Characterising mental health and addictions and assault-related health care use in the year prior to death: A population-based linked cohort study of homicide victims

Abstract

IntroductionHomicide is an important cause of death for older youth and adult Canadians; however, little isknown about health care use prior to death among this population. ObjectivesTo characterise health care use for mental health and addictions (MHA) and serious assault (hereinreferred to assault) one year prior to death among individuals who died by homicide in Ontario, Canada using linked mortality and health care utilisation data. MethodsWe report rates of health care use for MHA and assault in the year prior to death among all individuals16 years and older in Ontario, Canada, who died by homicide from April 2003 to December 2012 (N=1,541). Health care use for MHA included inpatient stays, emergency department (ED) visitsand outpatient visits, whereas health care use for assault included only hospital-based care (ED visitsand inpatient stays). Sociodemographic characteristics and health care utilisation were examinedacross homicide deaths, stratified by sex. ResultsOverall, 28.5% and 5.9% of homicide victims sought MHA and assault care in the year prior to death, respectively. A greater proportion of females accessed care for MHA, whereas a greater proportionof males accessed assault-related health care. Males were more likely to be hospitalised following anED visit for a MHA or assault related reason, in comparison to females. The most common reasonfor a MHA hospital visit was for substance-related disorders. We found an increase over time forhospital-based visits for assault prior to death, a trend that was not observed for MHA-related visits. ConclusionsA large proportion of homicide victims interacted with the health care system for MHA or assault inthe year prior to death. An increase in hospital-based visits for assault-related reasons prior to deathwas observed. These trends may offer insight into avenues for support and prevention for victims ofhomicide.