Skip to main content
Top
Published in: BMC Public Health 1/2007

Open Access 01-12-2007 | Research article

Hospitalizations for acetaminophen overdose: a Canadian population-based study from 1995 to 2004

Authors: Robert P Myers, Bing Li, Andrew Fong, Abdel Aziz M Shaheen, Hude Quan

Published in: BMC Public Health | Issue 1/2007

Login to get access

Abstract

Background

Acetaminophen overdose (AO) is the most common cause of acute liver failure. We examined temporal trends and sociodemographic risk factors for AO in a large Canadian health region.

Methods

1,543 patients hospitalized for AO in the Calgary Health Region (population ~1.1 million) between 1995 and 2004 were identified using administrative data.

Results

The age/sex-adjusted hospitalization rate decreased by 41% from 19.6 per 100,000 population in 1995 to 12.1 per 100,000 in 2004 (P < 0.0005). This decline was greater in females than males (46% vs. 29%). Whereas rates fell 46% in individuals under 50 years, a 50% increase was seen in those ≥ 50 years. Hospitalization rates for intentional overdoses fell from 16.6 per 100,000 in 1995 to 8.6 per 100,000 in 2004 (2004 vs. 1995: rate ratio [RR] 0.49; P < 0.0005). Accidental overdoses decreased between 1995 and 2002, but increased to above baseline levels by 2004 (2004 vs. 1995: RR 1.24;P < 0.0005). Risk factors for AO included female sex (RR 2.19; P < 0.0005), Aboriginal status (RR 4.04; P < 0.0005), and receipt of social assistance (RR 5.15; P < 0.0005).

