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 hospitalizations of drug users and on the relative contribution of drug users to the total burden of inpatient hospital care in Amsterdam.

Methods: During the years 1990-1992, data were collected on hospital admissions of injecting and non-injecting drug users to all 10 general and university hospitals in the city of Amsterdam (population 700 000; estimated number of drug users 5800). Total number of admissions, total days of hospitalization and primary discharge diagnoses according to HIV serostatus and sex were determined for drug users.

Results: A total of 1293 admissions were recorded among 842 hospitalized drug users. Between 53% and 77% of days of hospitalization attributable to drug users 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 numbers alone. For all ages, the contribution of drug users to hospitalizations was 1.2% for males, 0.4% for females, and 0.8% for all. Drug users occupied an average of 19 hospital beds, corresponding to an annual cost of US$ 3.1 million. Due to underreporting of admissions, these figures should be considered lower bound estimates.

Conclusions: On the total scale of inpatient hospital expenditure in Amsterdam, the contribution of illicit drug users appears to be small.