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Primary Submission Category: Health care/services
Associations between Socioeconomic Deprivation and Stigma during Overdose-related Emergency Medical Services Interactions: Evidence from an Ongoing, Community-engaged Evaluation of a County-Wide EMS Overdose Intervention in King County, Washington
Authors: Ohshue Gatanaga, Allyn Liu, Kimiam Waters, Adonica Warth, Cece Wettemann, Esther Rourke, Grover Williams, Robert Pitcher, Nicky Cotta, Alden Gu, India Ornelas, Malika Lamont, Deaunte Damper, Maryam Jernigan-Noesi, Callan Fockele, Emily Williams, Omeid Heidari, Tessa Frohe, Jenna van Draanen,
Presenting Author: Ohshue Gatanaga*
Background: Socioeconomic deprivation (SED) is a fundamental cause of overdose (OD)-related disparities. Due to issues including housing instability, material scarcity, and limited social support, SED may increase stigma during OD-related healthcare interactions and discourage future engagement with substance use treatment and lifesaving services. While emergency medical services (EMS) and emergency departments (ED) are frontline responders to the OD epidemic, little is known about the association between SED and stigma experienced during overdose-related EMS and E D interactions.
Methods: In the context of a community-engaged evaluation of a population-based EMS OD intervention in King County, WA, we assessed associations between facets of SED and EMS- and ED-related stigma among OD survivors (n = 349). Facets of SED included social support and material resources measured using validated scales and housing instability (binary). Linear regression models estimated associations between SED and multi-item scales of perceived stigma (rescaled to a 1-5 composite score) during healthcare interactions adjusting for age, gender, race, drug use frequency, and lifetime overdoses.
Results: Among 349 OD survivors, 82 (23.5%) reported agreeing or strongly agreeing to EMS-related stigma; among those transported to the ED (n = 132), 53 (40.2%) reported ED-related stigma. Housing displacement within 30 days of an OD was associated with higher EMS- (β = 0.37, 95% CI: 0.12, 0.63) and ED-related stigma (β = 0.70, 95% CI: 0.24, 1.16). Each one-unit increase in material resources (β = −0.043, 95% CI: −0.080, −0.006) or social support (β = −0.026, 95% CI: −0.049, −0.002) was associated with lower ED- or EMS-related stigma, respectively.
Conclusions: Stigma during overdose-related EMS and ED care was commonly reported and was higher among survivors experiencing SED. Addressing SED may reduce stigma, rebuild trust in emergency care, and promote equitable engagement with lifesaving services.