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Silver RA, Haidar J, Johnson C. A state-level analysis of macro-level factors associated with hospital readmissions. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:1205-1215. [PMID: 38244168 DOI: 10.1007/s10198-023-01661-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 12/14/2023] [Indexed: 01/22/2024]
Abstract
Investigation of the factors that contribute to hospital readmissions has focused largely on individual level factors. We extend the knowledge base by exploring macrolevel factors that may contribute to readmissions. We point to environmental, behavioral, and socioeconomic factors that are emerging as correlates to readmissions. Data were taken from publicly available reports provided by multiple agencies. Partial Least Squares-Structural Equation Modeling was used to test the association between economic stability and environmental factors on opioid use which was in turn tested for a direct association with hospital readmissions. We also tested whether hospital access as measured by the proportion of people per hospital moderates the relationship between opioid use and hospital readmissions. We found significant associations between Negative Economic Factors and Opioid Use, between Environmental Factors and Opioid Use, and between Opioid Use and Hospital Readmissions. We found that Hospital Access positively moderates the relationship between Opioid Use and Readmissions. A priori assumptions about factors that influence hospital readmissions must extend beyond just individualistic factors and must incorporate a holistic approach that also considers the impact of macrolevel environmental factors.
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Affiliation(s)
- Reginald A Silver
- University of North Carolina at Charlotte Belk College of Business, 9201 University City, Blvd, Charlotte, NC, 28223, USA.
| | - Joumana Haidar
- Gillings School of Global Public Health, Health University of North Carolina at Chapel Hill, 407D Rosenau, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA
| | - Chandrika Johnson
- Fayetteville State University, 1200 Murchison Road, Fayetteville, NC, 28301, USA
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Mulligan LD, Bojanić L, Hunt IM, Baird A, Turnbull P, Kapur N, Appleby L, Shaw J. Substance use and self-poisoning in schizophrenia: 11-year findings from a national clinical survey of suicide in mental health patients in the UK. Schizophr Res 2024; 267:254-260. [PMID: 38581828 DOI: 10.1016/j.schres.2024.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/03/2023] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
Suicide is the leading cause of unnatural death among people with schizophrenia. Substance use is a highly prevalent comorbid feature of schizophrenia and a modifiable risk factor for suicide. However, no studies have examined changes in the frequency of substance use or self-poisoning in those who died by suicide over time. Knowing this could support more tailored approaches to reducing specific risk factors and access to means in those with schizophrenia who are at risk of suicide. We conducted an 11-year observational study on a clinical survey of people with schizophrenia in the UK who died by suicide within 12 months of contact with mental health services between 2010 and 2020 (n = 2718). Overall, alcohol, cannabis and stimulants were the most frequently reported substances. The odds of lifetime use significantly increased over time for cannabis, stimulants, heroin, and benzodiazepines. There were differences in socio-demographic, behavioural and clinical factors between those with recent and historical alcohol and drug use before death. Deaths by hanging, jumping and self-poisoning were the most common suicide methods. Though deaths by hanging significantly increased over time, deaths by self-poisoning significantly decreased, especially by means of psychotropic medication and opioids. To improve risk management, clinical efforts should focus on identifying and treating people with schizophrenia using specific substances. Nationwide initiatives for improving safety in prescribing could be contributing to reduced risks of suicide via self-poisoning in this group.
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Affiliation(s)
- Lee D Mulligan
- Division of Psychology & Mental Health, Faculty of Biology, Medicine & Health, University of Manchester, M13 9PL, UK.
| | - Lana Bojanić
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| | - Isabelle M Hunt
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| | - Alison Baird
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| | - Pauline Turnbull
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| | - Nav Kapur
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Louis Appleby
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
| | - Jenny Shaw
- NCISH, Centre for Mental Health and Safety, Faculty of Biology, Medicine and Health, University of Manchester, M13 9PL, UK
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Seaman R, Walsh D, Beatty C, McCartney G, Dundas R. Social security cuts and life expectancy: a longitudinal analysis of local authorities in England, Scotland and Wales. J Epidemiol Community Health 2023; 78:jech-2023-220328. [PMID: 37935573 PMCID: PMC10850624 DOI: 10.1136/jech-2023-220328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND The UK Government's 'welfare reform' programme included reductions to social security payments, phased in over the financial years 2011/2012-2015/2016. Previous studies of social security cuts and health outcomes have been restricted to analysing single UK countries or single payment types (eg, housing benefit). We examined the association between all social security cuts fully implemented by 2016 and life expectancy, for local authorities in England, Scotland and Wales. METHODS Our unit of analysis was 201 upper tier local authorities (unitary authorities and county councils: 147 in England, 32 in Scotland, 22 in Wales). Our exposure was estimated social security loss per head of the working age population per year for each local authority, calculated against the baseline in 2010/2011. The primary outcome was annual life expectancy at birth between the calendar years 2012 and 2016 (year lagged following exposure). We used a panel regression approach with fixed effects. RESULTS Social security cuts implemented by 2016 were estimated to be £475 per head of the working age population in England, £390 in Scotland and £490 in Wales since 2010/2011. During the study period, there was either no improvement or only marginal increases in national life expectancy. Social security loss and life expectancy were significantly associated: an estimated £100 decrease in social security per head of working age population was associated with a 1-month reduction in life expectancy. CONCLUSIONS Social security cuts, at the UK local authority level, were associated with lower life expectancy. Further research should examine causality.
