title: Drugs-Related Death Soon after Hospital-Discharge among Drug Treatment Clients in Scotland: Record Linkage, Validation, and Investigation of Risk-Factors.
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.
authors.affiliation: Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, United Kingdom.
authors.forename: Simon R
authors.initials: SR
authors.lastname: White
authors.affiliation: Medical Research Council Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, United Kingdom.
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Bird
authors.affiliation: Novartis Pharam BV, Novartis Vaccines & Diagnostics, Hullenbergweg 83-85, 1101 CL Amsterdam, Netherlands.
authors.forename: Elizabeth L C
authors.initials: EL
authors.lastname: Merrall
authors.affiliation: Health Protection Scotland, Glasgow, G3 7LN, Scotland, United Kingdom.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Hutchinson
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008498:Medical Record Linkage; D010351:Patient Discharge / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000401:mortality* / Q000628:therapy; D013997:Time Factors; D055815:Young Adult