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Development and characteristics of the Provincial Overdose Cohort in British Columbia, Canada.
PLoS One. 2019; 14(1):e0210129.Plos

Abstract

INTRODUCTION

British Columbia (BC), Canada declared a public health emergency in April 2016 for opioid overdose. Comprehensive data was needed to identify risk factors, inform interventions, and evaluate response actions. We describe the development of an overdose cohort, including linkage strategy, case definitions, and data governance model, and present the resulting characteristics, including data linkage yields and case overlap among data sources.

METHODS

Overdose events from hospital admissions, physician visits, poison centre and ambulance calls, emergency department visits, and coroner's data were grouped into episodes if records were present in multiple sources. A minimum of five years of universal health care records (all prescription dispensations, fee-for-service physician billings, emergency department visits and hospitalizations) were appended for each individual. A 20% random sample of BC residents and a 1:5 matched case-control set were generated. Consultation and prioritization ensured analysts worked to address questions to directly inform public health actions.

RESULTS

10,456 individuals suffered 14,292 overdoses from January 1, 2015 to Nov 30, 2016. Only 28% of overdose events were found in more than one dataset with the unique contribution of cases highest from ambulance records (32%). Compared with fatal overdoses, non-fatal events more often involved females, younger individuals (20 to 29 years) and those 60 or older. In 78% of illegal drug deaths, there was no associated ambulance response. In the year prior to first recorded overdose, 60% of individuals had at least one ED visit, 31% at least one hospital admission, 80% at least one physician visit, and 87% had filled at least one prescription in a community pharmacy.

CONCLUSION

While resource-intensive to establish, a linked cohort is useful for characterizing the full extent of the epidemic, defining sub-populations at risk, and patterns of contact with the health system. Overdose studies in other jurisdictions should consider the inclusion of multiple data sources.

Authors+Show Affiliations

British Columbia Centre for Disease Control, Vancouver, BC, Canada.British Columbia Centre for Disease Control, Vancouver, BC, Canada. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.British Columbia Centre for Disease Control, Vancouver, BC, Canada. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.British Columbia Centre for Disease Control, Vancouver, BC, Canada.British Columbia Centre for Disease Control, Vancouver, BC, Canada.Data Management and Stewardship Branch, British Columbia Ministry of Health, Victoria, BC, Canada.Performance Measurement and Reporting, Provincial Health Services Authority, Vancouver, BC, Canada.Office of the Provincial Health Officer, British Columbia Ministry of Health, Victoria, BC, Canada.British Columbia Centre for Disease Control, Vancouver, BC, Canada.Office of the Provincial Health Officer, British Columbia Ministry of Health, Victoria, BC, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30629607

Citation

MacDougall, Laura, et al. "Development and Characteristics of the Provincial Overdose Cohort in British Columbia, Canada." PloS One, vol. 14, no. 1, 2019, pp. e0210129.
MacDougall L, Smolina K, Otterstatter M, et al. Development and characteristics of the Provincial Overdose Cohort in British Columbia, Canada. PLoS One. 2019;14(1):e0210129.
MacDougall, L., Smolina, K., Otterstatter, M., Zhao, B., Chong, M., Godfrey, D., Mussavi-Rizi, A., Sutherland, J., Kuo, M., & Kendall, P. (2019). Development and characteristics of the Provincial Overdose Cohort in British Columbia, Canada. PloS One, 14(1), e0210129. https://doi.org/10.1371/journal.pone.0210129
MacDougall L, et al. Development and Characteristics of the Provincial Overdose Cohort in British Columbia, Canada. PLoS One. 2019;14(1):e0210129. PubMed PMID: 30629607.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Development and characteristics of the Provincial Overdose Cohort in British Columbia, Canada. AU - MacDougall,Laura, AU - Smolina,Kate, AU - Otterstatter,Michael, AU - Zhao,Bin, AU - Chong,Mei, AU - Godfrey,David, AU - Mussavi-Rizi,Ali, AU - Sutherland,Jenny, AU - Kuo,Margot, AU - Kendall,Perry, Y1 - 2019/01/10/ PY - 2018/10/04/received PY - 2018/12/17/accepted PY - 2019/1/11/entrez PY - 2019/1/11/pubmed PY - 2019/10/1/medline SP - e0210129 EP - e0210129 JF - PloS one JO - PLoS One VL - 14 IS - 1 N2 - INTRODUCTION: British Columbia (BC), Canada declared a public health emergency in April 2016 for opioid overdose. Comprehensive data was needed to identify risk factors, inform interventions, and evaluate response actions. We describe the development of an overdose cohort, including linkage strategy, case definitions, and data governance model, and present the resulting characteristics, including data linkage yields and case overlap among data sources. METHODS: Overdose events from hospital admissions, physician visits, poison centre and ambulance calls, emergency department visits, and coroner's data were grouped into episodes if records were present in multiple sources. A minimum of five years of universal health care records (all prescription dispensations, fee-for-service physician billings, emergency department visits and hospitalizations) were appended for each individual. A 20% random sample of BC residents and a 1:5 matched case-control set were generated. Consultation and prioritization ensured analysts worked to address questions to directly inform public health actions. RESULTS: 10,456 individuals suffered 14,292 overdoses from January 1, 2015 to Nov 30, 2016. Only 28% of overdose events were found in more than one dataset with the unique contribution of cases highest from ambulance records (32%). Compared with fatal overdoses, non-fatal events more often involved females, younger individuals (20 to 29 years) and those 60 or older. In 78% of illegal drug deaths, there was no associated ambulance response. In the year prior to first recorded overdose, 60% of individuals had at least one ED visit, 31% at least one hospital admission, 80% at least one physician visit, and 87% had filled at least one prescription in a community pharmacy. CONCLUSION: While resource-intensive to establish, a linked cohort is useful for characterizing the full extent of the epidemic, defining sub-populations at risk, and patterns of contact with the health system. Overdose studies in other jurisdictions should consider the inclusion of multiple data sources. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/30629607/Development_and_characteristics_of_the_Provincial_Overdose_Cohort_in_British_Columbia_Canada_ L2 - https://dx.plos.org/10.1371/journal.pone.0210129 DB - PRIME DP - Unbound Medicine ER -