Drugs-Related Death Soon after Hospital-Discharge among Drug Treatment Clients in Scotland: Record Linkage, Validation, and Investigation of Risk-Factors

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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.

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Extreme cause-specific mortality in a cohort of adult prisoners--1988 to 2002: a data-linkage study.

Geraldine Butler, M. Levy, Azar Kariminia … (2007)

Describe the standardized mortality ratio (SMR) and its trend in adults who have served time in prison. A retrospective cohort study of 85,203 adults imprisoned in New South Wales (NSW), Australia, between 1 January 1988 and 31 December 2002. We obtained information on deaths by record linkage with the Australian National Death Index (NDI). Mortality rates were estimated using the person-time method. SMRs were calculated using sex, age, and calendar-specific death rates from the NSW population. Time trends in SMRs were assessed using the test for linear trends. The median overall follow-up of the cohort was 7.7 years. We identified 5137 deaths (4714 men, 423 women) among the cohort of which the vast majority (4834, 94%) occurred following release from custody. All-cause SMR was 3.7 (95% CI: 3.6-3.8) in men and 7.8 (95% CI: 7.1-8.5) in women. SMRs were substantially raised for deaths due to mental and behavioural disorders (men: 13.2, 95% CI: 12.3-14.0; women: 62.8, 95% CI: 52.7-74.9) and drug-related deaths (men: 12.8, 95% CI: 12.2-13.5; women: 50.3, 95% CI: 43.7-57.8). The SMR for death by homicide was 10.2 (95% CI: 8.9-11.7) in men and 26.3 (95% CI: 17.8-39.0) in women. Aboriginal men were 4.8 times, and Aboriginal women 12.6 times, more likely to die than the general NSW population. Over the study period on average all-cause SMR decreased significantly in men (p = 0.003) and women (p = 0.05) largely due to the decline in SMRs for drug-related deaths and suicide. In the largest study so far reported, mortality of male and female offenders was far greater than expected for all major causes, especially deaths caused by drug overdose. Despite some indication of a reduction in excess mortality in recent years, there remains an overwhelming need for enhanced responses to mental health and drug problems for people who have been in prison.

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Causes of death after diagnosis of hepatitis B or hepatitis C infection: a large community-based linkage study.

Adrian M. Bartlett, Gregory Dore, Mathew G. Law … (2006)

Hepatitis B and hepatitis C virus infections are common causes of death related to liver disease. In this large study, we aimed to investigate all cause mortality of the viruses in a community-based setting. In the study population, 39,109 people had hepatitis B, 75,834 had hepatitis C, and 2604 had hepatitis B and hepatitis C co-infection, notified to the New South Wales state health department, Australia, between 1990 and 2002. Their data were probabilistically linked to the National Death Index. Standardised mortality ratios for all causes of death were calculated and adjusted for age, sex, and calendar year. The number of deaths identified by the linkage were 1233 (3.2%) for hepatitis B, 4008 (5.3)% for hepatitis C, and 186 (7.1)% for hepatitis B and C co-infection. Raised risk of liver-related death (standardised mortality ratios 12.2, 95% CI 10.7-13.9; 16.8, 15.4-18.3, and 32.9, 23.1-46.7, for hepatitis B, hepatitis C, and hepatitis B and C co-infected patients, respectively) and drug-induced death (1.4, 1.0-2.0; 19.3, 18.1-20.5; and 24.7, 18.2-33.5, respectively) were detected. In people with hepatitis C, raised risk of dying from drug-related causes was significantly greater than from liver-related causes (p=0.012), with the greatest excess risk in women aged 15-24 years (56.9, 39.2-79.9). All groups had increased risk of liver-related death compared with the standard population, with the greatest excess in people diagnosed with hepatitis B and hepatitis C co-infection. Our data highlight that young people with hepatitis C and with co-infection face a higher mortality risk from continued drug use than from their infection, whereas the main cause of hepatitis B death was liver related.

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Suicide in recently discharged psychiatric patients: a case-control study.

