The hospital admission profile of people presenting to specialist addiction services with problematic use of alcohol or opioids: A national retrospective cohort study in England

Emmert Roberts*, Matthew Hotopf, John Strang, John Marsden, Martin White, Brian Eastwood, Colin Drummond

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: 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. Methods: 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. Findings: Inpatient data were available for 64,840 alcohol patients, and 107,296 opioid patients. The most common reasons for admission were alcohol withdrawal (n = 20,024 (5.3% of alcohol-cohort admissions)), and unspecified illness (n = 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);p < 0.001), higher odds of death during addiction treatment (adjusted OR 2.71 (95%CI 2.29–3.20);p < 0.001) and lower odds of successful treatment completion (adjusted OR 0.72 (95%CI 0.68–0.76);p < 0.001). Interpretation: 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. Funding: The work was funded by the Medical Research Council (MRC).

Original languageEnglish
Article number100036
JournalThe Lancet Regional Health - Europe
Volume3
DOIs
Publication statusPublished - Apr 2021

Bibliographical note

Funding Information:
Professor Hotopf reports grants from Innovative Medicines Initiative, outside the submitted work.

Funding Information:
Professor Marsden reports grants from National Institute for Health Research (NIHR), grants from NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Mental Health Foundation Trust (SLaM), grants from Indivior, outside the submitted work; and I have part-time employment as Senior Academic Advisor for the Alcohol, Drugs, Tobacco and Justice Division, Health Improvement, Public Health England and I am a clinical academic consultant for the US National Institute on Drug Abuse, Centre for Clinical Trials Network. I have received honoraria and travel support from PCM Scientific and Martindale for the Improving Outcomes in Treatment of Opioid Dependence conference. I hold no stocks in any company.

Publisher Copyright:
© 2021 The Author(s)

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