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, 29â€"90 days, 91 daysâ€"1 year, >1 year since most recent hospital discharge versus a ever admitted’. Factors of interest were: having ever injected, misuse of alcohol, length of hospital-stay (0â€"1 versus 2+ days), and main discharge-diagnosis. We confirm SDMD clients’ high DRD-rate soon after hospital-discharge in 2006â€"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 2006â€"2010, as in 1996â€"2006, especially for those with a history of injecting.