title: Hospitalization in a cohort seeking treatment for illicit drug use in Finland.
abstract: Illicit drug use is associated with various health problems that result in inpatient hospital admissions. The primary objective of this study was to examine all-cause and cause-specific hospitalizations by gender. The cohort comprised 4817 drug users (3365 males and 1452 females) who sought treatment in Helsinki between 1997 and 2008. Data on hospitalizations that occurred among these clients were extracted from the National Hospital Discharge Register. Crude hospitalization rates (CHRs) and standardized hospitalization ratios (SHRs) with 95% confidence intervals (CIs) were calculated, and Kaplan-Meier analysis with Log-Rank test was used to compare survival in terms of time to hospitalization between males and females. At the end of the follow-up period, 84.5% of females and 73.3% of male clients were hospitalized at least once. Female clients had higher CHR (607.6/1000 person-years, 95%CI: 594.1-621.4) than males (511.0/1000, 95% CI: 502.9-519.3), and had significantly poorer survival than males (Log-Rank test, P<0.001). However, male clients stayed longer on admission than females (mean length of stay 70.2days versus 60.7days respectively, P<0.001). Compared to the national rates, excess hospitalizations were noted in both males (SHR=6.3, 95% CI: 6.2-6.4) and female clients (SHR=4.3, 95% CI: 4.2-4.4). Based upon primary discharge diagnosis, the leading causes of hospitalizations included psychosis (n=622), schizophrenia (n=604), depression (n=497), cardiovascular diseases (n=223), hepatitis C (n=116), HIV (n=81), and other types of hepatitis (n=45). Female clients were more likely than males to be admitted for hepatitis C infection (P<0.001) and depression (P<0.001). Male clients were more likely than females to be diagnosed with other types of hepatitis infections (P=0.032) and psychosis (P=0.035). Excess hospitalizations signify excessive utilization of health resources. Effective drug abuse treatment, gender-sensitive approaches, and regular health checks can help to reduce morbidity. Appropriate measures are needed to address psychiatric problems in this population.
authors: Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland. Electronic address: ifeoma.onyeka@uef.fi.
authors: Ifeoma N
authors: IN
authors: Onyeka
authors: Independent Research Consultant, Liverpool, United Kingdom.
authors: Caryl M
authors: CM
authors: Beynon
authors: Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
authors: Kimmo
authors: K
authors: Ronkainen
authors: Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; National Institute for Health and Welfare, Helsinki, Finland; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
authors: Jari
authors: J
authors: Tiihonen
authors: Helsinki Deaconess Institute, Helsinki, Finland.
authors: Jaana
authors: J
authors: Föhr
authors: Helsinki Deaconess Institute, Helsinki, Finland.
authors: Outi
authors: O
authors: Kuikanmäki
authors: Helsinki Deaconess Institute, Helsinki, Finland.
authors: Mika
authors: M
authors: Paasolainen
authors: Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
authors: Jussi
authors: J
authors: Kauhanen
mesh_terms: D015331:Cohort Studies; D005260:Female; D005387:Finland; D005783:Gender Identity; D006801:Humans; D008297:Male; D010343:Patient Admission; D012189:Retrospective Studies; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000401:mortality / Q000523:psychology / Q000534:rehabilitation*; D016019:Survival Analysis; D055815:Young Adult
keywords: Finland; HUUTI study; Health services/resources utilization; Hospitalization; Standardize hospitalization ratio; Substance abuse