Gender differences in discharge dispositions of emergency department visits involving drug misuse and abuse\u20142004-2011

Jennifer I Manuel,Jane Lee

doi:10.1186/s13011-017-0114-5

Abstract

BackgroundDrug use-related visits to the emergency department (ED) can undermine discharge planning and lead to recurrent use of acute services. Yet, little is known about where patients go post discharge. We explored trends in discharge dispositions of drug-involved ED visits, with a focus on gender differences.MethodsWe extracted data from the 2004–2011 Drug Abuse Warning Network, a national probability sample of drug-related visits to hospital EDs in the U.S. We computed weighted multinomial logistic regression models to estimate discharge dispositions over time and to examine associations between gender and the relative risk of discharge dispositions, controlling for patient characteristics.ResultsThe final pooled sample included approximately 1.2 million ED visits between 2004 and 2011. Men accounted for more than half (57.6%) of all ED visits involving drug misuse and abuse. Compared with women, men had a greater relative risk of being released to the police/jail, being referred to outpatient detox or other treatment, and leaving against medical advice than being discharged home. The relative risk of being referred to outpatient detox/drug treatment than discharged home increased over time for men versus women.ConclusionsGreater understanding of gender-based factors involved in substance-related ED visits and treatment needs may inform discharge planning and preventive interventions.

Highlights

IntroductionWe explored trends in discharge dispositions of drug-involved emergency department (ED) visits, with a focus on gender differences
Drug use-related visits to the emergency department (ED) can undermine discharge planning and lead to recurrent use of acute services
Men compared to women were less likely to be discharged home and to have a general hospital admission, and more likely to be released to the police/jail, referred for outpatient detox/ drug treatment, admitted to inpatient detox or psychiatric hospital care, and leave against medical advice

Summary

Introduction

We explored trends in discharge dispositions of drug-involved ED visits, with a focus on gender differences. A greater percentage of men die from drug overdose, the rate of deaths involving drug overdose among women has significantly increased since 1999 [1]. The extant literature highlights gender disparities in health and social outcomes of individuals with substance use disorders, with women experiencing greater health and mental health comorbidity and financial difficulties [19, 21, 22]. While the influence of gender on patterns of substance use and treatment entry is widely acknowledged [19, 23], less is understood regarding the pathways by which men and women enter substance use treatment. Several studies have indicated that men are more likely to enter treatment via the criminal justice system, while women are most often referred from community and other health providers [20]

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