMLCA of 9844 observations from 1654 participants revealed five distinct patterns of socioeconomic status for both men and women. These patterns were primarily distinguished by variations in income, material and housing security, income generation activity, exposure to violence, criminal justice involvement, and police contact. Across gender, progressive increases in exposure to multiple dimensions of socioeconomic disadvantage were found to be associated with frequent use of opioids and stimulants, accessing social services, and being hepatitis C virus antibody-positive. Similar but less congruent trends across gender were observed for age, binge drug use, engagement with opioid agonist therapy, and living with HIV. Gendered patterns of multiple and overlapping dimensions of socioeconomic adversity aligned with patterns of frequent drug use and health-related concerns, highlighting priority areas for gender-inclusive, multilevel responses to mitigate health disparities and meet the diverse socioeconomic needs of urban-dwelling men and women who use drugs.

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Data availability

Public sharing of data for this study is not permitted under the parameters of the research ethics approval, given potentially identifying and sensitive health and legal information. For further inquiries, please contact inquiries@bccsu.ubc.ca.

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Acknowledgements

We acknowledge the land on which we conducted our research is the traditional territory of the Coast Salish peoples, including the Sḵwx̱wú7mesh (Squamish), Səl̓ílwətaʔ/Selilwitulh (Tsleil-Waututh) and xʷməθkʷəy̓əm (Musqueam) Nations. We would like to thank the study participants for their time and contributions to the research. We would also like to thank past and current researchers and staff, in particular Dr. Ekaterina Novosa, Jennifer Matthews, Steve Kain, and Ana Prado for their research and administrative assistance.

Funding

This study was supported by the US National Institutes of Health (NIH; U01DA038886, U01DA021525). SM was supported by a Frederick Banting and Charles Best CIHR Doctoral Award (CGS-D-379540). LR and TK are both supported by CIHR Foundation Grants (FDN-154320; 20R74326). KH holds the St. Paul’s Hospital Chair in Substance Use Research and is supported in part by the NIH (U01DA038886), a Michael Smith Foundation for Health Research Scholar Award (SCH-2017-2003), and the St. Paul’s Foundation (N/A). MJM is supported by the NIH (U01DA0251525). This research was undertaken, in part, thanks to funding from the Canada Research Chairs Program through a Canada Research Chair in Social Inclusion and Health Equity (CRC-2020-00210) that supports LR. Funding sources had no role in the design of this study; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

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Authors and Affiliations

  1. British Columbia Centre On Substance Use, University of British Columbia, 400-1045 Howe, Vancouver, BC, V6Z 2A9, Canada

    Sanjana Mitra, Thomas Kerr, Zishan Cui, Mathew Fleury, Kanna Hayashi, M.-J. Milloy & Lindsey Richardson

  2. Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada

    Thomas Kerr & M.-J. Milloy

  3. School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada

    Zishan Cui & Mark Gilbert

  4. British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada

    Mark Gilbert

  5. Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada

    Mathew Fleury & Kanna Hayashi

  6. Department of Sociology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada

    Lindsey Richardson

Authors
  1. Sanjana Mitra
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  2. Thomas Kerr
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  7. M.-J. Milloy
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  8. Lindsey Richardson
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Contributions

SM, LR and TK designed the study. SM drafted the initial manuscript, and incorporated feedback from all coauthors. TK, KH, and MJM designed and managed the cohorts. ZC conducted the statistical analyses in consultation with SM. All authors made significant contributions to the conception of the analyses, interpretation of the data, and drafting of the manuscript. All authors approved the final manuscript.

Corresponding author

Correspondence to Lindsey Richardson.

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Competing Interest

MJM is the Canopy Growth professor of cannabis science, a position established through arm’s length gifts to the university from Canopy Growth, a licensed producer of cannabis, and the Government of British Columbia’s Ministry of Mental Health and Addictions.

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Mitra, S., Kerr, T., Cui, Z. et al. Patterns of Socioeconomic Marginalization among People Who Use Drugs: A Gender-Stratified Repeated Measures Latent Class Analysis. J Urban Health 101, 402–425 (2024). https://doi.org/10.1007/s11524-024-00828-0

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