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

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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 (IDUs) on their self-reported health service utilization.


Interviewer-administered questionnaire.


IDUs who had injected illicit drugs within the previous month were recruited through street outreach. They underwent serology for HIV-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.


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); HIV-positive status (1.43; 1.06–1.92); injection of cocaine (1.50; 1.12–2.02); and primary care physician visit in past 6 months (1.91; 1.39–2.64).


IDUs with unstable housing were more likely to report emergency department and hospital use, which may be a reflection of their disorganized lifestyle or poorer health status. Further studies are required to assess the effect on the health status and health care use of IDUs of interventions that increase the availability of safe, affordable housing.

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Correspondence to Anita Palepu MD, MPH.

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Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital

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Palepu, A., Strathdee, S.A., Hogg, R.S. et al. The social determinants of emergency department and hospital use by injection drug users in Canada. J Urban Health 76, 409–418 (1999).

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