Date of Graduation

2017

Document Type

Dissertation

Degree Type

PhD

College

School of Public Health

Department

Epidemiology

Committee Chair

Roger D Parker

Committee Co-Chair

Tony Atkins

Committee Member

Michael Brumage

Committee Member

Sijin Wen

Abstract

In the United States, injection drug use is a serious public health concern associated with an array of negative health outcomes and substantial financial consequences for systems of care. The purpose of this study was to characterize a statewide sample of Medicaid insured persons who inject drugs in terms of health outcomes, service utilization and cost. A cross-sectional, retrospective analysis of West Virginia Medicaid claims data between 2014 and 2016 was conducted. Between 2014 and 2016, 5,082 West Virginia Medicaid beneficiaries amassed 14,414 service visits, among which inpatient, emergency room, and mental health and substance abuse were the most common. Drug poisonings (n=5,077), soft-tissue infections (n=4,127) and other infectious diseases (n=2,141) were the most common clinical conditions within this sample. Medicaid claims data were not a suitable proxy for state surveillance data as it pertains to new cases of Hepatitis B, Hepatitis C, HIV and heroin overdoses. Ordinal logistic regression results indicate that infectious diseases like endocarditis and soft-tissue infections are associated with increased service utilization. Similarly, multiple regression models show increased cost among individuals with HIV, endocarditis, and Hepatitis B. Preventative services, e.g. syringe exchange programs, are important tools to reducing the spread of infectious diseases, and thereby decrease frequent service utilization and cost among injection drug users.

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