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. 2020 Dec;51(12):2930-2937.
doi: 10.1016/j.injury.2020.10.048. Epub 2020 Oct 10.

20-year mortality after discharge in a cohort of 1,099 former trauma inpatients with and without substance use disorders

Zachary D W Dezman  1 , David A Gorelick  2 , Laura Buchanan  3 , Carl A Soderstrom  4
Affiliations

20-year mortality after discharge in a cohort of 1,099 former trauma inpatients with and without substance use disorders

Zachary D W Dezman et al. Injury. 2020 Dec.

Abstract

Introduction: Psychoactive substance use disorders (SUDs) are common in trauma patients and substance use has become a leading cause of death in the United States. The purpose of this study is to examine the impact of a lifetime SUD and SUD characteristics (substance used, current SUD versus in remission from dependence, etc.) on the long-term survival of trauma patients.

Methods: Cohort study of consecutive adult trauma inpatients who were discharged alive from a level-one trauma center (1994-1996). The presence of lifetime SUD was determined at the time of admission by the Structured Clinical Interview for the Diagnostic and Statistical Manual III-R. Mortality follow-up through the end of 2017 was obtained by linking patients to a national database of death certificates. Cox proportional hazards analysis was used to determine the association of lifetime SUD and death after adjusting for age and tobacco use.

Results: 1,220 patients were approached, 1,118 consented to participate, and 1,099 had personal identifiers for matching. 789 (71.8%) of subjects were men, 596 (54.2%) had lifetime SUDs, and 325 (29.6%) died. Injury was the most common cause of death (24.6%, 80/325), with poisonings (40.0%, 32/80) being the most common injury-related cause of death. Compared to those without a lifetime SUD, lifetime SUD was associated with increased all-cause mortality (adjusted hazard ratio [HRadj]=1.83; 95% CI, 1.4 to 2.4), injury death (HRadj=2.47; 95% CI: 1.4 to 4.2), and fatal opioid overdose (HRadj=12.96; 95% CI, 1.7 to 100.4)(p ≤ 0.01 for all HRadj).

Conclusions: The presence of a lifetime SUD was associated with early death, particularly from reinjury, in trauma patients. It is important to address a patient's SUD during admission to decrease their chances of dying after discharge, especially due to injury-related causes.

Keywords: Mortality; Substance use disorders; Trauma.

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Conflict of interest statement

Declaration of Competing Interest This manuscript has not previously been published and is not currently under consideration by another journal. A portion of the results were presented at the International Cannabinoid Research Society meeting in June 2019. The initial data collection was funded by the National Institutes of Health/National Institute on Alcohol Abuse and Addiction (R01 AA009050 01A2 awarded to CAS). The analysis was supported by the Maryland Emergency Medicine Network and the National Foundation of Emergency Medicine (awarded to ZDWD). None of the authors have any commercial associations or sources of support that suggest or constitute a conflict of interest.