Predictors of Death From Physical Illness or Accidental/Intentional Causes Among Patients With Substance-Related Disorders

Abstract

Objective This study identified patient clinical and sociodemographic characteristics, and, more originally, service use patterns as predictors of death from physical illness or accidental/intentional causes. Methods A cohort of 19,015 patients with substance-related disorders (SRD) from 14 addiction treatment centers was investigated using Quebec (Canada) health administrative databases. Death was studied over a 3-year period (April 1, 2013, to March 31, 2016), and most predictors from 4 years to 12 months prior to the time of death, using multinomial logistic regression. Results Frequent emergency department (ED) use strongly predicted both causes of death, suggesting that outpatient care responded inadequately to patient needs. Only receipt of specialized SRD and psychiatric care significantly decreased the risk of death from physical illness, with trends toward significance for accidental/intentional death. Hospitalization, greater material deprivation and having SRD-chronic physical illnesses or alcohol-related disorders most strongly predicted risk of death from physical illness. Sociodemographic characteristics, mainly social deprivation, were more likely to predict accidental/intentional death. Conclusions Outpatient services could be improved by increasing outreach and motivational interventions and, for ED and hospital units, better screening, brief intervention, and referral to treatment, particularly for men and socially deprived patients at high risk of accidental/intentional death. Patients with more severe health conditions, notably older or materially deprived men at higher risk of death from physical illness, could benefit from programs like assertive community treatment or intensive case management that respond well to diverse and continuous patient needs. Collaborative care between SRD and health services could also be improved.

Prior emergency medical services utilization is a risk factor for in-hospital death among patients with substance misuse: a retrospective cohort study

“…Prior studies have examined increased acute care utilization as a risk factor for mortality in patients with substance misuse [ 16 ]. Patients who visited the ED 1–3 times in the prior year for any medical reason had almost double the odds of mortality compared to those who did not [ 16 ]. In the same study, hospitalization in the previous year was associated with more than a ninefold risk of death.…”

“…EMS utilization attributable to substance misuse is likely even higher when accounting for the substantially increased risk of critical care conditions, such as organ dysfunction, infection, and metabolic derangements [ 9 ]. Previous studies have demonstrated that frequent emergency department (ED) visits and repeat hospitalizations are important risk factors for poor outcomes among patients with substance misuse [ 16 ]. However, EMS is usually the first and often the only healthcare contact during an encounter requiring medical assistance in patients with substance misuse.…”

All‐cause and cause‐specific mortality in individuals with an alcohol‐related emergency or hospital inpatient presentation: A retrospective data linkage cohort study

“…Those that have been conducted typically focus on all‐cause or specific causes of death (e.g. acute injury mortality [ 16 , 17 , 18 ]), or specific subpopulations of people presenting to health services with an alcohol‐related diagnosis (e.g. people with a non‐fatal injury with a comorbid alcohol use disorder diagnosis [ 19 ]).…”