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

Lewer, Dan and Tweed, Emily J and Aldridge, Robert W and Morley, Katherine . (2019) Causes of hospital admission and mortality among people who use heroin: a cohort study comparing relative and absolute risks. Drug and Alcohol Dependence, 204 (107525) https://doi.org/10.1016/j.drugalcdep.2019.06.027

URL: https://www.sciencedirect.com/science/article/pii/...

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.

Item Type:Evidence resource
Drug Type:Opioid
Intervention Type:AOD disorder harm reduction
Subjects:A Substance use, abuse, and dependence > Effects and consequences
B Substances > Opioids (opiates) > Heroin
G Health and disease > State of health
G Health and disease > Disorder by cause > Injury
G Health and disease > Digestive system disorder > Liver disorder
J Health care, prevention and rehabilitation > Risk and protective factors > Risk factors
J Health care, prevention and rehabilitation > Health care programme or facility > Hospital
P Demography, epidemiology, and history > Population dynamics > Substance related mortality / death
VA Geographic area > Europe > United Kingdom

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