Readmission with new comorbid drug use in individuals with and without mental illness after surviving firearm injury
Miriam Neufeld MD1, Elaine Lee PhD1, Mrithyunjay Vyliparambil2, Yi Zuo MPH3, Xiang Zhang MS1, Megan Janeway MD1, Michael Poulson MD1, Jeffrey Siracuse MD1, David Henderson MD1, Peter Burke MD1, Feng Li PhD4, Courtney Takahashi MD MCR1, Sabrina Sanchez MD MPH1, Lisa Allee MSW LICSW1, Tracey Dechert MD1, Bindu Kalesan PhD MPH5. 1. Boston University School of Medicine, Boston, MA 2. University of Massachusetts, Boston, MA 3. Vanderbilt University, Nashville, TN 4. Central University of Economics and Finance, Beijing, China 5. Boston University School of Medicine and Public Health, Boston, MA
Background:
Violence, mental illness, and drug use are correlated. Whether mental illness increases the risk drug use in patients surviving firearm injury has not been evaluated. We determined the risk of readmission with new drug use among patients with and without mental illness after firearm injury, and if risk varied based on treatment pathway.
Methods:
Retrospective cohort study, using California discharge data (2006 to 2010) of patients with firearm injury with and without mental illness (N=29,311). Primary outcome was any new drug (and opioid) use disorder at 1 year of follow-up. Risk of new drug use based on treatment pathway was assessed using Cox proportional hazard regression model.
Results:
Of 18,941 ED visits and 10,370 hospitalizations, 1,875 and 2,568 had mental illness at index injury. Patients with mental illness had greater risk of new drug use at one year [5.6% vs 2.1%; adjusted Hazard Ratio (aHR) 2.04 (95% CI 1.60, 2.60)]. Treated in ED alone, risk of new drug use was 7.7% for those with mental illness versus 2.2% for those without [(aHR=2.99 (95% CI 2.18, 4.09)]. Among those admitted, there was no significant difference. Risk of opioid use disorder at one year among patients with and without mental illness was 1.5% versus 0.6%, [aHR=1.81 (95% CI 1.13, 2.90)].
Conclusion:
Firearm injury patients with mental illness have an increased risk of 1-year readmission with new drug use when treated in ED alone. This vulnerable population may benefit from additional evaluation and treatment, to reduce risk of future drug use.
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