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

Objective. The aim of this study was to describe the relationship between s ociodemographic characteristics and human immunodeficiency (HIV) status of a cohort of injection drug users (IDUs) on their self-reported health servi ce 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 HIV-1 and q uestionnaires on demographics, drug using behaviors, housing status, and he alth service utilization (hospitalization overnight and emergency departmen t visits) in the previous 6 months. Logistic regression analysis was used t o identify independent associations with the use of health services. Results. Of 1,103 cohort participants, 65% were male, 63% were white, and 2 3% were HIV positive. Cocaine was the most frequently injected drug used. A lmost half (47%) had used health services in the previous 6 months. The fol lowing variables were associated independently with health service utilizat ion (adjusted odds ratio; 95% confidence interval): unstable housing, defin ed 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). Conclusion. IDUs with unstable housing were more likely to report emergency department and hospital use, which may be a reflection of their disorganiz ed lifestyle or poorer health status. Further studies are required to asses s the effect on the health status and health care use of IDUs of interventi ons that increase the availability of safe, affordable housing.