Determinants of emergency department use and hospitalization among people who inject drugs: A systematic review and meta-analysis

The present study aimed to identify sociodemographic characteristics, risky behaviors, type of drug use, and service use variables associated with emergency department (ED) use and hospitalization among people who inject drugs (PWID). Studies in English published from January 1, 1995, to December 15, 2021, were searched for on <i>PubMed, Scopus, Cochrane</i>, and <i>Web of Science</i> to identify primary studies on ED use and hospitalization among PWID. After a detailed assessment of 17,348 outputs, a total of 19 studies met the eligibility criteria for inclusion in the analysis. Greater risks of ED use and hospitalization among PWID were associated with (i) a history of homelessness, (ii) HIV-positive status, and (iii) injecting drugs more than four times per day. Individuals were more likely to use the ED if they (i) had a history of physical abuse, (ii) were using cocaine and methamphetamine, and (iii) had used primary care services. Women and individuals with chronic physical illnesses were more likely to be hospitalized. The present study is the first to integrate determinants related to ED use and hospitalization based on sociodemographic characteristics, risky behaviors, type of drug, and service use determinants among PWID. To reduce ED use and hospitalization among PWID, the paper also recommends various strategies could be implemented.

本研究旨在明确与注射毒品使用者（people who inject drugs, PWID）急诊科室（emergency department, ED）就诊及住院情况相关的社会人口学特征、危险行为、药物使用类型及服务使用变量。本研究检索了1995年1月1日至2021年12月15日期间发表于PubMed、Scopus、Cochrane及Web of Science的英文文献，以筛选针对注射毒品使用者急诊就诊与住院情况的原创研究。经对17348条检索结果进行详细评估后，最终共有19项研究符合纳入分析的合格标准。注射毒品使用者出现急诊就诊与住院的更高风险，与以下因素相关：(i) 无家可归史；(ii) 人类免疫缺陷病毒（HIV）阳性；(iii) 每日注射药物超过四次。若个体存在(i) 躯体虐待史；(ii) 吸食可卡因与甲基苯丙胺；(iii) 曾使用初级医疗服务，则其前往急诊科室就诊的可能性更高。女性及患有慢性躯体疾病的个体住院风险更高。本研究首次针对注射毒品使用者，整合了基于社会人口学特征、危险行为、药物类型及服务使用相关因素的急诊就诊与住院决定因素。为降低注射毒品使用者的急诊就诊与住院率，本研究同时提出了多项可落地实施的干预策略。