Risk of drug overdose death following discharge from a trauma center for an injury

Abstract

Background: Trauma patients have a higher rate of long-term mortality due to natural and external causes, yet drug overdose (OD) death within this population has not been explored previously. Pre-existing behavioral risk factors, such as drug and alcohol use disorders (DUD/AUD), and chronic pain resulting from traumatic injury may increase trauma patient’s risk of subsequent drug overdose death.

Objectives: To determine whether trauma patients are at greater risk of drug OD death than the general population and detect whether smoking status or fracture is associated with future drug OD death among surviving trauma patients.

Methods: Trauma patients between 18 and 64 years of age who were discharged alive from a Level I Trauma Center between January 1999 and October 2008 were linked to the National Death Index (N=36,288). Patients who were alive at least 30 days after discharge without cancer were included in this study. Trauma patient risk of drug OD death was compared with the age, gender and race adjusted state population using a standardized mortality ratio (SMR) and 95% confidence intervals (CI). Cox proportional hazard regression was used to determine whether current smoking status or lower limb fracture injury were risk factors for drug overdose death factors.

Results: Trauma patients had a significantly higher drug overdose mortality rate than the state population [SMR=6.10 (95% CI 5.35-6.93)]. Cox proportional hazard modeling revealed a significant increased risk of drug overdose for current smokers [HR = 1.66 (95% CI 1.25-2.21)]. The effect of smoking was stronger in patients with no DUD/AUD and BAC< 80mg/dL [HR=2.45, 95% CI 1.67-3.57], while smoking was not associated with drug OD death in those with DUD/AUD or BAC≥ 80mg/dL on admission. Patients with lower limb fracture were not at increased risk of drug overdose death compared to those without fracture injuries.

Conclusion: Trauma patients have a higher risk of drug OD death than the general population. Smoking is a significant risk factor for drug OD following traumatic injury. Future drug overdose prevention programs should focus efforts on reducing drug overdose mortality in trauma patients, particularly those who smoke.