Using the Extended Cox Model to Determine Factors Affecting the Length of Hospitalization in Patients with Drug Poisoning
Authors:   Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran, Sabbaghian Tousi Sara , Jabbari Roya ,   Research and Development Office, Food and Drug Administration, Mashhad University of Medical Sciences, Mashhad, Iran., Dadpour Bita ,   Medical Toxicology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran., Roghangaran Khiabani Hosein ,   Food and Drug Administration, Mashhad University of Medical Sciences, Mashhad, Iran., Salari Rosita ,   Food and Drug Administration, Mashhad University of Medical Sciences, Mashhad, Iran., Golpour Parastoo ,   Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
Published: July 2022

Background: Poisoning is a medical emergency, and is considered as a common cause of morbidity and mortality worldwide. In this study, the extended Cox model was used to determine the factors affecting the length of hospitalization in those with drug poisoning. Methods: The sample size included 2408 patients with opioids poisoning referring to the Emergency Department of Imam Reza Hospital in Mashhad, Iran from March 21, 2018 to March 20, 2019. Extended Cox model was fitted to determine the effect of five covariates (age, gender, marital status, type of poisoning, and type of opioids). In survival analysis, the length of hospitalization was considered as a time covariate (T). Patients’ recovery was also regarded as an event. Results: Of 2408 patients, 399 (16.6%) were censored and 2009 (83.4%) were uncensored. The risk of failure in complete recovery from poisoning in males was 1.189 times more compared to females. The risk of failure in complete recovery for the 15-24, 25-44, 45-64, and >65 years age groups were 0.277, 0.241, 0.289, and 0.481 times lower, respectively compared to the <2 years age group. For the married patients, the risk was 0.291 times lower compared to the divorced patients. For those poisoned accidentally, the risk was 0.490 times lower than compared to those poisoned intentionally. For those used methadone, morphine, opium, and tramadol, the risk was 1.195, 1.243, 1.193, and 1.147 times more, respectively compared to those used marijuana. By increasing the time (day) of hospital stay, the risk of failure for the 25-44, 45-64, and >65 years age groups were 1.024, 1.028, and 1.040 times more, respectively compared to the <2 years age group. Moreover, for those poisoned accidentally, the risk was 1.197 times more compared to those poisoned intentionally by the time (day) of hospital stay. Conclusion: The factors affecting the length of hospitalization in those poisoned by drugs are gender, marital status, and type of opioids covariate as time-independent covariate, and age and type of poisoning as time-dependent covariates. Since the complications of drug poisoning impose many costs on the health system, knowledge of these covariates can help take some measures for complete recovery of poisoned patients in a shorter length of hospital stay.