THE IMPACT OF DRUG-USERS ON INPATIENT HOSPITAL-CARE DURING THE HUMAN-IMMUNODEFICIENCY-VIRUS EPIDEMIC IN AMSTERDAM

Background. As a consequence of the human immunodeficiency virus (HIV) epidemic, which continues among illicit drug users, high rates of HIV -associated morbidity are believed to exist. This study focuses on hos pitalizations of drug users and on the relative contribution of drug u sers to the total burden of inpatient hospital care in Amsterdam. Meth ods. During the years 1990-1992, data were collected on hospital admis sions of injecting and non-injecting drug users to all 10 general and university hospitals in the city of Amsterdam (population 700 000; est imated number of drug users 5800). Total number of admissions, total d ays of hospitalization and primary discharge diagnoses according to HI V serostatus and sex were determined for drug users. Results. A total of 1293 admissions were recorded among 842 hospitalized drug users. Be tween 53% and 77% of days of hospitalization attributable to drug user s related to HIV-infected patients, and at least 23% to patients with AIDS. In the 20-44 age group of the Amsterdam population, 5.1% of days of hospitalization for men and 1.8% for women could be attributed to drug users, or about twice as much as could be expected from their num bers alone. For all ages, the contribution of drug users to hospitaliz ations was 1.2% for males, 0.4% for females, and 0.8% for all. Drug us ers occupied an average of 19 hospital beds, corresponding to an annua l cost of US$ 3.1 million. Due to underreporting of admissions, these figures should be considered lower bound estimates. Conclusions. On th e total scale of inpatient hospital expenditure in Amsterdam, the cont ribution of illicit drug users appears to be small.