Conclusion

Hospitalization rates for AO, particularly intentional ingestions, have fallen in our Canadian health region between 1995 and 2004. Young patients, especially females, Aboriginals, and recipients of social assistance, are at highest risk.
Appendix
Available only for authorised users
Literature
1.
go back to reference Hawton K, Ware C, Mistry H, Hewitt J, Kingsbury S, Roberts D, Weitzel H: Why patients choose paracetamol for self poisoning and their knowledge of its dangers. BMJ. 1995, 310 (6973): 164-CrossRefPubMedPubMedCentral Hawton K, Ware C, Mistry H, Hewitt J, Kingsbury S, Roberts D, Weitzel H: Why patients choose paracetamol for self poisoning and their knowledge of its dangers. BMJ. 1995, 310 (6973): 164-CrossRefPubMedPubMedCentral
2.
go back to reference Larson AM, Polson J, Fontana RJ, Davern TJ, Lalani E, Hynan LS, Reisch JS, Schiodt FV, Ostapowicz G, Shakil AO, Lee WM: Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology. 2005, 42 (6): 1364-1372. 10.1002/hep.20948.CrossRefPubMed Larson AM, Polson J, Fontana RJ, Davern TJ, Lalani E, Hynan LS, Reisch JS, Schiodt FV, Ostapowicz G, Shakil AO, Lee WM: Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology. 2005, 42 (6): 1364-1372. 10.1002/hep.20948.CrossRefPubMed
3.
go back to reference Lee WM: Acetaminophen and the U.S. Acute Liver Failure Study Group: lowering the risks of hepatic failure. Hepatology. 2004, 40 (1): 6-9. 10.1002/hep.20293.CrossRefPubMed Lee WM: Acetaminophen and the U.S. Acute Liver Failure Study Group: lowering the risks of hepatic failure. Hepatology. 2004, 40 (1): 6-9. 10.1002/hep.20293.CrossRefPubMed
4.
go back to reference Ostapowicz G, Fontana RJ, Schiodt FV, Larson A, Davern TJ, Han SH, McCashland TM, Shakil AO, Hay JE, Hynan L, Crippin JS, Blei AT, Samuel G, Reisch J, Lee WM: Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002, 137 (12): 947-954.CrossRefPubMed Ostapowicz G, Fontana RJ, Schiodt FV, Larson A, Davern TJ, Han SH, McCashland TM, Shakil AO, Hay JE, Hynan L, Crippin JS, Blei AT, Samuel G, Reisch J, Lee WM: Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002, 137 (12): 947-954.CrossRefPubMed
5.
go back to reference Schiodt FV, Atillasoy E, Shakil AO, Schiff ER, Caldwell C, Kowdley KV, Stribling R, Crippin JS, Flamm S, Somberg KA, Rosen H, McCashland TM, Hay JE, Lee WM: Etiology and outcome for 295 patients with acute liver failure in the United States. Liver Transpl Surg. 1999, 5 (1): 29-34. 10.1002/lt.500050102.CrossRefPubMed Schiodt FV, Atillasoy E, Shakil AO, Schiff ER, Caldwell C, Kowdley KV, Stribling R, Crippin JS, Flamm S, Somberg KA, Rosen H, McCashland TM, Hay JE, Lee WM: Etiology and outcome for 295 patients with acute liver failure in the United States. Liver Transpl Surg. 1999, 5 (1): 29-34. 10.1002/lt.500050102.CrossRefPubMed
6.
go back to reference Prior MJ, Cooper K, Cummins P, Bowen D: Acetaminophen availability increases in Canada with no increase in the incidence of reports of inpatient hospitalizations with acetaminophen overdose and acute liver toxicity. Am J Ther. 2004, 11 (6): 443-452. 10.1097/01.mjt.0000140217.48324.e3.CrossRefPubMed Prior MJ, Cooper K, Cummins P, Bowen D: Acetaminophen availability increases in Canada with no increase in the incidence of reports of inpatient hospitalizations with acetaminophen overdose and acute liver toxicity. Am J Ther. 2004, 11 (6): 443-452. 10.1097/01.mjt.0000140217.48324.e3.CrossRefPubMed
7.
go back to reference Rumack BH: Acetaminophen hepatotoxicity: the first 35 years. J Toxicol Clin Toxicol. 2002, 40 (1): 3-20.CrossRefPubMed Rumack BH: Acetaminophen hepatotoxicity: the first 35 years. J Toxicol Clin Toxicol. 2002, 40 (1): 3-20.CrossRefPubMed
8.
go back to reference Bond GR, Novak JE: The human and economic cost of paracetamol (acetaminophen) overdose. Pharmacoeconomics. 1995, 8 (3): 177-181.CrossRefPubMed Bond GR, Novak JE: The human and economic cost of paracetamol (acetaminophen) overdose. Pharmacoeconomics. 1995, 8 (3): 177-181.CrossRefPubMed
9.
go back to reference Medicines Control Agency, Department of Health. Analgesic medicines available without prescription: proposed changes to product information and sale or supply of paracetamol(MLX231) . London: Department of Health, 1996 November 22. Medicines Control Agency, Department of Health. Analgesic medicines available without prescription: proposed changes to product information and sale or supply of paracetamol(MLX231) . London: Department of Health, 1996 November 22.
