title: Pre-AIDS mortality and morbidity among injection drug users in Amsterdam and Baltimore: an ecological comparison.
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.
authors.affiliation: Division of Public Health and Environment, Municipal Health Service, Amsterdam, The Netherlands. evameijden@GGGD.amsterdam.nl
authors.forename: E J
authors.initials: EJ
authors.lastname: van Ameijden
authors.forename: A
authors.initials: A
authors.lastname: Krol
authors.forename: D
authors.initials: D
authors.lastname: Vlahov
authors.forename: C
authors.initials: C
authors.lastname: Flynn
authors.forename: H J
authors.initials: HJ
authors.lastname: van Haastrecht
authors.forename: R A
authors.initials: RA
authors.lastname: Coutinho
mesh_terms: D000328:Adult; D000662:Amphetamines / Q000009:adverse effects; D015142:Baltimore / Q000453:epidemiology; D002423:Cause of Death; D003042:Cocaine / Q000009:adverse effects; D015331:Cohort Studies; D015897:Comorbidity; D003363:Cost Control; D003431:Cross-Cultural Comparison; D062787:Drug Overdose / Q000453:epidemiology; D000431:Ethanol / Q000009:adverse effects; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000523:psychology; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D003932:Heroin / Q000009:adverse effects; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D013405:Suicide / Q000208:ethnology / Q000706:statistics & numerical data*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
chemical_list: D000662:Amphetamines; D000431:Ethanol; D003932:Heroin; D003042:Cocaine; D008691:Methadone