High drug-related death rate soon after hospital discharge for drug-treatment clients in Scotland

E. Merrall, S. Bird, S. Hutchinson

Research output: Contribution to journalConference Contribution

Abstract

Leading causes of death for drug-treatment clients across Scotland, 1996–2006, were drug-related (1383 DRDs) and non-drug-related suicides (269). We investigate DRD-risk by time since most recent hospital stay. Drug-treatment records were linked to national registers of deaths, hepatitis C virus (HCV) diagnoses, and hospital/psychiatric episodes. We calculated DRD-rates (and suicide-rates): during hospitalisation, within 28 days, 29–90 days, 91 days -1 year, >1 year since discharge from most recent hospital stay vs never admitted. Proportional hazards analysis adjusted for demographic and other time-specific influences on DRD-risk. The cohort comprised 69 457 individuals, 350 317 person-years (pys) and 90 314 hospital-stays. DRD-rate per 1000 person-years (pys) was: 87 (95% CI 72 to 103) during hospitalisation, 21 (18 to 25) within 28 days, 12 (10 to 15) during 29–90 days and 8.5 (7.5 to 9.5) during 91 days to 1 year after discharge vs 4.2 (3.7 to 4.7) when >1 year after most recent hospitalisation and 1.9 (1.7–2.1) for those never admitted. Adjusted HRs by time since hospital-discharge (vs never admitted) were: 10 (95% CI 8 to 12) within 28 days, 5.6 (4.6 to 6.8) during 29–90 days, and 4.0 (3.5 to 4.7) vs 2.3 (2.0 to 2.7) when >1 year after most recent hospital stay. Alcohol misuse increased HR (1.5, 1.3 to 1.7) and female, never injector, and no HCV diagnosis decreased it: 0.56 (0.49 to 0.64), 0.62 (0.52 to 0.73), 0.74 (0.65 to 0.85). Hospital discharge marks high DRD-risk periods. Doctors should consider prescribing Naloxone when discharging patients with opiate-dependency, and emailing discharge summary to alert the patients' general practitioner or drug treatment agency.
LanguageEnglish
Article numberP1-241
PagesA133-A133
Number of pages1
JournalJournal of Epidemiology and Community Health
Volume65
Issue numberSupplement 1
DOIs
Publication statusPublished - Aug 2011
EventIEA World Congress of Epidemiology - Edinburgh, United Kingdom
Duration: 7 Aug 201111 Aug 2011

Fingerprint

Scotland
Length of Stay
Hospitalization
Mortality
Hepacivirus
Pharmaceutical Preparations
Suicide
Opiate Alkaloids
Psychiatric Hospitals
Therapeutics
Naloxone
Mental Disorders
General Practitioners
Cause of Death
Alcohols
Demography

Keywords

  • drug related death
  • drug related morbidity
  • hospital discharge
  • drug treatment
  • Scotland

Cite this

Merrall, E. ; Bird, S. ; Hutchinson, S. / High drug-related death rate soon after hospital discharge for drug-treatment clients in Scotland. In: Journal of Epidemiology and Community Health. 2011 ; Vol. 65, No. Supplement 1. pp. A133-A133.
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abstract = "Leading causes of death for drug-treatment clients across Scotland, 1996–2006, were drug-related (1383 DRDs) and non-drug-related suicides (269). We investigate DRD-risk by time since most recent hospital stay. Drug-treatment records were linked to national registers of deaths, hepatitis C virus (HCV) diagnoses, and hospital/psychiatric episodes. We calculated DRD-rates (and suicide-rates): during hospitalisation, within 28 days, 29–90 days, 91 days -1 year, >1 year since discharge from most recent hospital stay vs never admitted. Proportional hazards analysis adjusted for demographic and other time-specific influences on DRD-risk. The cohort comprised 69 457 individuals, 350 317 person-years (pys) and 90 314 hospital-stays. DRD-rate per 1000 person-years (pys) was: 87 (95{\%} CI 72 to 103) during hospitalisation, 21 (18 to 25) within 28 days, 12 (10 to 15) during 29–90 days and 8.5 (7.5 to 9.5) during 91 days to 1 year after discharge vs 4.2 (3.7 to 4.7) when >1 year after most recent hospitalisation and 1.9 (1.7–2.1) for those never admitted. Adjusted HRs by time since hospital-discharge (vs never admitted) were: 10 (95{\%} CI 8 to 12) within 28 days, 5.6 (4.6 to 6.8) during 29–90 days, and 4.0 (3.5 to 4.7) vs 2.3 (2.0 to 2.7) when >1 year after most recent hospital stay. Alcohol misuse increased HR (1.5, 1.3 to 1.7) and female, never injector, and no HCV diagnosis decreased it: 0.56 (0.49 to 0.64), 0.62 (0.52 to 0.73), 0.74 (0.65 to 0.85). Hospital discharge marks high DRD-risk periods. Doctors should consider prescribing Naloxone when discharging patients with opiate-dependency, and emailing discharge summary to alert the patients' general practitioner or drug treatment agency.",
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High drug-related death rate soon after hospital discharge for drug-treatment clients in Scotland. / Merrall, E.; Bird, S.; Hutchinson, S.

