Gender Differences in Health Status Among Opiate Users in a 25-Year Follow-up

Study

Christine Grella & Luz RodriguezUCLA Integrated Substance Abuse Programs

Addiction Health Services Research ConferenceLittle Rock, AR

October 24, 2006

Funded by NIDA DA015390

Study Design

Original study examined effects of closure of methadone clinics on clients (McGlothlin & Anglin, 1981; Anglin et al., 1979)

Clients were sampled in 1978-80 from methadone clinics in 6 counties in Central & Southern California

All clients are being contacted for a 25-year follow-up study

Client Characteristics at Baseline (N=914)

►63% male, 37% female

►65% non-Hispanic white, 32% Hispanic, 3% African-American

►Average age:

•males, 35.4 years

• females, 30.2 years

Current Status of Study Sample(N = 914)

Deceased41%

Prison/refused2%

Tracking & locating

27%

Located - to be interviewed

7%

Interviewed23%

Topics

Gender differences in mortalityHealth status of study sample compared with

general populationGender differences in drug use and health

statusA note on alcohol use

Primary Causes of Death(N = 317)

36

4

4

7

8

8

11

17

19

38

47

50

68

0 10 20 30 40 50 60 70 80

All other causes

HIV

Motor vehicle accident

Homicide

Hepatitis

Suicide

Infections

Respiratory

Alcohol/drug disorder

Cardiovascular

Liver disease

Cancer

Drug overdose

Number of deaths

Top 5 Causes of Death by Age Group

Homicide

Suicide

Respiratory Respiratory

Cardiovascular

CardiovascularCardiovascular

AOD disorder

Liver

Liver

Liver

Cancer

Cancer

CancerOverdose

Overdose

Hepatitis

Cardiovascular

Liver

Overdose

0%

20%

40%

60%

80%

100%

Under 40(n = 59)

40 - 49(n = 105)

50 - 59(n = 116)

60+(n = 37)

Age

Causes of Death by Gender, Ethnicity

Rank Males Females1 Overdose Overdose2 Liver Cancer3 Cancer Liver4 Cardiovascular Respiratory5 AOD disorder AOD disorder/infection

Rank Non-Hisp White Af-American Hispanic1 Overdose Cancer Liver2 Cancer Liver Overdose3 Liver Cardiovascular Cancer4 Cardiovascular Cardiovascular5 AOD disorder Respiratory

Gender, ethnic differences are NS

52.154.5

47.146.0

50.3

10

20

30

40

50

60

Male(n = 233)

Female(n = 84)

Non-HispanicWhite

(n = 194)

AfricanAmerican(n = 10)

Hispanic(n = 113)

Ag

e

Average Age at Death by Gender, Ethnicity

Overall average age at death = 49.1 years (SD=9.5)Differences by gender and ethnicity (p<.001)Gender-by-ethnicity interaction is NS

27.425.7

32.9

29.0

24.7

10

20

30

40

Male(n = 233)

Female(n = 84)

Non-HispanicWhite

(n = 194)

AfricanAmerican(n = 10)

Hispanic(n = 113)

Yea

rsYears of Potential Life Lost Before Age 75Average per Death by Gender, Ethnicity

Overall average YLL75=25.9 years (SD=9.5)Differences by gender and ethnicity (p<.001)Gender-by-ethnicity interaction is NS

2.75

1.29

4.03

4.96

2.90

0

1

2

3

4

5

6

Male(n = 233)

Female(n = 84)

Non-HispanicWhite

(n = 194)

AfricanAmerican(n = 10)

Hispanic(n = 113)

SM

RStandardized Mortality Ratios by Gender, Ethnicity

Overall SMR=3.27

Calculations used 1996 national mortality data adjusted for age group, gender, and ethnicity

Characteristics of Interview Sample(N = 180)