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Affiliation(s)
- Rosie Seaman
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - David Walsh
- Glasgow Centre for Population Health, Glasgow, UK
| | - Christina Beatty
- Centre for Regional Economic and Social Research, Sheffield Hallam University, Sheffield, UK
| | - Gerry McCartney
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Dowd JB, Angus C, Zajacova A, Tilstra AM. Comparing trends in mid-life 'deaths of despair' in the USA, Canada and UK, 2001-2019: is the USA an anomaly? BMJ Open 2023; 13:e069905. [PMID: 37591647 PMCID: PMC10441077 DOI: 10.1136/bmjopen-2022-069905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 07/27/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES In recent years, 'deaths of despair' due to drugs, alcohol and suicide have contributed to rising mid-life mortality in the USA. We examine whether despair-related deaths and mid-life mortality trends are also changing in peer countries, the UK and Canada. DESIGN Descriptive analysis of population mortality rates. SETTING The USA, UK (and constituent nations England and Wales, Northern Ireland and Scotland) and Canada, 2001-2019. PARTICIPANTS Full population aged 35-64 years. OUTCOME MEASURES We compared all-cause and 'despair'-related mortality trends at mid-life across countries using publicly available mortality data, stratified by three age groups (35-44, 45-54 and 55-64 years) and by sex. We examined trends in all-cause mortality and mortality by causes categorised as (1) suicides, (2) alcohol-specific deaths and (3) drug-related deaths. We employ several descriptive approaches to visually inspect age, period and cohort trends in these causes of death. RESULTS The USA and Scotland both saw large relative increases and high absolute levels of drug-related deaths. The rest of the UK and Canada saw relative increases but much lower absolute levels in comparison. Alcohol-specific deaths showed less consistent trends that did not track other 'despair' causes, with older groups in Scotland seeing steep declines over time. Suicide deaths trended slowly upward in most countries. CONCLUSIONS In the UK, Scotland has suffered increases in drug-related mortality comparable with the USA, while Canada and other UK constituent nations did not see dramatic increases. Alcohol-specific and suicide mortalities generally follow different patterns to drug-related deaths across countries and over time, questioning the utility of a cohesive 'deaths of despair' narrative.
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Affiliation(s)
- Jennifer Beam Dowd
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anna Zajacova
- University of Western Ontario, London, Ontario, Canada
| | - Andrea M Tilstra
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, UK
- Nuffield College, University of Oxford, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Abstract
The opioid crisis in the United States (US) is one of the most high-profile public health scandals of the 21st century with millions of people unknowingly becoming dependent on opioids. The United Kingdom (UK) had the world's highest rate of opioid consumption in 2019, and opiate-related drug poisoning deaths have increased by 388% since 1993 in England and Wales. This article explores the epidemiological definitions of public health emergencies and epidemics in the context of opioid use, misuse, and mortality in England, to establish whether England is facing an opioid crisis.
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Affiliation(s)
- Antonia-Olivia Roberts
- Medical Sciences Division, University of Oxford, Oxford, UK
- Green Templeton College, University of Oxford, Oxford, UK
| | - Georgia C Richards
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Williamson AE, Tydeman F, Miners A, Pyper K, Martineau AR. Short-term and long-term impacts of COVID-19 on economic vulnerability: a population-based longitudinal study (COVIDENCE UK). BMJ Open 2022; 12:e065083. [PMID: 35998959 PMCID: PMC9402446 DOI: 10.1136/bmjopen-2022-065083] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To determine whether COVID-19 has a significant impact on adequacy of household income to meet basic needs (primary outcome) and work absence due to sickness (secondary outcome), both at the onset of illness (short term) and subsequently (long term). DESIGN Multilevel mixed regression analysis of self-reported data from monthly online questionnaires, completed 1 May 2020 to 28 October 2021, adjusting for baseline characteristics including age, sex, socioeconomic status and self-rated health. SETTING AND PARTICIPANTS Participants (n=16 910) were UK residents aged 16 years or over participating in a national longitudinal study of COVID-19 (COVIDENCE UK). RESULTS Incident COVID-19 was independently associated with increased odds of participants reporting household income as being inadequate to meet their basic needs in the short term (adjusted OR (aOR) 1.39, 95% CI 1.12 to 1.73) though this did not persist in the long term (aOR 1.00, 95% CI 0.86 to 1.16). Exploratory analysis revealed a stronger short-term association among those who reported long COVID, defined as the presence of symptoms lasting more than 4 weeks after disease onset, than those reporting COVID-19 without long COVID (p for trend 0.002). Incident COVID-19 associated with increased odds of reporting sickness absence from work in the long term (aOR 4.73, 95% CI 2.47 to 9.06) but not in the short term (aOR 1.34, 95% CI 0.52 to 3.49). CONCLUSIONS We demonstrate an independent association between COVID-19 and increased risk of economic vulnerability among COVIDENCE participants, measured by both household income sufficiency and sickness absence from work. Taking these findings together with pre-existing research showing that socioeconomic disadvantage increases the risk of developing COVID-19, this may suggest a 'vicious cycle' of impaired health and poor economic outcomes. TRIAL REGISTRATION NUMBER NCT04330599.
