Abstract
We validate that the 28 days after hospital-discharge are high-risk for drugs-related death (DRD) among drug users in Scotland and investigate key risk-factors for DRDs soon after hospital-discharge. Using data from an anonymous linkage of hospitalisation and death records to the Scottish Drugs Misuse Database (SDMD), including over 98,000 individuals registered for drug treatment during 1 April 1996 to 31 March 2010 with 705,538 person-years, 173,107 hospital-stays, and 2,523 DRDs. Time-at-risk of DRD was categorised as: during hospitalization, within 28 days, 29–90 days, 91 days–1 year, >1 year since most recent hospital discharge versus ‘never admitted’. Factors of interest were: having ever injected, misuse of alcohol, length of hospital-stay (0–1 versus 2+ days), and main discharge-diagnosis. We confirm SDMD clients’ high DRD-rate soon after hospital-discharge in 2006–2010. DRD-rate in the 28 days after hospital-discharge did not vary by length of hospital-stay but was significantly higher for clients who had ever-injected versus otherwise. Three leading discharge-diagnoses accounted for only 150/290 DRDs in the 28 days after hospital-discharge, but ever-injectors for 222/290. Hospital-discharge remains a period of increased DRD-vulnerability in 2006–2010, as in 1996–2006, especially for those with a history of injecting.
Highlights
We investigated drugs-related death (DRD) as nationally defined by Jackson [18] and National Records of Scotland, which comprise deaths involving drugs or attributed to one’s drug dependence and have the following groupings: mental and behavioral disorders due to psychoactive substance misuse; accidental poisoning; intentional self-poisoning by drugs, medicaments and biological substances; assault by drugs, medicaments and biological substances; and events of undetermined intent, poisoning
For adequately-powered secondary analyses of behavioral risks and hospitalization covariates, we considered the 1996–2010 Scottish Drugs Misuse Database (SDMD) cohort in its entirety so that at least 30 DRDs in the 28 days after hospital-discharge might be available for analysis per discharge-diagnosis
Non-drug-related suicide accounted for 11% (284) of deaths in the first era, but for only 6% (165) in the second
Summary
Injecting drug users experience significantly higher mortality rates [1,2,3,4,5,6,7,8,9,10,11,12,13], and identifying opportunities of intervention, such as upon release from prison or expiry of methadone prescription [5, 10], are important for public health policy. Scotland has invested in record linkage for drug users to monitor blood born viruses and prevalence of injecting drug users. Merrall et al [14] added to the literature of drug user mortality by showing that drug treatment clients were at increased risk of PLOS ONE | DOI:10.1371/journal.pone.0141073. Merrall et al [14] added to the literature of drug user mortality by showing that drug treatment clients were at increased risk of PLOS ONE | DOI:10.1371/journal.pone.0141073 November 5, 2015
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