10.
go back to reference Committee of Safety of Medicines MCA. Paracetamol and Aspirin. Current Problems in Pharmacovigilance 1997;23:9. Committee of Safety of Medicines MCA. Paracetamol and Aspirin. Current Problems in Pharmacovigilance 1997;23:9.
11.
go back to reference Morgan O, Majeed A: Restricting paracetamol in the United Kingdom to reduce poisoning: a systematic review. J Public Health (Oxf). 2005, 27 (1): 12-18. 10.1093/pubmed/fdh200.CrossRef Morgan O, Majeed A: Restricting paracetamol in the United Kingdom to reduce poisoning: a systematic review. J Public Health (Oxf). 2005, 27 (1): 12-18. 10.1093/pubmed/fdh200.CrossRef
12.
go back to reference Bateman DN, Bain M, Gorman D, Murphy D: Changes in paracetamol, antidepressants and opioid poisoning in Scotland during the 1990s. QJM. 2003, 96 (2): 125-132. 10.1093/qjmed/hcg015.CrossRefPubMed Bateman DN, Bain M, Gorman D, Murphy D: Changes in paracetamol, antidepressants and opioid poisoning in Scotland during the 1990s. QJM. 2003, 96 (2): 125-132. 10.1093/qjmed/hcg015.CrossRefPubMed
13.
go back to reference Nourjah P, Ahmad SR, Karwoski C, Willy M: Estimates of acetaminophen (paracetomal)-associated overdoses in the United States. Pharmacoepidemiol Drug Saf. 2005 Nourjah P, Ahmad SR, Karwoski C, Willy M: Estimates of acetaminophen (paracetomal)-associated overdoses in the United States. Pharmacoepidemiol Drug Saf. 2005
15.
go back to reference Allard YE, Wilkins R, Berthelot JM: Premature mortality in health regions with high aboriginal populations. Health Rep. 2004, 15 (1): 51-60.PubMed Allard YE, Wilkins R, Berthelot JM: Premature mortality in health regions with high aboriginal populations. Health Rep. 2004, 15 (1): 51-60.PubMed
16.
go back to reference Lemstra M, Neudorf C, Opondo J: Health disparity by neighbourhood income. Can J Public Health. 2006, 97 (6): 435-439.PubMed Lemstra M, Neudorf C, Opondo J: Health disparity by neighbourhood income. Can J Public Health. 2006, 97 (6): 435-439.PubMed
18.
go back to reference International Classificiation of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). 2001, Los Angeles , Practice Management Information Corporation International Classificiation of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). 2001, Los Angeles , Practice Management Information Corporation
19.
go back to reference International Statistical Classifications of Diseases and Related Health Problems, 10th Revision (ICD-10). 2005, Geneva , World Health Organization, 3: Second International Statistical Classifications of Diseases and Related Health Problems, 10th Revision (ICD-10). 2005, Geneva , World Health Organization, 3: Second
20.
go back to reference Data Disclosure Handbook. 2003, Alberta Health and Wellness, 1-15. Data Disclosure Handbook. 2003, Alberta Health and Wellness, 1-15.
22.
go back to reference Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA: Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005, 43 (11): 1130-1139. 10.1097/01.mlr.0000182534.19832.83.CrossRefPubMed Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA: Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005, 43 (11): 1130-1139. 10.1097/01.mlr.0000182534.19832.83.CrossRefPubMed
23.
go back to reference Saitz R, Ghali WA, Moskowitz MA: The impact of alcohol-related diagnoses on pneumonia outcomes. Arch Intern Med. 1997, 157 (13): 1446-1452. 10.1001/archinte.157.13.1446.CrossRefPubMed Saitz R, Ghali WA, Moskowitz MA: The impact of alcohol-related diagnoses on pneumonia outcomes. Arch Intern Med. 1997, 157 (13): 1446-1452. 10.1001/archinte.157.13.1446.CrossRefPubMed
24.
go back to reference Adams WL, Yuan Z, Barboriak JJ, Rimm AA: Alcohol-related hospitalizations of elderly people. Prevalence and geographic variation in the United States. JAMA. 1993, 270 (10): 1222-1225. 10.1001/jama.270.10.1222.CrossRefPubMed Adams WL, Yuan Z, Barboriak JJ, Rimm AA: Alcohol-related hospitalizations of elderly people. Prevalence and geographic variation in the United States. JAMA. 1993, 270 (10): 1222-1225. 10.1001/jama.270.10.1222.CrossRefPubMed
25.
go back to reference Sniezek JE, Finklea JF, Graitcer PL: Injury coding and hospital discharge data. JAMA. 1989, 262 (16): 2270-2272. 10.1001/jama.262.16.2270.CrossRefPubMed Sniezek JE, Finklea JF, Graitcer PL: Injury coding and hospital discharge data. JAMA. 1989, 262 (16): 2270-2272. 10.1001/jama.262.16.2270.CrossRefPubMed
26.
