Dataset Information

Risk-factors for methadone-specific deaths in Scotland's methadone-prescription clients between 2009 and 2013.

ABSTRACT:

Aim

To quantify gender, age-group and quantity of methadone prescribed as risk factors for drugs-related deaths (DRDs), and for methadone-specific DRDs, in Scotland's methadone-prescription clients.

Design

Linkage to death-records for Scotland's methadone-clients with one or more Community Health Index (CHI)-identified methadone prescriptions during July 2009 to June 2013.

Setting

Scotland's Prescribing Information System and National Records of Scotland.

Measurements

Covariates defined at first CHI-identified methadone prescription, and person-years at-risk (pys) thereafter until the earlier of death-date or 31 December 2013. Methadone-specific DRDs were defined as: methadone implicated but neither heroin nor buprenorphine. Hazard ratios (HRs) were assessed using proportional hazards regression.

Findings

Scotland's CHI-identified methadone-prescription cohort comprised 33,128 clients, 121,254 pys, 1,171 non-DRDs and 760 DRDs (6.3 per 1,000 pys), of which 362 were methadone-specific. Irrespective of gender, methadone-specific DRD-rate, per 1,000 pys, was higher in the 35+ age-group (4.2; 95% CI: 3.6-4.7) than for younger clients (1.9; 95% CI: 1.5-2.2). For methadone-specific DRDs, age-related HRs (e.g., 2.9 at 45+ years; 95% CI: 2.1-3.9) were steeper than for all DRDs (1.9; 95% CI: 1.5-2.4); there was no hazard-reduction for females; no gender by age-group interaction; and, unlike for all DRDs, the highest quintile for quantity of prescribed methadone at cohort-entry (>1960mg) was associated with increased HR (1.8; 95% CI: 1.3-2.5).

Conclusion

Higher methadone-specific DRD rates in older clients, irrespective of gender, call for better understanding of methadone's pharmaco-dynamics in older, opioid-dependent clients, many with progressive physical or mental ill-health.

SUBMITTER: Gao L

PROVIDER: S-EPMC5047032 | biostudies-literature | 2016 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Risk-factors for methadone-specific deaths in Scotland's methadone-prescription clients between 2009 and 2013.

Gao Lu L Dimitropoulou Polyxeni P Robertson J Roy JR McTaggart Stuart S Bennie Marion M Bird Sheila M SM

Drug and alcohol dependence 20160829

<h4>Aim</h4>To quantify gender, age-group and quantity of methadone prescribed as risk factors for drugs-related deaths (DRDs), and for methadone-specific DRDs, in Scotland's methadone-prescription clients.<h4>Design</h4>Linkage to death-records for Scotland's methadone-clients with one or more Community Health Index (CHI)-identified methadone prescriptions during July 2009 to June 2013.<h4>Setting</h4>Scotland's Prescribing Information System and National Records of Scotland.<h4>Measurements</h ...[more]

PMID: 27593969

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Project description:ObjectivesTo identify the risk factors for and adverse newborn outcomes associated with maternal deaths from direct and indirect causes in the UK.DesignUnmatched case-control analysis.SettingAll hospitals caring for pregnant women in the UK.PopulationComprised 383 women who died (cases) from direct or indirect causes from 2009 to 2013 (Confidential Enquiry into Maternal Deaths in the UK) and 1516 women who did not have any life-threatening complications during pregnancy and childbirth (controls) obtained from UK Obstetric Surveillance System (UKOSS).MethodsMultivariable regression analyses were undertaken to examine potential risk factors, their incremental effects, and adverse newborn outcomes associated with maternal deaths.OutcomesOdds ratios associated for risk factors for maternal death and newborn outcomes (stillbirth, admission to neonatal intensive care unit [NICU], early neonatal death) and incremental risk.ResultsSeven factors, of 13 examined, were independently associated with increased odds of maternal death: pre-existing medical comorbidities (adjusted odds ratio [aOR] 8.65; 95% CI 6.29-11.90), anaemia during pregnancy (aOR 3.58; 95% CI 1.14-11.21), previous pregnancy problems (aOR 1.85; 95% CI 1.33-2.57), inadequate use of antenatal care (aOR 46.85; 95% CI 19.61-111.94), substance misuse (aOR 12.21; 95% CI 2.33-63.98), unemployment (aOR 1.81; 95% CI 1.08-3.04) and maternal age (aOR 1.06; 95% CI 1.04-1.09). There was a four-fold increase in the odds of death per unit increase in the number of risk factors. Odds of stillbirth, admission to NICU and early neonatal death were higher among women who died.ConclusionThis study reiterates the need for optimal care for women with medical comorbidities and older age, and the importance of adequate antenatal care. It demonstrates the existence of socio-economic inequalities in maternal death in the UK.Tweetable abstractMedical comorbidities and socio-economic inequalities are important risk factors for maternal death in the UK.

Dataset Information

Risk-factors for methadone-specific deaths in Scotland's methadone-prescription clients between 2009 and 2013.

Aim

Design

Setting

Measurements

Findings

Conclusion

Publications

Risk-factors for methadone-specific deaths in Scotland's methadone-prescription clients between 2009 and 2013.

Similar Datasets

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