1. Pre-AIDS mortality and morbidity among injection drug users in Amsterdam and Baltimore: an ecological comparison.
- Author
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van Ameijden EJ, Krol A, Vlahov D, Flynn C, van Haastrecht HJ, and Coutinho RA
- Subjects
- Adult, Amphetamines adverse effects, Baltimore epidemiology, Cause of Death, Cocaine adverse effects, Cohort Studies, Comorbidity, Cost Control, Drug Overdose epidemiology, Ethanol adverse effects, Female, HIV Seropositivity psychology, Heroin adverse effects, Hospitalization economics, Hospitalization statistics & numerical data, Humans, Male, Methadone therapeutic use, Netherlands epidemiology, Risk Factors, Suicide ethnology, Survival Rate, United States epidemiology, Cross-Cultural Comparison, HIV Seropositivity epidemiology, Health Services Accessibility statistics & numerical data, Substance Abuse, Intravenous epidemiology, Suicide statistics & numerical data
- Abstract
Mortality and morbidity between injecting drug users in Amsterdam (n = 624) and Baltimore (n = 2,185) are compared to generate a hypothesis about the role of different health care systems and drug user policies (universal care and harm reduction versus episodic care and criminalization, respectively). Overdose/suicide mortality was twofold higher in Amsterdam; no sufficient explanation was found. Other independent "risk factors" for overdose/suicide mortality were recent injecting, polydrug use, and HIV-seropositivity (especially with CD4 count < 200/mm3). High dose methadone maintenance was associated with lower mortality. Incidence of hospitalizations and emergency room visits was substantially lower in Amsterdam, suggesting that higher accessibility to primary care in Amsterdam lowers (inpatient) hospital visits and presumably societal costs.
- Published
- 1999
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