53% male, 47% femaleAverage age: 58.8 for males, 54.9 for

females28% are Hispanic, 2% are African American,

70% are whiteAbout half (48%) are currently employedAbout one third (34%) are on disabilityHalf (51%) of males and 39% of females are

currently married34% of males and 39% of females reported

illegal drug use in past year

Gender Differences in Chronic Health Problems

26

23

23

38

15

5

5

8

14

34

11

19

0 20 40 60 80

Headaches/Migraines*

Liver Cirrhosis

Heart Problems***

Asthma**

Diabetes

Hypertension

%

Males

Females

*p < .05, **p < .01, ***p < .001

Gender Differences in Infectious Diseases (Ever)

46

4

43

42

3

55

0 20 40 60 80

Hepatitis C

STDs

TB

%

Males

Females

†p < .10

†

Comparison of Females in Study with Females in General Population on SF-36 Scales1 (N = 84)

0

20

40

60

80

100

PhysicalFunction

Role Physical

Bodily Pain

General Health

Vitality SocialFunction

Role Emotional

MentalHealth

BestHealth

Poorest Health

1Norms are for females aged 55-64 (Ware et al., 1997); 95% confidence intervals for study sample scores

Norm

Mean Scores

Comparison of Males in Study with Males in General Population on SF-36 Scales1 (N =

96)

0

20

40

60

80

100

PhysicalFunction

Role Physical

Bodily Pain

General Health

Vitality SocialFunction

Role Emotional

Mental Health

BestHealth

PoorestHealth

1Norms are for males aged 55-64 (Ware et al., 1997); 95% confidence intervals for study sample scores

Mean Scores

Norm

Comparison of Females in Study with Females in General Population on SF-36 Scales by Past-Year Drug Use (N = 84)

0

20

40

60

80

100

Physical Function

RolePhysical

Bodily Pain

General Health

BestHealth

Poorest Health

Past-Year Use

No Past-Year Use

Mean Scores

Norm

Comparison of Females in Study with Females in General Population on SF-36 Scales by Past-Year Drug Use (N = 84)

0

20

40

60

80

100

Vitality Social Function

Role Emotional

Mental Health

BestHealth

Poorest Health

Past-Year Use

No Past-Year Use

Mean Scores

Norm

0

20

40

60

80

100

Physical Function

Role Physical

Bodily Pain

General Health

BestHealth

PoorestHealth

Past-Year Use

No Past-Year Use

Mean Scores

Norm

Comparison of Males in Study with Males in General Population on SF-36 Scales by Past-Year Drug Use (N = 96)

0

20

40

60

80

100

Vitality Social Function

RoleEmotional

Mental Health

BestHealth

PoorestHealth

Past-Year Use

No Past-Year Use

Comparison of Males in Study with Males in General Population on SF-36 Scales by Past-Year Drug Use (N = 96)

Mean Scores

Norm

Gender Differences in Alcohol Abuse/Dependence and Current Use (N = 180)

21

43

1518

36

12

0

20

40

60

Alcohol Abuse

(Lifetime)

Alcohol Dependence

(Lifetime)

Any Alcohol Use Past 30 Days

%

Males

Females

Alcohol Use and HepC Status

2130

35

182223

0

20

40

60

80

100

Any in Past Year

Past90 Days

Past30 Days

%

HepC

No HepC

Summary of FindingsAmong the deceased in the original sample:

► Women died at an earlier age and had more potential life lost

► Both males and females had higher risk of death than general population, although women had higher risk than men (SMR = 5 vs. 3, respectively)

Among those interviewed for the follow-up study:

► Women report poorer overall health status and functioning

► About 40% report past-year drug use, with no significant gender difference

Summary of Findings► Both males & females in the study had poorer

health status compared with their counterparts in the general population

► Among women, past-year drug users had more impaired functioning in several areas compared with non-users

► Among men, past-year drug users reported better functioning in several areas (e.g., pain, social functioning, emotional health), compared with non-users

► Alcohol use among those with Hepatitis C emerged as an important area for health services intervention

Limitations

Findings are preliminary __ current sample is about half of the targeted follow-up sample size

“Survivor bias” __ most severe have “self-selected” out of remaining sample

Health status is based on self-report and not verified by clinical diagnosis