J. Burns, L Appleby, Alex A. R. Webb … (2009)

Few controlled studies have specifically investigated aspects of mental health care in relation to suicide risk among recently discharged psychiatric patients. We aimed to identify risk factors, including variation in healthcare received, for suicide within 3 months of discharge. We conducted a national population-based case-control study of 238 psychiatric patients dying by suicide within 3 months of hospital discharge, matched on date of discharge to 238 living controls. Forty-three per cent of suicides occurred within a month of discharge, 47% of whom died before their first follow-up appointment. The first week and the first day after discharge were particular high-risk periods. Risk factors for suicide included a history of self-harm, a primary diagnosis of affective disorder, recent last contact with services and expressing clinical symptoms at last contact with staff. Suicide cases were more likely to have initiated their own discharge and to have missed their last appointment with services. Patients who were detained for compulsory treatment at last admission, or who were subject to enhanced levels of aftercare, were less likely to die by suicide. The weeks after discharge from psychiatric care represent a critical period for suicide risk. Measures that could reduce risk include intensive and early community follow-up. Assessment of risk should include established risk factors as well as current mental state and there should be clear follow-up procedures for those who have self-discharged. Recent detention under the Mental Health Act and current use of enhanced levels of aftercare may be protective.

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Author and article information

Contributors

Kent E. Vrana: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 5 November 2015

Publication date Collection: 2015

Volume: 10

Issue: 11

Electronic Location Identifier: e0141073

Affiliations

[1 ]Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, United Kingdom

[2 ]Novartis Pharam BV, Novartis Vaccines & Diagnostics, Hullenbergweg 83–85, 1101 CL Amsterdam, Netherlands

[3 ]Health Protection Scotland, Glasgow, G3 7LN, Scotland, United Kingdom

Penn State College of Medicine, UNITED STATES

Author notes

Competing Interests: The Home Office’s Surveys, Design and Statistics Subcommittee issued its report on 21st Century Drugs and Statistical Science in UK under SMB’s chairmanship; SMB and SJH contributed to the MRC-funded NIQUAD cluster on Nationally Integrated Quantitative Understanding of Addiction Harms (MRC grant G1000021); SJH has received speaker honoraria from Schering-Plough in relation to HCV educational events; SMB holds GSK shares; SRW and ELCM have declared no competing interests. This did not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Analyzed the data: SRW SMB. Wrote the paper: SRW SMB ELCM SJH.

* E-mail: Simon.White@ 123456mrc-bsu.cam.ac.uk

Article

Publisher ID: PONE-D-14-35187

DOI: 10.1371/journal.pone.0141073

PMC ID: 4634860

PubMed ID: 26539701

SO-VID: 6a03917c-295f-4f17-81e2-8f490148fc1b

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This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

History

Date received : 5 August 2014

Date accepted : 5 October 2015

Page count

Figures: 0, Tables: 8, Pages: 11

Funding

This work was funded by the Medical Research Council (reference: MC_US_A030_0007 / 01). The data for this work were made available as a result of research funded by a grant from the Chief Scientist Office of the Scottish Executive. No sponsor had any role in the study design, data collection, data analysis, data interpretation, or writing of the report.

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Data Availability The record-linkage was initiated by Chief Scientist Office, Scotland (reference CZH/4/328) and Privacy Advisory Committee Approved study (reference RM/sh/ISD 13-06). Data are available from Scotland's Information Services Division, a division of National Services Scotland, part of NHS Scotland, for researchers who meet the criteria for access to confidential information; contact Dr. Lorna Ramsay ( lorna.ramsay@ 123456isd.csa.scot.nhs.uk ) or Michael Fleming ( michael.fleming@ 123456nhs.net ).

Drugs-Related Death Soon after Hospital-Discharge among Drug Treatment Clients in Scotland: Record Linkage, Validation, and Investigation of Risk-Factors

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Most cited references 8

Extreme cause-specific mortality in a cohort of adult prisoners--1988 to 2002: a data-linkage study.

Causes of death after diagnosis of hepatitis B or hepatitis C infection: a large community-based linkage study.

Suicide in recently discharged psychiatric patients: a case-control study.

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