Health-related quality of life measures as predictors for recurrent hospitalization and mortality among patients in heroin-assisted treatment

Individuals with opioid use disorder face complex health needs often necessitating hospital-based care, and many reported low health-related quality of life (HRQoL). This study assessed HRQoL factors as predictors of recurrent hospital-based care and mortality among heroin-assisted treatment (HAT) patients, identified patient groups with distinct HRQoL trajectories, and compared their hospital contact hours and mortality rates with the general population. A longitudinal cohort study was conducted, involving 541 HAT patients in Denmark from 2010 to 2018, along with a matched sample from the general Danish population. Using recurrent event regression and latent class growth analysis, we analyzed predictors of recurrent hospitalization and established trajectory groups. HRQoL was assessed using the 36-Item Short Form Health Survey (SF-36) and linked to multiple national registry data which provided demographic variables, hospital utilization, and mortality data. “General health” emerged as the largest and only significant predictor of recurrent hospitalization. Mortality was predicted by age and ‘role limitations due to emotional problems’. We identified four trajectory groups based on “general health ”, showing either a decreasing or stable trajectory. Groups differed significantly in terms of average hospital contact hours and mortality and all groups had lower ‘general health’ scores and greater mortality than the representative Danish sample. The most severe group had four times higher usage of hospitalization hours. SF-36 ‘general health’ is a key risk stratification tool for HAT patients predicting outcomes like hospitalization and mortality. Identifying high-risk individuals can help clinicians implement timely (somatic) care, particularly for long-term patients. People with opioid use disorder, in particular those in heroin-assisted treatment (HAT), often experience serious health challenges, frequent hospital visits, and a lower quality of life compared to the general population. Understanding their health-related quality of life (HRQoL) is essential for improving care and outcomes for this vulnerable group. The key issue this study addresses is whether patients’ own report of HRQoL can identify those who will need more healthcare and die prematurely. We assessed aspects of HRQoL associated with recurrent healthcare contacts and mortality, and constructed groups based on the development of their HRQoL over time. “General health” was the strongest and only predictor of repeated hospital contacts, while age and “role limitations due to emotional problems” were the only predictors of mortality. We found four distinct HRQoL trajectory groups among HAT patients. Three groups deteriorated in HRQoL, and one was stable. All groups utilized more health services and were at higher risk of dying compared to the general population. The group with the most severe HRQoL challenges used hospital resources four times more frequently. In summary, measuring the “general health” factor is essential for predicting hospitalizations. These findings highlight the importance of implementing targeted interventions to enhance healthcare for the most at-risk individuals in this population, particularly addressing somatic health issues.