In: Journal of Epidemiology and Community Health, Vol. 65, No. Supplement 1, P1-241, 08.2011, p. A133-A133.

Research output: Contribution to journalConference Contribution

TY - JOUR

T1 - High drug-related death rate soon after hospital discharge for drug-treatment clients in Scotland

AU - Merrall, E.

AU - Bird, S.

AU - Hutchinson, S.

PY - 2011/8

Y1 - 2011/8

N2 - Leading causes of death for drug-treatment clients across Scotland, 1996–2006, were drug-related (1383 DRDs) and non-drug-related suicides (269). We investigate DRD-risk by time since most recent hospital stay. Drug-treatment records were linked to national registers of deaths, hepatitis C virus (HCV) diagnoses, and hospital/psychiatric episodes. We calculated DRD-rates (and suicide-rates): during hospitalisation, within 28 days, 29–90 days, 91 days -1 year, >1 year since discharge from most recent hospital stay vs never admitted. Proportional hazards analysis adjusted for demographic and other time-specific influences on DRD-risk. The cohort comprised 69 457 individuals, 350 317 person-years (pys) and 90 314 hospital-stays. DRD-rate per 1000 person-years (pys) was: 87 (95% CI 72 to 103) during hospitalisation, 21 (18 to 25) within 28 days, 12 (10 to 15) during 29–90 days and 8.5 (7.5 to 9.5) during 91 days to 1 year after discharge vs 4.2 (3.7 to 4.7) when >1 year after most recent hospitalisation and 1.9 (1.7–2.1) for those never admitted. Adjusted HRs by time since hospital-discharge (vs never admitted) were: 10 (95% CI 8 to 12) within 28 days, 5.6 (4.6 to 6.8) during 29–90 days, and 4.0 (3.5 to 4.7) vs 2.3 (2.0 to 2.7) when >1 year after most recent hospital stay. Alcohol misuse increased HR (1.5, 1.3 to 1.7) and female, never injector, and no HCV diagnosis decreased it: 0.56 (0.49 to 0.64), 0.62 (0.52 to 0.73), 0.74 (0.65 to 0.85). Hospital discharge marks high DRD-risk periods. Doctors should consider prescribing Naloxone when discharging patients with opiate-dependency, and emailing discharge summary to alert the patients' general practitioner or drug treatment agency.

AB - Leading causes of death for drug-treatment clients across Scotland, 1996–2006, were drug-related (1383 DRDs) and non-drug-related suicides (269). We investigate DRD-risk by time since most recent hospital stay. Drug-treatment records were linked to national registers of deaths, hepatitis C virus (HCV) diagnoses, and hospital/psychiatric episodes. We calculated DRD-rates (and suicide-rates): during hospitalisation, within 28 days, 29–90 days, 91 days -1 year, >1 year since discharge from most recent hospital stay vs never admitted. Proportional hazards analysis adjusted for demographic and other time-specific influences on DRD-risk. The cohort comprised 69 457 individuals, 350 317 person-years (pys) and 90 314 hospital-stays. DRD-rate per 1000 person-years (pys) was: 87 (95% CI 72 to 103) during hospitalisation, 21 (18 to 25) within 28 days, 12 (10 to 15) during 29–90 days and 8.5 (7.5 to 9.5) during 91 days to 1 year after discharge vs 4.2 (3.7 to 4.7) when >1 year after most recent hospitalisation and 1.9 (1.7–2.1) for those never admitted. Adjusted HRs by time since hospital-discharge (vs never admitted) were: 10 (95% CI 8 to 12) within 28 days, 5.6 (4.6 to 6.8) during 29–90 days, and 4.0 (3.5 to 4.7) vs 2.3 (2.0 to 2.7) when >1 year after most recent hospital stay. Alcohol misuse increased HR (1.5, 1.3 to 1.7) and female, never injector, and no HCV diagnosis decreased it: 0.56 (0.49 to 0.64), 0.62 (0.52 to 0.73), 0.74 (0.65 to 0.85). Hospital discharge marks high DRD-risk periods. Doctors should consider prescribing Naloxone when discharging patients with opiate-dependency, and emailing discharge summary to alert the patients' general practitioner or drug treatment agency.

KW - drug related death

KW - drug related morbidity

KW - hospital discharge

KW - drug treatment

KW - Scotland

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M3 - Conference Contribution

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T2 - Journal of Epidemiology and Community Health

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