Theme: Epidemiology & Public Health Research Year: 2024
Background: For people who inject drugs, the emergency department (ED) can serve as a touchpoint for linkage to services and prevention of overdose death. We characterized ED utilization among PWID who experienced fatal overdose from the AIDS Linked to the IntraVenous Experience (ALIVE) study, a community-based cohort of PWID in Baltimore, Maryland.
Methods: We used the National Death Index to identify ALIVE participants who died from overdose from 2012-2022 (n=243). This analysis was limited to participants who had ≥1 ED encounter one year prior to death whose data were ascertained through the state’s health information exchange (n=135). Mortality and ED data were merged with sociodemographic, biobehavioral, and mental health comorbidities ascertained at biannual study visits. ED encounters were classified into clinically meaningful categories based on ICD-10 codes. We compared participant characteristics between overdose deaths occurring within 30 days of ED discharge to deaths occurring more than 30 days after ED discharge using chi-squared and Wilcoxon Rank Sum tests.
Results: Participants were mostly male (78%), Black (66%), and one year prior to death, had 693 ED encounters, 33% of which were drug/behavioral health related. 34% of participants died within 30 days of their last ED discharge. The median number of ED encounters in the year prior to death was higher among those who died within 30 days of their last discharge (4, IQR: 3-10) compared to those who did not (2, IQR: 1-4, p<0.0001). Among 59 participants with an ALIVE visit within 2 years of death, 53% with major depression (CESD≥23) died within 30 days from last ED discharge, while 17% of participants without major depression (CESD<23) died within 30 days (p=0.005).
Conclusion: By integrating ED data with measures routinely collected from community-based research, these findings can inform discharge planning for ED clinicians regarding proximate overdose risk to patients after discharge.