The prevalence of injection drug use among black adult residents of large U.S. metropolitan areas decreased substantially between 1992 and 2002, while injection drug use prevalence among white adults in these metro areas remained stable, according to a recent Emory University public health report.
The study, the first of its kind to provide a detailed picture of the prevalence of injection drug use by racial and ethnic groups in U.S. metropolitan areas over time, appears in the online Journal of Urban Health.
Lead study author Hannah Cooper, ScD, assistant professor of behavioral science and health education, Rollins School of Public Health, Emory University, and colleagues developed a method of estimating injection drug use (IDU) prevalence among black and white adult residents of 95 large U.S. metropolitan areas over an 11-year period (1992-2002).
Among key study findings:
- Overall, across the 95 metro areas, the median prevalence of IDU among black adults declined by 45 percent between 1992 and 2002.
- The median IDU prevalence for white adults in these metro areas remained stable throughout the study period.
- Metro areas with lower IDU prevalence rates in 1992 experienced more gradual declines than other cities.
- Metro areas with steep declines saw those declines decay more rapidly than declines elsewhere.
AIDS-related mortality, incarceration and decreasing injection initiation may have played a role in shaping trends in injection prevalence among black adults and white adults.
For instance, black injection drug users suffered a heavy burden of AIDS-related mortality during the study period, and that mortality may have reduced IDU prevalence by reducing injectors' life spans. In addition, large and increasing "forced migration" of tens of thousands of black drug users into prison may have further reduced black IDU prevalence in the communities under study.
The stability of IDU prevalence among white adults between 1992 and 2002 may be a result of lower AIDS-related mortality rates among this population, and relative stability, or slight increases in initiating IDU among white drug users, study authors note.
"For the first time, these data give insight into trends in injection drug use prevalence among black and white adults in large U.S. metropolitan areas over time," says Cooper.
"It also lays the groundwork for exploring social determinants of IDU prevalence among racial/ethnic groups," says Cooper. "These data will help us to identify causes of population-level patterns of IDU among different racial and ethnic groups, and to interpret surveillance data on drug-related health problems. They will also help to inform planning efforts for IDU-related health services."
Cooper and team also note that the decline in injection drug use for black adults may partially explain recent reductions in newly reported cases of IDU-related HIV infection among this population.
In addition to Cooper, study authors were J.E. Brady, S. Friedman, B. Tempalski, K. Gostnell, and P. Flom, of the National Development and Research Institutes, Inc. (NDRI).
The project was supported by the National Institute of Drug Abuse (R01 DA13336; Community Vulnerability and Response to IDU-Related HIV; Dr. Samuel R. Friedman, PI). Reference: J Urban Health. 2008 Aug 16