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Background: Understanding demographic disparities in hospitalisation is crucial for the identification of vulnerable populations, interventions, and resource planning., Methods: Data were from the Antiretroviral Therapy Cohort Collaboration (ART-CC) on people living with HIV in Europe and North America, followed up between January, 2007 and December, 2020. We investigated differences in all-cause hospitalisation according to gender and mode of HIV acquisition, ethnicity, and combined geographical origin and ethnicity, in people living with HIV on modern combination antiretroviral therapy (cART). Analyses were performed separately for European and North American cohorts. Hospitalisation rates were assessed using negative binomial multilevel regression, adjusted for age, time since cART intitiaion, and calendar year., Findings: Among 23 594 people living with HIV in Europe and 9612 in North America, hospitalisation rates per 100 person-years were 16·2 (95% CI 16·0-16·4) and 13·1 (12·8-13·5). Compared with gay, bisexual, and other men who have sex with men, rates were higher for heterosexual men and women, and much higher for men and women who acquired HIV through injection drug use (adjusted incidence rate ratios ranged from 1·2 to 2·5 in Europe and from 1·2 to 3·3 in North America). In both regions, individuals with geographical origin other than the region of study generally had lower hospitalisation rates compared with those with geographical origin of the study country. In North America, Indigenous people and Black or African American individuals had higher rates than White individuals (adjusted incidence rate ratios 1·9 and 1·2), whereas Asian and Hispanic people living with HIV had somewhat lower rates. In Europe there was a lower rate in Asian individuals compared with White individuals., Interpretation: Substantial disparities exist in all-cause hospitalisation between demographic groups of people living with HIV in the current cART era in high-income settings, highlighting the need for targeted support., Funding: Royal Free Charity and the National Institute on Alcohol Abuse and Alcoholism., Competing Interests: Declaration of interests SMR reports fellowship payments from the Royal Free Charity. FCL reports grants from the National Institute for Health and Care Research paid to their institution. JACS and SMI report grants from the National Institutes of Health paid to their institution. JACS also received grants from the UK National Institute for Health and Care Research paid to their institution. MvdV received grants and consulting fees from Gilead, ViiV, and MSD paid to their institution. GW reports grants from Gilead and Roche Diagnostics and honoraria from Gilead, ViiV, and MSD. MJG participated on advisory boards for Merck, Gilead, and ViiV. HMC and JC report separate grants from the National Institutes of Health paid to their institution. HMC received grants from ViiV and AHRQ paid to their institution. LW reports grants from ANRS MIE. All other authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)