The social determinants of emergency department and hospital use by injection drug users in Canada

Abstract

Objective. The aim of this study was to describe the relationship between sociodemographic characteristics and human immunodeficiency (HIV) status of a cohort of injection drug users (tDUs) on their self-reported health service utilization.Design. Interviewer-administered questionnaire.Methods. IDUs who had injected illicit drugs within the previous month were recruited through street outreach. They underwent serology for H1V-1 and questionnaires on demographics, drug using behaviors, housing status, and health service utilization (hospitalization overnight and emergency department visits) in the previous 6 months. Logistic regression analysis was used to identify independent associations with the use of health services.Results. Of 1,103 cohort participants, 65% were male, 63% were white, and 23% were HIV positive. Cocaine was the most frequently injected drug used. Almost half (47%) had used health services in the previous 6 months. The following variables were associated independently with health service utilization (adjusted odds ratio; 95% confidence interval): unstable housing, defined as living primarily in a hotel, boarding room, or transition house or on the street in the past 6 months (1.44; 1.11-1.86); female gender (1.45; 1.11-1.89); HIVDrs. Palepu, Hogg, and Anis are from the

Illicit Opioid Use in Canada: Comparing Social, Health, and Drug Use Characteristics of Untreated Users in Five Cities (OPICAN Study)

“…74,75 At the same time, drug dependency hinders many individuals from access to general health care or receiving specialized care (e.g., HCV treatment). 76,77 Further analysis also needs to explore specifically to which extent the cooccurrence of opioid and cocaine/crack use is associated with psychiatric comorbidity status (and thus may be driven by potential dynamics of "self-medication") among cohort participants, 78 and to what extent these specific polydrug use patterns and resulting intervention needs are not met by existing treatment services.…”

Injection Drug Use and the Hepatitis C Virus: Considerations for a Targeted Treatment Approach--The Case Study of Canada

“…32 Studies of illicit drug user populations across Canada reported disproportionately high frequencies of medical visits to emergency rooms or physicians; conversely, illicit drug users report a high frequency of medical emergency situations in which required medical help was not available or accessible. 32,61,62 Disproportionate levels of compromised physical health of IDUs may be related in part to greater susceptibility of HCV infection and thus the high rate of HCV within populations of IDUs.…”

Housing Instability among People Who Inject Drugs: Results from the Australian Needle and Syringe Program Survey

“…The associated economic burden is nevertheless substantial due to the significantly higher utilization of hospital emergency services among homeless substance users than the general population. 14,36 Substance dependence renders homeless people at increased risk of violent victimization 37,38 ; involvement in other illegal activities 39,40 ; and elevated levels of harmful behavior including suicide attempts 41,42 and risky injecting practices. 38,[43][44][45] Among newly released prisoners, the risk factors most strongly associated with reincarceration are homelessness and escalating heroin use.…”