TY - JOUR
T1 - Differences in Health Care Utilization in the Year Before Suicide Death
T2 - A Population-Based Case-Control Study
AU - Chock, Megan M.
AU - Lin, Jane C.
AU - Athyal, Vidush P.
AU - Bostwick, J. Michael
N1 - Publisher Copyright:
© 2019 Mayo Foundation for Medical Education and Research
PY - 2019/10
Y1 - 2019/10
N2 - Objective: To compare health care usage between suicide decedents and living controls in the year before suicide in a large representative US population. Patients and Methods: Cases (n=1221) and controls (n=3663) belonged to an integrated health care system from January 1, 2009, through December 31, 2014. Cases and controls were matched for age and sex in a 1:3 ratio, with diagnostic and/or billing codes used to enumerate and classify health care visits in the year before the index suicide. Matched analysis via conditional logistic regression related odds of suicide to visit type. A generalized estimating equation model was used to compare timing and frequency of visits between cases and controls. Results: In the year before death, cases had an increased odds of both inpatient hospitalizations and emergency department nonmental health visits (odds ratio [OR], 1.55; 95% CI, 1.27-1.88; P<.001 and OR, 1.42; 95% CI, 1.26-1.60; P<.001) but not outpatient nonmental health visits (OR, 1.00; 95% CI, 0.99-1.01; P=.63). Decedents increased health care utilization closer to suicide death and had significantly more health care visits than did controls 3 months before suicide (6 vs 2; P=.01) but not 9 to 12 months before suicide (4 vs 2; P=.07). At all time points, cases used more mental health care services than did controls. Conclusion: Compared with controls, suicide decedents had emergency department visits and more inpatient hospitalizations, both mental health and nonmental health related. As death approached, cases' frequency of health care usage increased. The only category in which cases and controls did not differ was in the frequency of outpatient nonmental health visits.
AB - Objective: To compare health care usage between suicide decedents and living controls in the year before suicide in a large representative US population. Patients and Methods: Cases (n=1221) and controls (n=3663) belonged to an integrated health care system from January 1, 2009, through December 31, 2014. Cases and controls were matched for age and sex in a 1:3 ratio, with diagnostic and/or billing codes used to enumerate and classify health care visits in the year before the index suicide. Matched analysis via conditional logistic regression related odds of suicide to visit type. A generalized estimating equation model was used to compare timing and frequency of visits between cases and controls. Results: In the year before death, cases had an increased odds of both inpatient hospitalizations and emergency department nonmental health visits (odds ratio [OR], 1.55; 95% CI, 1.27-1.88; P<.001 and OR, 1.42; 95% CI, 1.26-1.60; P<.001) but not outpatient nonmental health visits (OR, 1.00; 95% CI, 0.99-1.01; P=.63). Decedents increased health care utilization closer to suicide death and had significantly more health care visits than did controls 3 months before suicide (6 vs 2; P=.01) but not 9 to 12 months before suicide (4 vs 2; P=.07). At all time points, cases used more mental health care services than did controls. Conclusion: Compared with controls, suicide decedents had emergency department visits and more inpatient hospitalizations, both mental health and nonmental health related. As death approached, cases' frequency of health care usage increased. The only category in which cases and controls did not differ was in the frequency of outpatient nonmental health visits.
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U2 - 10.1016/j.mayocp.2019.04.037
DO - 10.1016/j.mayocp.2019.04.037
M3 - Article
C2 - 31427140
AN - SCOPUS:85072389858
SN - 0025-6196
VL - 94
SP - 1983
EP - 1993
JO - Mayo Clinic proceedings
JF - Mayo Clinic proceedings
IS - 10
ER -