Variation in patterns of health care before suicide: A population case-control study
Recommended Citation
Ahmedani BK, Westphal J, Autio K, Elsiss F, Peterson EL, Beck A, Waitzfelder BE, Rossom RC, Owen-Smith AA, Lynch F, Lu CY, Frank C, Prabhakar D, Braciszewski JM, Miller-Matero LR, Yeh HH, Hu Y, Doshi R, Waring SC, and Simon GE. Variation in Patterns of Health Care Before Suicide: A Population Case-Control Study. Prev Med 2019; 127:105796.
Document Type
Article
Publication Date
10-1-2019
Publication Title
Preventive medicine
Abstract
BACKGROUND: The United States has experienced a significant rise in suicide. As decision makers identify how to address this national concern, healthcare systems have been identified as an optimal location for prevention.
OBJECTIVE: To compare variation in patterns of healthcare use, by health setting, between individuals who died by suicide and the general population.
DESIGN: Case-Control Study.
SETTING: Eight healthcare systems across the United States.
PARTICIPANTS: 2674 individuals who died by suicide between 2000 and 2013 along with 267,400 individuals matched on time-period of health plan membership and health system affiliation.
MEASUREMENTS: Healthcare use in the emergency room, inpatient hospital, primary care, and outpatient specialty setting measured using electronic health record data during the 7-, 30-, 60-, 90-, 180-, and 365-day time periods before suicide and matched index date for controls.
RESULTS: Healthcare use was more common across all healthcare settings for individuals who died by suicide. Nearly 30% of individuals had a healthcare visit in the 7-days before suicide (6.5% emergency, 16.3% outpatient specialty, and 9.5% primary care), over half within 30 days, and >90% within 365 days. Those who died by suicide averaged 16.7 healthcare visits during the year. The relative risk of suicide was greatest for individuals who received care in the inpatient setting (aOR = 6.23). There was both a large relative risk (aOR = 3.08) and absolute utilization rate (43.8%) in the emergency room before suicide.
LIMITATIONS: Participant race/ethnicity was not available. The sample did not include uninsured individuals.
CONCLUSIONS: This study provides important data about how care utilization differs for those who die by suicide compared to the general population and can inform decision makers on targeting of suicide prevention activities within health systems.
PubMed ID
31400374
Volume
127
First Page
105796
Last Page
105796
