Association between neighbourhood socioeconomic characteristics and high-risk injection behaviour amongst injection drug users living in inner and other city areas in Montréal, Canada

Généreux, Mélissa; Bruneau, Julie; Daniel, Mark

doi:10.1016/j.drugpo.2009.01.004

« Previous Next »International Journal of Drug Policy
Volume 21, Issue 1 , Pages 49-55, January 2010

Association between neighbourhood socioeconomic characteristics and high-risk injection behaviour amongst injection drug users living in inner and other city areas in Montréal, Canada

Mélissa Généreux
- Community Medicine Residency Program, Université de Montréal, Québec, Canada
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Québec, Canada
Julie Bruneau
- CRCHUM, Centre Hospitalier de l′Université de Montréal, Montréal, Québec, Canada
- Department of Family Medicine, Université de Montréal, Montréal, Québec, Canada
- Corresponding author at: Centre Hospitalier de l′Université de Montréal, Hôpital Saint-Luc, 1058 rue Saint-Denis, Montréal, Québec, Canada H2X 3J4.
Mark Daniel
- Department of Social and Preventive Medicine, Université de Montréal, Montréal, Québec, Canada
- CRCHUM, Centre Hospitalier de l′Université de Montréal, Montréal, Québec, Canada
- School of Health Sciences, University of South Australia, Adelaide, Australia

Received 16 November 2008; accepted 22 January 2009. published online 02 March 2009.

Abstract

Background

Area-level socioeconomic conditions are associated with epidemic rates of viral hepatitis and HIV amongst urban injection drug users (IDUs), but whether specific socioeconomic markers are uniformly related to IDU outcomes across different urban environments is unclear. We evaluated whether injection behaviour is differentially related to neighbourhood socioeconomic characteristics for IDUs in inner city vs. surrounding urban areas.

Methods

The study population was 468 active IDUs on the Island of Montréal. Neighbourhoods were represented as 500m radius buffers around individual IDU dwelling places. High-risk injection behaviour (HRIB) was defined dichotomously. Relations between neighbourhood socioeconomic disadvantage (percentage households below low-income cutoff), neighbourhood educational attainment (percentage adults with university degree), and HRIB were assessed using multivariate logistic regression. Stratified analyses were conducted for inner city IDUs (n=219), and those in surrounding areas (n=249).

Results

Similar proportions of IDUs in inner city and surrounding areas reported HRIB. Neighbourhood socioeconomic characteristics were not associated with HRIB for IDUs in surrounding areas. For inner city IDUs, those in socioeconomically disadvantaged neighbourhoods were more likely to practice HRIB (OR 4.34; 95% CI 1.15–16.35). Conversely, inner city IDUs residing in lower educational attainment neighbourhoods had a lower odds of HRIB (OR 0.41; 95% CI 0.21–0.80).

Conclusion

HRIB did not vary according to urban environment but for inner-city IDUs was differentially related to socioeconomic markers. Associations between HRIB and neighbourhood socioeconomic disadvantage and lower educational attainment, positive and negative, respectively, indicate that adverse socioeconomic circumstances are not related to a uniformly greater likelihood of HRIB.

Keywords: Urban health, Injection drug use, Syringe sharing, Neighbourhoods, Small-area analysis