National trends in drug-related hospitalizations and registered drug-related deaths in Ecuador, 2004-2024: a nationwide serial cross-sectional study.

Authors

Esteban Ortiz-Prado, Juan S Izquierdo-Condoy, Jorge Vasconez-Gonzalez, María Gabriela Davila

Published in

Frontiers in public health. Volume 14. Pages 1845384. Epub Aug 03, 2026.

Abstract

Ecuador implemented a threshold-based drug possession policy in 2013 to distinguish personal possession from trafficking-related offenses. This policy was repealed in November 2023. Although threshold-based policies are often discussed within public health and harm-reduction frameworks, their effects cannot be inferred from hospitalization data alone.
This study describes national patterns of drug-related hospitalizations and registered drug-related deaths in Ecuador using administrative records from 2004 to 2024. We additionally applied quasi-experimental and trend methods (joinpoint regression, interrupted time-series, and individual-level logistic regression) to explore whether patterns changed in association with the 2013 policy.
We conducted a nationwide serial cross-sectional descriptive analysis of administrative hospital discharge records and registered mortality data from the National Institute of Statistics and Censuses of Ecuador (INEC). Drug-related records were identified using selected ICD-10 categories (F11-F16, F18, F19). Annual hospitalization rates per 100,000 population and registered drug-related deaths were summarized descriptively; Wilson 95% confidence intervals were calculated for proportions. Joinpoint regression characterized trend changes; segmented quasi-Poisson interrupted time-series (ITS) models with a population offset estimated level and slope changes at 2013 (with the November 2023 repeal and the COVID-19 period assessed in sensitivity analyses); and a logistic regression on all hospital discharges (2010-2024) estimated the adjusted odds that a discharge was drug-related before versus after 2013.
Drug-related hospitalization rates increased from 2.479 per 100,000 in 2004 to 7.311 per 100,000 in 2024, with the highest observed rate in 2019 (11.935 per 100,000). A total of 164 registered drug-related deaths were identified during 2004-2024 (151 males, 92.1%; 95% CI 86.9-95.3). F19 remained the most frequent category (107 deaths, 65.2%). In the ITS model, the 2013 implementation was associated with an immediate increase in the hospitalization-rate level [incidence rate ratio (IRR) 2.14; 95% CI 1.22-3.76; p = 0.008], without a significant change in slope. Joinpoint analysis identified rising hospitalization rates [annual percentage change (APC) +11.3% through ~2018] and accelerating mortality from ~2014 (APC +26.8%). In the individual-level analysis, discharges after 2013 had higher adjusted odds of being drug-related (adjusted odds ratio 2.64; 95% CI 2.50-2.79; 2.17 after adjustment for the secular trend).
Administrative records show an increasing recorded hospital burden associated with drug-related disorders in Ecuador. Although the quasi-experimental analyses showed a statistically significant change in level coinciding with 2013, these models lack a control group and cannot establish causality; the estimates remain associational and are vulnerable to secular trends, coding changes, and concurrent events, notably COVID-19.

PMID:
42609346
Bibliographic data and abstract were imported from PubMed on 18 Aug 2026.

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