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TEMPORAL TRENDS AND RISK FACTORS FOR ACETAMINOPHEN OVERDOSE: A CANADIAN POPULATION-BASED STUDY

RP Myers¹, B Li², A Fong², AM Shaheen¹, H Quan²
¹Liver Unit, Department of Medicine; ²Department of Community Health Sciences, University of Calgary, Calgary, Alberta

BACKGROUND: Acetaminophen overdose (AO) is the most common cause of acute liver failure. The objective of this study was to examine risk factors and temporal trends of AO in a large Canadian health region.
METHODS: Hospitalized patients with AO in the Calgary Health Region (population ~ 1 million) between 1995 and 2004 were identified from hospital discharge data. Temporal changes in adjusted hospitalization rates were analyzed in 2,159 patients. Sociodemographic risk factors including Aboriginal and socioeconomic status (SES) were examined. The circumstances of the overdoses (intentional versus unintentional) were determined using external causes of injury codes.
RESULTS: The age/sex-adjusted hospitalization rate for AO decreased by 49% from 28.8 per 100,000 population in 1995 to 14.7 per 100,000 in 2004 (P<0.0005). This decline was more marked in females than males (56% vs 15%). Hospitalization rates for intentional overdoses fell steadily from 21.8 per 100,000 in 1995 to 9.2 per 100,000 in 2004 (2004 vs 1995: rate ratio [RR] 0.40; 95% CI 0.396-0.402). Unintentional overdoses decreased between 1995 and 2000, but increased to 1995 levels by 2004 (2004 vs 1995: RR 1.01; 0.99-1.02). Risk factors for AO included female sex (RR 1.99; 1.99-2.00), Aboriginal status (RR 3.46; 2.86-4.18) and low SES (RR 4.86; 4.26-5.56). The highest overall rates were observed in the 10-19 and 20-29 year age groups (40.1 and 36.3 per 100,000 population, respectively).
CONCLUSIONS: Hospitalization rates for AO, particularly intentional ingestions, have fallen, but unintentional overdoses are on the rise. These findings highlight the necessity of preventive initiatives targeted at young age groups, females, Aboriginals, and socioeconomically disadvantaged groups.

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