• Ryan Ng, Claire E Kendall, Ann N Burchell, Ahmed M Bayoumi, Mona R Loutfy, Janet Raboud, Richard H Glazier, Sean Rourke, and Tony Antoniou.
• Institute for Clinical Evaluative Sciences (Ng, Kendall, Loutfy, Raboud, Glazier, Antoniou), Toronto, Ont.; Department of Family Medicine (Kendall), University of Ottawa, Ottawa, Ont.; C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Dalla Lana School of Public Health (Burchell, Raboud), University of Toronto; Li Ka Shing Knowledge Institute (Burchell, Bayoumi, Antoniou), St. Michael's Hospital; Department of Family and Community Medicine (Burchell, Glazier, Antoniou), St. Michael's Hospital and University of Toronto; Centre for Research on Inner City Health (Bayoumi, Rourke), St. Michael's Hospital; Department of Medicine (Bayoumi, Loutfy), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Toronto General Research Institute (Raboud), University Health Network; Department of Psychiatry (Rourke), University of Toronto; Ontario HIV Treatment Network (Rourke), Toronto, Ont.
• CMAJ Open. 2016 Apr 1; 4 (2): E240-8.

BackgroundEmergency department use may reflect poor access to primary care. Our objective was to compare rates and causes of emergency department use between adults living with and without HIV.MethodsWe conducted a population-based study involving Ontario residents living with and without HIV between Apr. 1, 2011, and Mar. 31, 2012. We frequency matched adults with HIV to 4 HIV-negative people by age, sex and census division, and used random-effects negative binomial regression to compare rates of emergency department use. We classified visits as low urgency or high urgency, and also examined visits for ambulatory care sensitive conditions. Hospital admission following an emergency department visit was a secondary outcome.ResultsWe identified 14 534 people with HIV and 58 136 HIV-negative individuals. Rates of emergency department use were higher among people with HIV (67.3 v. 31.2 visits per 100 person-years; adjusted rate ratio 1.58, 95% confidence interval [CI] 1.51-1.65). Similar results were observed for low-urgency visits. With the exception of hypertension, visit rates for ambulatory care sensitive conditions were higher among people with HIV. People with HIV were also more likely than HIV-negative individuals to be admitted to hospital following an emergency department visit (adjusted odds ratio 1.55, 95% CI 1.43-1.69).InterpretationCompared with HIV-negative individuals, people with HIV had high rates of emergency department use, including potentially avoidable visits. These findings strongly support the need for comprehensive care for people with HIV.

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