Personality, high-risk behaviors, and the elevated risk of unintentional deaths related to drug poisoning among those with spinal cord injury
Krause J, Cao Y, DiPiro N
Medical University of South Carolina, Charleston, SC, United states
Objective: The United States is in the midst of an overdose epidemic, experiencing an alarming rise in the rate of unintentional death related to drug poisoning, primarily driven by prescription opioids (National Institute on Drug Abuse, 2017; Martin et al., 2015; Rudd et al., 2016). People with spinal cord injury (SCI) are at greater risk for secondary health conditions, many of which are treated with prescription medications (e.g., pain, spasticity). Polypharmacy is more common than in the general population (Jensen, 2014; Kitzman, 2017). There is also a significant elevation in all cause mortality, at least partially attributable to prescription medication use (Cao, 2017). Unfortunately, we know little about the risk factors specific to unintentional death due to drug poisoning and how they may differ from other causes. Our purpose was to conduct a prospective cohort study to identify risk factors for mortality after SCI related to unintentional drug poisoning and due to all other causes.
Design/methods: We conducted a prospective cohort study of mortality using participants from a large specialty hospital in the Southeastern USA. Two participant cohorts were enrolled, the first in 1997-1998 and the second in 2007-2009. There were 3024 participants. Participants completed self-report assessments that included multiple alcohol, smoking, and prescription indicators, as well as the Zuckerman Kuhlman Personality Questionnaire (ZKPQ) [Zuckerman, 1993]. Mortality status was determined as of December 31, 2014, using the National Death Index. CDC guidelines were used in classifying participants into three groups: (1) unintentional death related to drug poisoning, (2) other death, and (3) alive. A multinomial logit model was developed using SAS CATMOD procedure.
Results: There were 692 deaths (23%), including 25 unintentional deaths due to drug poisoning, and 667 for other causes. Binge drinking, medication usage total score and the ZKPQ sensation seeking scale were risk factors for unintentional death related to drug poisoning, whereas the ZKPQ activity scale was protective. No demographic or injury factors differentiated those alive from unintentional drug poisoning. In contrast, risk factors for other causes of mortality included an older age, more severe SCI, history of being a regular smoker, and higher on the ZKPQ neuroticism-anxiety scale. The medication use total score and the ZKPQ activity scale were also significant, consistent with predictors for deaths due to drug poisoning.
Conclusions: Unintentional death due to drug overdose (prescription medications) are related to a clear set of risk factors. So, these deaths, while unintentional, should not be taken as accidental or nonpreventable. There is a clear pattern of elevated risk that differs in meaningful ways from risk of death due to other causes after SCI. Understanding these differences is critical to the prevention of unintentional deaths due to drug poisoning.
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