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Affiliation(s)
- Anne E Williamson
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Florence Tydeman
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kate Pyper
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Adrian R Martineau
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Friebel R, Maynou L. Trends and characteristics of hospitalisations from the harmful use of opioids in England between 2008 and 2018: Population-based retrospective cohort study. J R Soc Med 2022; 115:173-185. [PMID: 35114090 PMCID: PMC9066666 DOI: 10.1177/01410768221077360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 01/15/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine the trends and characteristics of opioid-related hospital admissions in England over 10 years, and its burden for the National Health Service and public finances. DESIGN Patient-level data from the Hospital Episode Statistics database to examine all opioid-related hospitalisations from 2008 to 2018, stratified by type of opioid admission and patient demographics. SETTING All National Health Service hospitals in England. PARTICIPANTS Patients hospitalised from the harmful use of opioids. MAIN OUTCOME MEASURES The number of opioid-related hospitalisations, length of stay, in-hospital mortality, 30-day readmission rate and treatment costs. RESULTS Opioid-related hospitalisations increased by 48.9%, from 10,805 admissions in 2008 to 16,091 admissions in 2018, with total treatment costs of £137 million. The growth in opioid-related hospitalisations was 21% above the corresponding rate for all other emergency admissions in England. Relative changes showed that hospitalisations increased most for individuals older than 55 years (160%), those living in the most affluent areas of England (93.8%), and suffering from four co-morbidities (627.6%) or more. Hospitals reduced mean patient length of stay from 2.8 days to 1.1 days over 10 years. Mean in-hospital mortality was 0.4% and mean 30-day readmission risk was 16.6%. CONCLUSION Opioid use is an increasing public health concern in England, though hospitalisation and mortality rates are less pronounced than in other countries. There are concerns about significant rises in hospitalisations from older, less deprived and sicker population groups. Our findings should prompt policymakers to go beyond monitoring mortality statistics when assessing the impacts of harmful use of opioids.
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Affiliation(s)
- Rocco Friebel
- Department of Health Policy, The London School of Economics and Political Science, London, Houghton Street, WC2A 2AE, UK
- Center for Global Development Europe, London, Abbey Gardens, SW1P 3SE, UK
| | - Laia Maynou
- Department of Health Policy, The London School of Economics and Political Science, London, Houghton Street, WC2A 2AE, UK
- Department of Econometrics, Statistics and Applied Economics, Universitat de Barcelona, 08034 Barcelona, Spain
- Center for Research in Health and Economics, University of Pompeu Fabra, 08005 Barcelona, Spain
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Abstract
Opiates, such as morphine, and synthetic opioids, such as fentanyl, constitute a class of drugs acting on opioid receptors which have been used therapeutically and recreationally for centuries. Opioid drugs have strong analgesic properties and are used to treat moderate to severe pain, but also present side effects including opioid dependence, tolerance, addiction, and respiratory depression, which can lead to lethal overdose if not treated. This chapter explores the pathophysiology, the neural circuits, and the cellular mechanisms underlying opioid-induced respiratory depression and provides a translational perspective of the most recent research. The pathophysiology discussed includes the effects of opioid drugs on the respiratory system in patients, as well as the animal models used to identify underlying mechanisms. Using a combination of gene editing and pharmacology, the neural circuits and molecular pathways mediating neuronal inhibition by opioids are examined. By using pharmacology and neuroscience approaches, new therapies to prevent or reverse respiratory depression by opioid drugs have been identified and are currently being developed. Considering the health and economic burden associated with the current opioid epidemic, innovative research is needed to better understand the side effects of opioid drugs and to discover new therapeutic solutions to reduce the incidence of lethal overdoses.
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