ArticleFrontiers in public health2026
National trends in drug-related hospitalizations and registered drug-related deaths in Ecuador, 2004-2024: a nationwide serial cross-sectional study.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: 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 This policy was repealed in November 2023.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. Objective: 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. Methods: 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. Results: 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; Conclusion: 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.
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