Risk Of Drug-related Death Research Articles

Designing and validating a Markov model for hospital-based addiction consult service impact on 12-month drug and non-drug related mortality.

Addiction consult services (ACS) engage hospitalized patients with opioid use disorder (OUD) in care and help meet their goals for substance use treatment. Little is known about how ACS affect mortality for patients with OUD. The objective of this study was to design and validate a model that estimates the impact of ACS care on 12-month mortality among hospitalized patients with OUD. We developed a Markov model of referral to an ACS, post-discharge engagement in SUD care, and 12-month drug-related and non-drug related mortality among hospitalized patients with OUD. We populated our model using Oregon Medicaid data and validated it using international modeling standards. There were 6,654 patients with OUD hospitalized from April 2015 through December 2017. There were 114 (1.7%) drug-related deaths and 408 (6.1%) non-drug related deaths at 12 months. Bayesian logistic regression models estimated four percent (4%, 95% CI = 2%, 6%) of patients were referred to an ACS. Of those, 47% (95% CI = 37%, 57%) engaged in post-discharge OUD care, versus 20% not referred to an ACS (95% CI = 16%, 24%). The risk of drug-related death at 12 months among patients in post-discharge OUD care was 3% (95% CI = 0%, 7%) versus 6% not in care (95% CI = 2%, 10%). The risk of non-drug related death was 7% (95% CI = 1%, 13%) among patients in post-discharge OUD treatment, versus 9% not in care (95% CI = 5%, 13%). We validated our model by evaluating its predictive, external, internal, face and cross validity. Our novel Markov model reflects trajectories of care and survival for patients hospitalized with OUD. This model can be used to evaluate the impact of other clinical and policy changes to improve patient survival.

Investigation of age, period, and cohort effects to understand Scotland's excess mortality: use of Lexis diagrams and intrinsic estimator regression modelling

BackgroundMortality rates are higher in Scotland than in England and Wales, even after accounting for deprivation. This excess mortality is partly due to higher mortality from suicide, alcohol-related deaths, and drug-related deaths. We investigated whether age, period, or cohort effects from exposure to adversity from the 1980s might explain the recent trends in these outcomes in Scotland. MethodsData on registered alcohol-related deaths (36 635) and suicide (31 061) for 1974–2013, and drug-related deaths (15 427) for 1979–2013 were obtained from the National Records of Scotland. To identify and quantify relative age–period–cohort effects, data were analysed by sex and deprivation using line plots, shaded contour plots (Lexis diagrams commonly used in demography but limited in epidemiology and health sciences), and intrinsic estimator regression modelling. FindingsCohort effects were identified for people born between 1960 and 1980 for both drug-related deaths and suicide. The 1960–80 birth cohort had roughly a 30% higher risk of suicide than other generations, and the increase in risk of drug-related deaths was at least twice as high. Both cohort effects were largely driven by male sex and people living in the most deprived areas, but the birth cohort most affected by suicide occurred slightly earlier than for drug-related deaths. The timing of the cohort at highest risk also differed by deprivation for both suicide and drug-related deaths, being earlier for men in the most deprived group. By contrast, an age–period effect for working-age adults, particularly in the most deprived areas, helped explain the trends in alcohol-related deaths; the risk of these deaths increased at least two times from 1990 to the mid-2000s. InterpretationThe results for drug-related deaths and suicide are consistent with the hypothesis that exposure to the changing socioeconomic and political contexts of the 1980s created a delayed negative health impact because the populations most affected were the same as those subsequently with higher risks of mortality. Limitations include definition of death outcomes, changes to coding, the use of year of registration, difficulties in disentangling age–period–cohort effects, and only having a partial view of each birth cohort. The use of several methods in triangulation added strength to the findings. FundingNone.

Substance abuse and psychiatric co-morbidity as predictors of premature mortality in Swedish drug abusers a prospective longitudinal study 1970 - 2006

BackgroundFew longitudinal cohort studies have focused on the impact of substances abused and psychiatric disorders on premature mortality. The aim of the present study was to identify predictors of increased risk of drug related death and non drug related death in substance abusers of opiates, stimulants, cannabis, sedatives/hypnotics, hallucinogens and alcohol over several decades.MethodsFollow-up study of a consecutive cohort of 561 substance abusers, admitted to a detoxification unit January 1970 to February 1978 in southern Sweden, and followed up in 2006. Demographic and clinical data, substance diagnoses and three groups of psychiatric diagnoses were identified at first admission. Causes of death were coded according to ICD-10 and classified as drug related deaths or non drug related deaths. To identify the incidence of some probable risk factors of drug related premature death, the data were subjected to a competing risks Cox regression analysis.ResultsOf 561 patients in the cohort, 11 individuals had either emigrated or could not be located, and 204/561 patients (36.4%) were deceased by 2006. The cumulative risk of drug related death increased more in the first 15 years and leveled out later on when non drug related causes of death had a similar incidence. In the final model, male gender, regular use of opiates or barbiturates at first admission, and neurosis were associated with an increased risk of drug related premature death, while cannabis use and psychosis were associated with a decreased risk. Neurosis, mainly depression and/or anxiety disorders, predicted drug related premature death while chronic psychosis and personality disorders did not. Chronic alcohol addiction was associated with increased risk of non drug related death.ConclusionsThe cohort of drug abusers had an increased risk of premature death to the age of 69. Drug related premature death was predicted by male gender, the use of opiates or barbiturates and depression and anxiety disorders at first admission. The predicted cumulative incidence of drug related death was significantly higher in opiate and barbiturate abusers over the observed period of 37 years, while stimulant abuse did not have any impact. Alcohol contributed to non drug related death.

Risk of drug-related death higher for elderly patients with multiple diseases?

Risk of drug-related death higher for elderly patients with multiple diseases?