go back to reference Cameron AC, Trivedi PK: Regression Analysis of Count Data. Edited by: Cameron AC, Trivedi PK. 1998, New York, NY , Cambridge University Press, 1-404.CrossRef Cameron AC, Trivedi PK: Regression Analysis of Count Data. Edited by: Cameron AC, Trivedi PK. 1998, New York, NY , Cambridge University Press, 1-404.CrossRef
27.
go back to reference Wilkinson S, Taylor G, Templeton L, Mistral W, Salter E, Bennett P: Admissions to hospital for deliberate self-harm in England 1995-2000: an analysis of hospital episode statistics. J Public Health Med. 2002, 24 (3): 179-183. 10.1093/pubmed/24.3.179.CrossRefPubMed Wilkinson S, Taylor G, Templeton L, Mistral W, Salter E, Bennett P: Admissions to hospital for deliberate self-harm in England 1995-2000: an analysis of hospital episode statistics. J Public Health Med. 2002, 24 (3): 179-183. 10.1093/pubmed/24.3.179.CrossRefPubMed
28.
go back to reference Turvill JL, Burroughs AK, Moore KP: Change in occurrence of paracetamol overdose in UK after introduction of blister packs. Lancet. 2000, 355 (9220): 2048-2049. 10.1016/S0140-6736(00)02355-2.CrossRef Turvill JL, Burroughs AK, Moore KP: Change in occurrence of paracetamol overdose in UK after introduction of blister packs. Lancet. 2000, 355 (9220): 2048-2049. 10.1016/S0140-6736(00)02355-2.CrossRef
29.
go back to reference Langlois S, Morrison P: Suicide deaths and suicide attempts. Health Rep. 2002, 13 (2): 9-22.PubMed Langlois S, Morrison P: Suicide deaths and suicide attempts. Health Rep. 2002, 13 (2): 9-22.PubMed
31.
go back to reference Colman I, Yiannakoulias N, Schopflocher D, Svenson LW, Rosychuk RJ, Rowe BH: Population-based study of medically treated self-inflicted injuries. Can J Emerg Med. 2004, 6 (5): 313-320. Colman I, Yiannakoulias N, Schopflocher D, Svenson LW, Rosychuk RJ, Rowe BH: Population-based study of medically treated self-inflicted injuries. Can J Emerg Med. 2004, 6 (5): 313-320.
32.
go back to reference Hughes B, Durran A, Langford NJ, Mutimer D: Paracetamol poisoning--impact of pack size restrictions. J Clin Pharm Ther. 2003, 28 (4): 307-310. 10.1046/j.1365-2710.2003.00497.x.CrossRefPubMed Hughes B, Durran A, Langford NJ, Mutimer D: Paracetamol poisoning--impact of pack size restrictions. J Clin Pharm Ther. 2003, 28 (4): 307-310. 10.1046/j.1365-2710.2003.00497.x.CrossRefPubMed
33.
go back to reference Huchcroft SA, Tanney BL: Sex-specific trends in suicide method, Canada, 1971-1985. Can J Public Health. 1989, 80 (2): 120-123.PubMed Huchcroft SA, Tanney BL: Sex-specific trends in suicide method, Canada, 1971-1985. Can J Public Health. 1989, 80 (2): 120-123.PubMed
34.
go back to reference Seeff LB, Cuccherini BA, Zimmerman HJ, Adler E, Benjamin SB: Acetaminophen hepatotoxicity in alcoholics. A therapeutic misadventure. Ann Intern Med. 1986, 104 (3): 399-404.CrossRefPubMed Seeff LB, Cuccherini BA, Zimmerman HJ, Adler E, Benjamin SB: Acetaminophen hepatotoxicity in alcoholics. A therapeutic misadventure. Ann Intern Med. 1986, 104 (3): 399-404.CrossRefPubMed
35.
38.
go back to reference Schiodt FV, Rochling FA, Casey DL, Lee WM: Acetaminophen toxicity in an urban county hospital. N Engl J Med. 1997, 337 (16): 1112-1117. 10.1056/NEJM199710163371602.CrossRefPubMed Schiodt FV, Rochling FA, Casey DL, Lee WM: Acetaminophen toxicity in an urban county hospital. N Engl J Med. 1997, 337 (16): 1112-1117. 10.1056/NEJM199710163371602.CrossRefPubMed
39.
go back to reference Whitcomb DC, Block GD: Association of acetaminophen hepatotoxicity with fasting and ethanol use. JAMA. 1994, 272 (23): 1845-1850. 10.1001/jama.272.23.1845.CrossRefPubMed Whitcomb DC, Block GD: Association of acetaminophen hepatotoxicity with fasting and ethanol use. JAMA. 1994, 272 (23): 1845-1850. 10.1001/jama.272.23.1845.CrossRefPubMed
40.
go back to reference Gunnell D, Hawton K, Murray V, Garnier R, Bismuth C, Fagg J, Simkin S: Use of paracetamol for suicide and non-fatal poisoning in the UK and France: are restrictions on availability justified?. J Epidemiol Community Health. 1997, 51 (2): 175-179.CrossRefPubMedPubMedCentral Gunnell D, Hawton K, Murray V, Garnier R, Bismuth C, Fagg J, Simkin S: Use of paracetamol for suicide and non-fatal poisoning in the UK and France: are restrictions on availability justified?. J Epidemiol Community Health. 1997, 51 (2): 175-179.CrossRefPubMedPubMedCentral
41.
