Accidental poisoning mortality among patients in the Department of Veterans Affairs health system

Background: Accidental poisoning mortality is an increasingly important concern, particularly for health systems, which distribute potentially poisoning medications and treat substance use disorders. Objectives: To describe the rate of accidental poisoning mortality in the Veterans Health Administration (VHA) during fiscal year 2005, assess differences with rates observed in the general US population, and describe the frequency with which specific drugs and medications were mentioned on the death records of accidental poisoning decedents. Research Design: Cohort study. Subjects: All 5,567,621 individuals aged 18+ who received VHA inpatient or outpatient services in fiscal year 2004 (October 1, 2003 to September 30, 2004) or fiscal year 2005 and were alive at the start of fiscal year 2005. Measures: The National Death Index indicated vital status and cause of death, the National Patient Care Database indicated who used VHA services and consequently was in the study cohort, and the Web-based Injury Statistics Query and Reporting System indicated poisoning mortality rates in the general US population. Results: The crude rate of accidental poisoning mortality in the VHA for fiscal year 2005 was 19.85 deaths per 100,000 personyears. After accounting for gender and age distribution, VHA patients had nearly twice the rate of fatal accidental poisoning compared with adults in the general US population (standardized mortality ratio = 1.96; 95% confidence interval: 1.83, 2.08). Opioid medications and cocaine were frequently mentioned as the agents causing poisoning on death records. Conclusions: The present work indicates that a substantial need exists for interventions to reduce the risk of accidental poisoning among VHA patients.