Access, Awareness, and Risk: Drivers of Unsafe Sharps Disposal and Needle Reuse in Insulin-Treated Adults in China

Shaoping WuFang Wang^*

• Department of Respiratory and Critical Care Medicine, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China

Background: Unsafe household sharps disposal and needle reuse among insulin-treated adults carry clinical and public health risks, yet population-based data from China are limited. Methods: We conducted a cross-sectional survey of consecutive insulin-treated outpatients at a tertiary hospital in Enshi, Hubei (February 2023–December 2024). A cross-culturally adapted questionnaire captured 30-day disposal and reuse practices, community safety incidents, and access determinants. Primary outcomes were unsafe disposal (household trash, public bin, or toilet/sink) and any needle reuse. Multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: Among 1,810 insulin‑treated adults, unsafe sharps disposal was common (59.0%, 95% CI: 56.7–61.2%), loose trash 43.5%, public bins 15.9%; approved containers 24.7%. Needle reuse occurred in 32.5%, 95% CI: 30.4–34.7%; among reusers (n=588), cost was the leading reason (47.1%). In adjusted models, unsafe disposal was associated with younger age (<30 years aOR 2.31, 95% CI 1.42–3.76; 30–44 years 1.67, 1.28–2.18), male sex (1.38, 1.14–1.67), lower education (no formal/primary 2.84, 2.02–3.99), low income (3.42, 2.31–5.07), travel time >30 minutes (1.94, 1.51–2.49), unawareness of take‑back programs (2.12, 1.75–2.57), and limited container availability (2.45, 2.01–2.98); pump use (0.45, 0.27–0.75) and counseling (0.35, 0.29–0.43). Needle reuse showed similar patterns: younger age (1.89, 1.18–3.03), male sex (1.29, 1.07–1.55), lower education (2.16, 1.56–2.99), low income (2.87, 1.95–4.24), diabetes duration ≥10 years (1.34, 1.11–1.61), travel time >30 minutes (1.78, 1.39–2.28), unawareness (1.87, 1.55–2.26), and limited containers (3.21, 2.64–3.90); pump use (0.31, 0.15–0.64) and counseling (0.42, 0.35–0.51). Community‑safety risks increased: unsafe disposal raised odds of household needlestick (3.47, 2.01–5.99) and observed community needles (2.89, 1.85–4.52); reuse increased both (2.23, 1.42–3.50; 1.67, 1.13–2.47). Conclusions: Unsafe disposal and needle reuse are prevalent, with strong socioeconomic gradients. Targeted education, container provision, and accessible take-back programs may improve patient and community safety in China.