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Causes of hospital admission and mortality among people who use heroin: a cohort study comparing relative and absolute risks

Lewer, D; Tweed, EJ; Aldridge, RW; Morley, K; (2019) Causes of hospital admission and mortality among people who use heroin: a cohort study comparing relative and absolute risks. Drug and Alcohol Dependence 10.1016/j.drugalcdep.2019.06.027. (In press). Green open access

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Abstract

Background: Mortality in high-risk groups such as people who use illicit drugs is often expressed in relative terms such as standardised ratios. These measures are highest for diseases that are rare in the general population, such as hepatitis C, and may understate the importance of common long-term conditions. // Population: 6,683 people in community-based treatment for heroin dependence between 2006 and 2017 in London, England, linked to national hospital and mortality databases with 55,683 years of follow-up. // Method: Age- and sex-specific mortality and hospital admission rates in the general population of London were used to calculate the number of expected events. We compared standardised ratios (relative risk) to excess deaths and admissions (absolute risk) across ICD-10 chapters and subcategories. // Results: Drug-related diseases had the highest relative risks, with a standardised mortality ratio (SMR) of 48 (95% CI 42-54) and standardised admission ratio (SAR) of 293 (95% CI 282-304). By contrast, other diseases had an SMR of 4.4 (95% CI 4.0-4.9) and an SAR of 3.15 (95% CI 3.11-3.19). However, the majority of the 621 excess deaths (95% CI 569-676) were not drug-related (361; 58%). The largest groups were liver disease (75 excess deaths) and COPD (45). Similarly, 80% (11,790) of the 14,668 excess admissions (95% CI 14,382-14,957) were not drug-related. The largest groups were skin infections (1,073 excess admissions), alcohol (1,060), COPD (812) and head injury (612). // Conclusions: Although relative risks of drug-related diseases are very high, most excess morbidity and mortality in this cohort was caused by common long-term conditions.

Type: Article
Title: Causes of hospital admission and mortality among people who use heroin: a cohort study comparing relative and absolute risks
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.drugalcdep.2019.06.027
Publisher version: https://doi.org/10.1016/j.drugalcdep.2019.06.027
Language: English
Additional information: © Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed.
Keywords: Heroin, Crack Cocaine, Substance-Related Disorders, Public Health, Epidemiology
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Epidemiology and Health > Epidemiology and Public Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10081127
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