Causes of hospital admission and mortality among 6683 people who use heroin: a cohort study comparing relative and absolute risks

Lewer, D., Tweed, E. J. , Aldridge, R. W. and Morley, K. I. (2019) Causes of hospital admission and mortality among 6683 people who use heroin: a cohort study comparing relative and absolute risks. Drug and Alcohol Dependence, 204, 107525. (doi: 10.1016/j.drugalcdep.2019.06.027) (PMID:31581023) (PMCID:PMC6891224)

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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: 6683 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 (1073 excess admissions), alcohol (1060), 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.

Item Type:Articles
Additional Information:DL is funded by the National Institute for Health Research [DRF-2018-11-ST2-016]. This work was supported by a grant from the Wellcome Trust [109823/Z/15/Z] to KIM. EJT is funded by the Medical Research Council (MC_UU_12017/13 and MC_UU_12017/15) and Chief Scientist Office (SPHSU13 and SPHSU15), and by a Chief Scientist Office Clinical Academic Fellowship (CAF/17/11). RWA was supported by the Wellcome Trust through a Clinical Research Career Development Fellowship [206602].
Glasgow Author(s) Enlighten ID:Tweed, Dr Emily
Authors: Lewer, D., Tweed, E. J., Aldridge, R. W., and Morley, K. I.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:Drug and Alcohol Dependence
ISSN (Online):1879-0046
Published Online:03 September 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Drug and Alcohol Dependence 204:107525
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
727651SPHSU Core Renewal: Measuring and Analysing Socioeconomic Inequalities in Health Research ProgrammeAlastair LeylandMedical Research Council (MRC)MC_UU_12017/13IHW - MRC/CSO SPHU
727671SPHSU Core Renewal: Informing Healthy Public Policy Research ProgrammePeter CraigMedical Research Council (MRC)MC_UU_12017/15IHW - MRC/CSO SPHU
Chief Scientist Office (CSO)SPHSU13
Chief Scientist Office (CSO)SPHSU15
301147Morbidity and mortality among people experiencing severe and multiple disadvantage: a cohort study using cross-sectoral data linkageEmily TweedChief Scientist Office (CSO)CAF/17/11HW - MRC/CSO Social and Public Health Sciences Unit