Predictors of Overdose Death Among High-Risk Emergency Department Patients With Substance-Related Encounters: A Data Linkage Cohort Study - 21/12/19
, Matthew Eisenberg, PhD b, Kristin E. Schneider, BA a, Tom M. Richards, MS c, B. Casey Lyons, MPH d, Kate Jackson, MPH d, Lindsey Ferris, DrPH b, e, Jonathan P. Weiner, DrPH b, c, Brendan Saloner, PhD a, bAbstract |
Study objective |
Persons with substance use disorders frequently utilize emergency department (ED) services, creating an opportunity for intervention and referral to addiction treatment and harm-reduction services. However, EDs may not have the appropriate tools to distinguish which patients are at greatest risk for negative outcomes. We link hospital ED and medical examiner mortality databases in one state to identify individual-level risk factors associated with overdose death among ED patients with substance-related encounters.
Methods |
This retrospective cohort study linked Maryland statewide ED hospital claims records for adults with nonfatal overdose or substance use disorder encounters in 2014 to 2015 with medical examiner mortality records in 2015 to 2016. Logistic regression was used to identify factors in hospital records associated with risk of opioid overdose death. Predicted probabilities for overdose death were calculated for hypothetical patients with different combinations of overdose and substance use diagnostic histories.
Results |
A total of 139,252 patients had substance-related ED encounters in 2014 to 2015. Of these patients, 963 later experienced an opioid overdose death, indicating a case fatality rate of 69.2 per 10,000 patients, 6 times higher than that of patients who used the ED for any cause. Factors most strongly associated with death included having both an opioid and another substance use disorder (adjusted odds ratio 2.88; 95% confidence interval 2.04 to 4.07), having greater than or equal to 3 previous nonfatal overdoses (adjusted odds ratio 2.89; 95% confidence interval 1.54 to 5.43), and having a previous nonfatal overdose involving heroin (adjusted odds ratio 2.24; 95% confidence interval 1.64 to 3.05).
Conclusion |
These results highlight important differences in overdose risk among patients receiving care in EDs for substance-related conditions. The findings demonstrate the potential utility of incorporating routine data from patient records to assess risk of future negative outcomes and identify primary targets for initiation and linkage to lifesaving care.
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| Please see page 2 for the Editor’s Capsule Summary of this article. |
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| Supervising editors: Patrick M. Carter, MD; Megan L. Ranney, MD, MPH. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: NK, JPW, and BS conceptualized the study question. NK conducted the analyses and drafted the article. ME, KES, TMR, BCL, KJ, LF, JPW, and BS revised the article. ME, KES, and TMR generated the analytic database. NK, ME, KES, TMR, BCL, KJ, and LF developed study variables. BCL, KJ, and LF contributed to the conception of the study and secured databases for analysis and linkage. JPW and BS led and oversaw the research project and conceptualized the study variables. NK takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This study was funded by a Harold Rogers Prescription Drug Monitoring Program grant awarded by the US Department of Justice, Office of Justice Programs, and Bureau of Justice Assistance. Dr. Krawczyk was also supported by the National Institute on Drug Abuse of the National Institutes of Health under award F31DA047021. Ms. Schneider was supported by the National Institute on Drug Abuse (5T32DA007292-25). This project was supported by grant no. 2015-PM-BX-K002 awarded by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Department of Justice's Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime, and the SMART Office. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of the US Department of Justice. |
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Vol 75 - N° 1
P. 1-12 - janvier 2020 Retour au numéro
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