A record-linkage study of drug-related death and suicide after hospital discharge among drug-treatment clients in Scotland, 1996–2006
Article first published online: 1 NOV 2012
© 2012 The Authors, Addiction © 2012 Society for the Study of Addiction
Volume 108, Issue 2, pages 377–384, February 2013
How to Cite
Merrall, E. L. C., Bird, S. M. and Hutchinson, S. J. (2013), A record-linkage study of drug-related death and suicide after hospital discharge among drug-treatment clients in Scotland, 1996–2006. Addiction, 108: 377–384. doi: 10.1111/j.1360-0443.2012.04066.x
- Issue published online: 17 JAN 2013
- Article first published online: 1 NOV 2012
- Accepted manuscript online: 24 AUG 2012 03:37AM EST
- Manuscript Accepted: 21 AUG 2012
- Manuscript Revised: 24 JAN 2012
- Manuscript Received: 9 NOV 2011
- Chief Scientist Office of the Scottish Executive
- Medical Research Council. Grant Number: MC_US_A030_0007/01
- Drug-related death;
- harm reduction;
- hospital discharge
To investigate the relationship between time after hospital discharge and drug-related death (DRD) and suicide among drug users in Scotland, while controlling for potential confounders.
Setting and participants
The 69 457 individuals who registered for drug treatment in Scotland during 1 April 1996–31 March 2006.
Time-at-risk was from the date of an individual's first attendance at drug treatment services after 1 April 1996 until the earlier date of death or end-of-study, 31 March 2006, and was categorized according to time since the most recent hospitalization, as during hospitalization, within 28 days, 29–90 days, 91 days to 1 year and >1 year since discharge from most recent hospital stay versus ‘never admitted’ (reference).
Time-periods soon after discharge were associated with increased risk of DRD. DRD rates per 1000 person-years were: 87 (95% CI: 72–103) during hospitalization, 21 (18–25) within 28 days, 12 (10–15) during 29–90 days and 8.5 (7.5–9.5) during 91 days to 1 year after discharge versus 4.2 (3.7–4.7) when >1 year after most recent hospitalization and 1.9 (1.7–2.1) for those never admitted. Adjusted hazard ratios by time since hospital discharge (versus never admitted) were: 9.6 (95% CI: 8–12) within 28 days, 5.6 (4.6–6.8) during days 29–90, thereafter 4.0 (3.5–4.7) and 2.3 (2.0–2.7) when >1 year. Non-drug-related suicides were less frequent than DRDs (269 versus 1383) but a similar risk pattern was observed.
In people receiving treatment for drug dependence, discharge from a period of hospitalization marks the start of a period of heightened vulnerability to drug-related death.