SUD Hospitalization History Increases Mortality Risk for Subsequent Health Condition

A cohort study on data from Czech nationwide registers of all-cause hospitalizations and deaths showed physical comorbidity in people with substance use disorders.

Patients with a history of hospitalization for substance use disorders (SUDs) were associated with a poorer prognosis for most subsequent physical health conditions, according to results of a retrospective cohort study published in The Lancet Psychiatry.

Investigators from the National Institute of Mental Health in Czechia sourced data for this study from 2 Czech nationwide health registers. Patients (n=121,153) with a history of SUD hospitalizations were evaluated for all-cause hospitalizations and deaths between 1994 and 2017. Outcomes were compared with a cohort of patients (n=6,742,134) without SUD hospitalizations but with the same non-SUD subsequent condition. A 3:1 propensity matching approach was used to balance cohort differences.

Among a total of 28 subsequent health conditions, the cohort sizes ranged between 444 (multiple sclerosis [MS]) to 36,365 (circulatory system diseases). The proportion of men in the cohorts ranged from 31.4% (thyroid disorders) to 100% (prostate disorders) and the ages ranged from 30.0 years (chronic viral hepatitis) to 62.2 years (Parkinson disease [PD]).

For all but 2 of the 28 subsequent health conditions, a SUD history was associated with increased risk for mortality compared with controls (adjusted hazard ratio [aHR] range, 1.15-3.86). The highest mortality risk following SUD was observed for thyroid disorders. The two conditions that did not reach significance were MS (aHR, 1.70; 95% CI, 0.88-3.28) and PD (aHR, 1.38; 95% CI, 0.98-1.96).

History of hospitalization for SUDs was associated with a profound negative impact on prognosis following the development of subsequent physical health conditions requiring hospitalization.

Stratified by gender, men with a history of SUD hospitalization who had onset of a subsequent health condition by 30 years of age were associated with 10.12 to 37.17 years of life lost compared with non-SUD counterparts and for women, 10.01-41.49 years of life lost compared with controls. Onset by 45 years of age associated with 8.10-24.27 years of life lost for men and 8.48-25.20 years of life lost for women compared with controls.

This study may have been limited by only considering hospital-based healthcare encounters.

Study authors concluded, “History of hospitalization for SUDs was associated with a profound negative impact on prognosis following the development of subsequent physical health conditions requiring hospitalization. When compared with individuals without SUDs, people with preexisting SUDs were more likely to die after developing a subsequent physical health condition in 26 of 28 physical health conditions examined. Likewise, people with preexisting SUDs had substantial losses in life-years and, in most cases, lost markedly more life-years than their counterparts without SUDs.”

References:

Formánek T, Krupchanka D, Mladá K, Winkler P, Jones PB. Mortality and life-years lost following subsequent physical comorbidity in people with pre-existing substance use disorders: a national registry-based retrospective cohort study of hospitalised individuals in Czechia. Lancet Psychiatry. 2022;9(12):957-968. doi:10.1016/S2215-0366(22)00335-2