Sex-Based Disparities in Health Outcomes and Pandemic-Related Stressors Among Persons with Substance Use Disorders: Findings from the National Survey on Drug Use and Health, 2021

The COVID-19 pandemic disrupted healthcare access and exacerbated health disparities, particularly among persons with a substance use disorder (SUD). Research on gender and sex-based disparities in health outcomes among people with SUDs is warranted, especially following periods of economic and social shocks like the COVID-19 pandemic. The objective of this study is to examine sex-based differences in health outcomes and pandemic-related stressors among US adults with past-year SUD following the first year of the COVID-19 pandemic. Data from the 2021 National Survey on Drug Use and Health were used to examine past-year sexually transmitted infection (STI) diagnoses, emergency department visits, overnight hospital stays, serious psychological distress, and unmet mental health needs among those with SUDs. Pandemic-related stressors included frequency of serious financial worries, mental health impacts, changes to substance use, and health care access challenges. Weighted prevalence estimates for sociodemographics, SUD-type, and outcomes were calculated by sex. Multivariable logistic regression models were used to estimate adjusted prevalence odds ratios. Female persons with SUDs had higher odds of adverse health outcomes-including past-year STI diagnosis (AOR = 2.00; 95%CI:1.25-3.20) and serious psychological distress (AOR = 2.06; 95%CI:1.72-2.47)-as well as higher odds of experiencing pandemic-related stressors including frequent, serious financial worries (AOR = 1.31; 95%CI:1.09-1.57) and increased alcohol use due to the pandemic (AOR = 1.51; 95%CI:1.23-1.85) compared to male persons. Following the initial waves of the COVID-19 pandemic, female persons with SUDs experienced disproportionate adverse health and pandemic-related impacts. These findings underscore the need for targeted interventions to address health and social vulnerabilities exacerbated by large-scale crises.