Spatial epidemiology of nonfatal overdose in a community-based cohort of marginalized women in Vancouver, British Columbia (2014–2022)

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence Pub Date : 2025-04-29 DOI:10.1016/j.drugalcdep.2025.112670

Shira Goldenberg , Esteban J. Valencia , Ofer Amram , Kate Shannon , Kirstin Kielhold , Charlie (Haouxan) Zhou , Kathleen Deering

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引用次数: 0

Abstract

Background

Given limited data regarding the spatial epidemiology of overdose among women amid the current overdose crisis, we evaluated (1) changes in spatiotemporal clustering of overdose over time, (2) the association between residential proximity to overdose clusters and recent nonfatal overdose, and (3) the association between ‘risk environment’ features and residential proximity to overdose clusters.

Methods

Questionnaire data were from a merged community-based cohort of marginalized women who use drugs in Vancouver, Canada (09/2014–08/2022). Emerging hotspot analysis was used to classify residential proximity to spatiotemporal clusters of nonfatal overdose and kernel density estimation was used to visualize the spatiotemporal distribution of nonfatal overdose clustering over the 8-year study. Statistical analyses drew on bivariate and multivariable logistic regression using generalized estimating equations (GEE).

Findings

Over eight years, among 650 participants (3461 observations), 37·2 % experienced a nonfatal overdose at least once. Annual period prevalence of nonfatal overdose increased from 9·1 % in 2014–15 to 25·6 % in 2021–2022. The highest-density clusters were in Vancouver’s Downtown Eastside/Strathcona neighborhoods, where clusters became larger and more dispersed from 2016-onwards. Residential proximity to overdose clusters was associated with higher odds of recent nonfatal overdose. ‘Risk environment’ features of unstable housing, unsafe sleeping environments, and physical violence were associated with elevated odds of residential proximity to overdose clusters.

Interpretation

Marginalized women face a high and rising burden of nonfatal overdose, which is influenced by the ‘risk environments’ in which they reside. Scale-up of geographically tailored overdose prevention services, harm reduction, and programs addressing violence and housing are needed.

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2014-2022年不列颠哥伦比亚省温哥华社区边缘妇女非致死性用药过量的空间流行病学研究

背景：在当前药物过量危机中，女性药物过量的空间流行病学数据有限，我们评估了(1)药物过量时空聚类随时间的变化，(2)药物过量集群与近期非致命性药物过量的住宅邻近度之间的关系，以及(3)“风险环境”特征与药物过量集群的住宅邻近度之间的关系。方法问卷数据来自加拿大温哥华一个合并的社区边缘用药妇女队列（2014年9月- 2022年8月）。利用新兴热点分析对非致死性药物过量时空聚类的居住邻近度进行分类，并利用核密度估计对8年研究期间非致死性药物过量聚类的时空分布进行可视化。统计分析利用广义估计方程（GEE）进行双变量和多变量逻辑回归。在8年多的时间里，在650名参与者（3461次观察）中，37.2%的人至少经历过一次非致命性的过量用药。非致死性用药过量的年患病率从2014-15年的9.1%上升到2021-2022年的25.6%。密度最高的集群位于温哥华市中心东区/斯特拉斯科纳社区，从2016年起，这些集群变得更大、更分散。居住地靠近过量用药聚集区与近期非致命性过量用药的较高几率相关。不稳定的住房、不安全的睡眠环境和身体暴力等“风险环境”特征与过量用药聚集区附近居住的可能性增加有关。边缘化妇女面临着非致命性用药过量的沉重负担，而且这种负担不断上升，这受到她们所处的“风险环境”的影响。需要扩大针对不同地区的过量预防服务、减少伤害以及解决暴力和住房问题的规划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Drug and alcohol dependence 医学-精神病学

CiteScore

7.40

自引率

7.10%

发文量

409

审稿时长

41 days

期刊介绍： Drug and Alcohol Dependence is an international journal devoted to publishing original research, scholarly reviews, commentaries, and policy analyses in the area of drug, alcohol and tobacco use and dependence. Articles range from studies of the chemistry of substances of abuse, their actions at molecular and cellular sites, in vitro and in vivo investigations of their biochemical, pharmacological and behavioural actions, laboratory-based and clinical research in humans, substance abuse treatment and prevention research, and studies employing methods from epidemiology, sociology, and economics.