Roberts Emmert, Hotopf Matthew, Strang John, Marsden John, White Martin, Eastwood Brian, Drummond Colin
National Addiction Centre and the Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, South London and the Maudsley NHS Foundation Trust and Public Health England, United Kingdom.
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and the Maudsley NHS Foundation Trust, United Kingdom.
Lancet Reg Health Eur. 2021 Apr;3:100036. doi: 10.1016/j.lanepe.2021.100036.
Over the past decade in England the rate of alcohol and opioid-related hospitalisation has increased alongside a simultaneous reduction in people accessing specialist addiction treatment. We aimed to determine the hospitalisation patterns of people presenting to addiction treatment with problematic use of alcohol or opioids, and estimate how individual sociodemographic characteristics and hospital admission diagnoses are associated with the rate of hospitalisation, death and successful completion of addiction treatment.
A national record linkage between Hospital Episode Statistics (HES) and the National Drug Treatment Monitoring System (NDTMS) captured lifetime hospital admission profiles of people presenting to addiction services in England in 2018/19. Latent class analysis assigned individuals to clusters based on the ICD-10 diagnosis coded as primary reason for admission. Negative binomial, and multilevel logistic regression models determined if outcomes differed due to sociodemographic characteristics or assigned diagnostic clusters.
Inpatient data were available for 64,840 alcohol patients, and 107,296 opioid patients. The most common reasons for admission were alcohol withdrawal ( = 20,024 (5.3% of alcohol-cohort admissions)), and unspecified illness ( = 11,387 (2.1% of opioid-cohort admissions)). Seven diagnostic clusters were identified for each substance cohort. People with admissions predominantly relating to mental and behavioural disorders, and injuries or poisonings had significantly higher hospitalisation rates (adjusted IRR 7.06 (95%CI 6.72-7.42); < 0.001), higher odds of death during addiction treatment (adjusted OR 2.71 (95%CI 2.29-3.20); < 0.001) and lower odds of successful treatment completion (adjusted OR 0.72 (95%CI 0.68-0.76); < 0.001).
This is the first study to interrogate national hospitalisation patterns within people presenting to addiction services with problematic use of alcohol or opioids. Having identified high-risk, high-cost individuals with increased hospital usage, and increased odds of death, future work should focus on targeting appropriate interventions, to improve their health outcomes and prevent unnecessary hospital readmission.
The work was funded by the Medical Research Council (MRC).
在过去十年中，英格兰与酒精和阿片类药物相关的住院率有所上升，与此同时，接受专科成瘾治疗的人数却在减少。我们旨在确定因酒精或阿片类药物使用问题而接受成瘾治疗的患者的住院模式，并估计个体社会人口学特征和医院入院诊断与住院率、死亡率以及成瘾治疗成功完成率之间的关联。
通过将医院事件统计数据（HES）与国家药物治疗监测系统（NDTMS）进行全国性记录链接，获取了2018/19年在英格兰接受成瘾服务的患者的终生住院情况。潜在类别分析根据作为入院主要原因编码的ICD - 10诊断将个体分配到不同类别。负二项式和多水平逻辑回归模型确定了由于社会人口学特征或分配的诊断类别不同，结果是否存在差异。
有64840名酒精患者和107296名阿片类药物患者的住院数据可用。最常见的入院原因是酒精戒断（酒精队列入院的20024例（5.3%））和未指明的疾病（阿片类药物队列入院的11387例（2.1%））。为每个药物队列确定了七个诊断类别。主要因精神和行为障碍以及损伤或中毒入院的患者住院率显著更高（调整后的IRR为7.06（95%CI 6.72 - 7.42）；P < 0.001），在成瘾治疗期间死亡的几率更高（调整后的OR为2.71（95%CI 2.29 - 3.20）；P < 0.001），成功完成治疗的几率更低（调整后的OR为0.72（95%CI 0.68 - 0.76）；P < 0.001）。
这是第一项研究因酒精或阿片类药物使用问题而接受成瘾服务的患者的全国住院模式的研究。在确定了住院使用率高、死亡几率增加的高风险、高成本个体后，未来的工作应侧重于针对性的干预措施，以改善他们的健康状况并防止不必要的再次入院。
这项工作由医学研究理事会（MRC）资助。