go back to reference Hawton K, Townsend E, Deeks J, Appleby L, Gunnell D, Bennewith O, Cooper J: Effects of legislation restricting pack sizes of paracetamol and salicylate on self poisoning in the United Kingdom: before and after study. BMJ. 2001, 322 (7296): 1203-1207. 10.1136/bmj.322.7296.1203.CrossRefPubMedPubMedCentral Hawton K, Townsend E, Deeks J, Appleby L, Gunnell D, Bennewith O, Cooper J: Effects of legislation restricting pack sizes of paracetamol and salicylate on self poisoning in the United Kingdom: before and after study. BMJ. 2001, 322 (7296): 1203-1207. 10.1136/bmj.322.7296.1203.CrossRefPubMedPubMedCentral
42.
go back to reference Sheen CL, Dillon JF, Bateman DN, Simpson KJ, MacDonald TM: Paracetamol pack size restriction: the impact on paracetamol poisoning and the over-the-counter supply of paracetamol, aspirin and ibuprofen. Pharmacoepidemiol Drug Saf. 2002, 11 (4): 329-331. 10.1002/pds.701.CrossRefPubMed Sheen CL, Dillon JF, Bateman DN, Simpson KJ, MacDonald TM: Paracetamol pack size restriction: the impact on paracetamol poisoning and the over-the-counter supply of paracetamol, aspirin and ibuprofen. Pharmacoepidemiol Drug Saf. 2002, 11 (4): 329-331. 10.1002/pds.701.CrossRefPubMed
43.
go back to reference Sheen CL, Dillon JF, Bateman DN, Simpson KJ, MacDonald TM: Paracetamol-related deaths in Scotland, 1994-2000. Br J Clin Pharmacol. 2002, 54 (4): 430-432. 10.1046/j.1365-2125.2002.t01-1-01671.x.CrossRefPubMedPubMedCentral Sheen CL, Dillon JF, Bateman DN, Simpson KJ, MacDonald TM: Paracetamol-related deaths in Scotland, 1994-2000. Br J Clin Pharmacol. 2002, 54 (4): 430-432. 10.1046/j.1365-2125.2002.t01-1-01671.x.CrossRefPubMedPubMedCentral
44.
go back to reference Thomas MR, Jowett NI: Severity of overdose after restriction of paracetamol availability. Restriction has not reduced admissions with self poisoning. BMJ. 2001, 322 (7285): 554-10.1136/bmj.322.7285.554.CrossRefPubMed Thomas MR, Jowett NI: Severity of overdose after restriction of paracetamol availability. Restriction has not reduced admissions with self poisoning. BMJ. 2001, 322 (7285): 554-10.1136/bmj.322.7285.554.CrossRefPubMed
45.
go back to reference Malchy B, Enns MW, Young TK, Cox BJ: Suicide among Manitoba's aboriginal people, 1988 to 1994. CMAJ. 1997, 156 (8): 1133-1138.PubMedPubMedCentral Malchy B, Enns MW, Young TK, Cox BJ: Suicide among Manitoba's aboriginal people, 1988 to 1994. CMAJ. 1997, 156 (8): 1133-1138.PubMedPubMedCentral
46.
go back to reference Clayer JR, Czechowicz AS: Suicide by aboriginal people in South Australia: comparison with suicide deaths in the total urban and rural populations. Med J Aust. 1991, 154 (10): 683-685.PubMed Clayer JR, Czechowicz AS: Suicide by aboriginal people in South Australia: comparison with suicide deaths in the total urban and rural populations. Med J Aust. 1991, 154 (10): 683-685.PubMed
47.
go back to reference Wilcox HC, Connor KR, Caine ED: Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies . Drug Alcohol Depend. 2004, 76 (Suppl): S11-9. 10.1016/j.drugalcdep.2004.08.003.CrossRefPubMed Wilcox HC, Connor KR, Caine ED: Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies . Drug Alcohol Depend. 2004, 76 (Suppl): S11-9. 10.1016/j.drugalcdep.2004.08.003.CrossRefPubMed
48.
go back to reference LeMier M, Cummings P, West TA: Accuracy of external cause of injury codes reported in Washington State hospital discharge records. Inj Prev. 2001, 7 (4): 334-338. 10.1136/ip.7.4.334.CrossRefPubMedPubMedCentral LeMier M, Cummings P, West TA: Accuracy of external cause of injury codes reported in Washington State hospital discharge records. Inj Prev. 2001, 7 (4): 334-338. 10.1136/ip.7.4.334.CrossRefPubMedPubMedCentral
49.
go back to reference Iribarren C, Sidney S, Jacobs DR, Weisner C: Hospitalization for suicide attempt and completed suicide: epidemiological features in a managed care population. Soc Psychiatry Psychiatr Epidemiol. 2000, 35 (7): 288-296. 10.1007/s001270050241.CrossRefPubMed Iribarren C, Sidney S, Jacobs DR, Weisner C: Hospitalization for suicide attempt and completed suicide: epidemiological features in a managed care population. Soc Psychiatry Psychiatr Epidemiol. 2000, 35 (7): 288-296. 10.1007/s001270050241.CrossRefPubMed
Metadata
Title
Hospitalizations for acetaminophen overdose: a Canadian population-based study from 1995 to 2004
Authors
Robert P Myers
Bing Li
Andrew Fong
Abdel Aziz M Shaheen
Hude Quan
Publication date
01-12-2007
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2007
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-7-143

Other articles of this Issue 1/2007

BMC Public Health 1/2007 Go to the issue