Emergency department utilization and subsequent prescription drug overdose death.
OBJECTIVE
Prescription drug overdose (PDO) deaths are a critical public health problem in the United States. This study aims to assess the association between emergency department (ED) utilization patterns in a cohort of ED patients and the risk of subsequent unintentional PDO mortality.


METHODS
Using data from the New York Statewide Planning and Research Cooperative System for 2006-2010, a nested case-control design was used to examine the relationship between ED utilization patterns in New York State residents of age 18-64 years and subsequent PDO death.


RESULTS
The study sample consisted of 2732 case patients who died of PDO and 2732 control ED patients who were selected through incidence density sampling. With adjustment for demographic characteristics, and diagnoses of pain, substance abuse, and psychiatric disorders, the estimated odds ratios of PDO death relative to one ED visit or less in the previous year were 4.90 (95% confidence interval [CI]: 4.50-5.34) for those with two ED visits, 16.61 (95% CI: 14.72-18.75) for those with three ED visits, and 48.24 (95% CI: 43.23-53.83) for those with four ED visits or more.


CONCLUSIONS
Frequency of ED visits is strongly associated with the risk of subsequent PDO death. Intervention programs targeting frequent ED users are warranted to reduce PDO mortality.
Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, NY. Electronic address: jobrady@gmail.com.
Joanne E
JE
Brady
Department of Surgery, New York University School of Medicine, New York, NY.
Charles J
CJ
DiMaggio
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, NY.
Katherine M
KM
Keyes
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
John J
JJ
Doyle
Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY.
Lynne D
LD
Richardson
Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Center for Injury Epidemiology and Prevention, Columbia University Medical Center, New York, NY.
Guohua
G
Li
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003643:Death; D062787:Drug Overdose / Q000401:mortality*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D055553:Prescription Drugs / Q000008:administration & dosage / Q000506:poisoning*; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D055815:Young Adult
D055553:Prescription Drugs
Drug overdose; Emergency service, hospital; Prescription drugs; Prevention and control