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Hospitalizations, costs and outcomes associated with heroin and prescription opioid overdoses in the United States 2001-12.
Addiction. 2017 Sep; 112(9):1558-1564.A

Abstract

BACKGROUND AND AIMS

The full burden of the opioid epidemic on US hospitals has not been described. We aimed to estimate how heroin (HOD) and prescription opioid (POD) overdose-associated admissions, costs, outcomes and patient characteristics have changed from 2001 to 2012.

DESIGN

Retrospective cohort study of hospital admissions from the National Inpatient Sample (NIS).

SETTING

United States of America.

PARTICIPANTS

Hospital admissions in patients aged 18 years or older admitted with a diagnosis of HOD or POD. The NIS sample included 94 492 438 admissions from 2001 to 2012. The final unweighted study sample included 138 610 admissions (POD: 122 147 and HOD: 16 463).

MEASUREMENTS

Primary outcomes were rates of admissions per 100 000 people using US Census Bureau annual estimates. Other outcomes included in-patient mortality, hospital length-of-stay, cumulative and mean hospital costs and patient demographics. All analyses were weighted to provide national estimates.

FINDINGS

Between 2001 and 2012, an estimated 663 715 POD and HOD admissions occurred nation-wide. HOD admissions increased 0.11 per 100 000 people per year [95% confidence interval (CI) = 0.04, 0.17], while POD admissions increased 1.25 per 100 000 people per year (95% CI = 1.15, 1.34). Total in-patient costs increased by $4.1 million dollars per year (95% CI = 2.7, 5.5) for HOD admissions and by $46.0 million dollars per year (95% CI = 43.1, 48.9) for POD admissions, with an associated increase in hospitalization costs to more than $700 million annually. The adjusted odds of death in the POD group declined modestly per year [odds ratio (OR) = 0.98, 95% CI = 0.97, 0.99], with no difference in HOD mortality or length-of-stay. Patients with POD were older, more likely to be female and more likely to be white compared with HOD patients.

CONCLUSIONS

Rates and costs of heroin and prescription opioid overdose related admissions in the United States increased substantially from 2001 to 2012. The rapid and ongoing rise in both numbers of hospitalizations and their costs suggests that the burden of POD may threaten the infrastructure and finances of US hospitals.

Authors+Show Affiliations

Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28191702

Citation

Hsu, Douglas J., et al. "Hospitalizations, Costs and Outcomes Associated With Heroin and Prescription Opioid Overdoses in the United States 2001-12." Addiction (Abingdon, England), vol. 112, no. 9, 2017, pp. 1558-1564.
Hsu DJ, McCarthy EP, Stevens JP, et al. Hospitalizations, costs and outcomes associated with heroin and prescription opioid overdoses in the United States 2001-12. Addiction. 2017;112(9):1558-1564.
Hsu, D. J., McCarthy, E. P., Stevens, J. P., & Mukamal, K. J. (2017). Hospitalizations, costs and outcomes associated with heroin and prescription opioid overdoses in the United States 2001-12. Addiction (Abingdon, England), 112(9), 1558-1564. https://doi.org/10.1111/add.13795
Hsu DJ, et al. Hospitalizations, Costs and Outcomes Associated With Heroin and Prescription Opioid Overdoses in the United States 2001-12. Addiction. 2017;112(9):1558-1564. PubMed PMID: 28191702.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospitalizations, costs and outcomes associated with heroin and prescription opioid overdoses in the United States 2001-12. AU - Hsu,Douglas J, AU - McCarthy,Ellen P, AU - Stevens,Jennifer P, AU - Mukamal,Kenneth J, Y1 - 2017/03/16/ PY - 2016/06/01/received PY - 2016/09/13/revised PY - 2017/02/08/accepted PY - 2017/2/14/pubmed PY - 2018/5/19/medline PY - 2017/2/14/entrez KW - Admission KW - heroin KW - hospitalization KW - inpatient KW - overdose KW - prescription opioid SP - 1558 EP - 1564 JF - Addiction (Abingdon, England) JO - Addiction VL - 112 IS - 9 N2 - BACKGROUND AND AIMS: The full burden of the opioid epidemic on US hospitals has not been described. We aimed to estimate how heroin (HOD) and prescription opioid (POD) overdose-associated admissions, costs, outcomes and patient characteristics have changed from 2001 to 2012. DESIGN: Retrospective cohort study of hospital admissions from the National Inpatient Sample (NIS). SETTING: United States of America. PARTICIPANTS: Hospital admissions in patients aged 18 years or older admitted with a diagnosis of HOD or POD. The NIS sample included 94 492 438 admissions from 2001 to 2012. The final unweighted study sample included 138 610 admissions (POD: 122 147 and HOD: 16 463). MEASUREMENTS: Primary outcomes were rates of admissions per 100 000 people using US Census Bureau annual estimates. Other outcomes included in-patient mortality, hospital length-of-stay, cumulative and mean hospital costs and patient demographics. All analyses were weighted to provide national estimates. FINDINGS: Between 2001 and 2012, an estimated 663 715 POD and HOD admissions occurred nation-wide. HOD admissions increased 0.11 per 100 000 people per year [95% confidence interval (CI) = 0.04, 0.17], while POD admissions increased 1.25 per 100 000 people per year (95% CI = 1.15, 1.34). Total in-patient costs increased by $4.1 million dollars per year (95% CI = 2.7, 5.5) for HOD admissions and by $46.0 million dollars per year (95% CI = 43.1, 48.9) for POD admissions, with an associated increase in hospitalization costs to more than $700 million annually. The adjusted odds of death in the POD group declined modestly per year [odds ratio (OR) = 0.98, 95% CI = 0.97, 0.99], with no difference in HOD mortality or length-of-stay. Patients with POD were older, more likely to be female and more likely to be white compared with HOD patients. CONCLUSIONS: Rates and costs of heroin and prescription opioid overdose related admissions in the United States increased substantially from 2001 to 2012. The rapid and ongoing rise in both numbers of hospitalizations and their costs suggests that the burden of POD may threaten the infrastructure and finances of US hospitals. SN - 1360-0443 UR - https://www.unboundmedicine.com/medline/citation/28191702/Hospitalizations_costs_and_outcomes_associated_with_heroin_and_prescription_opioid_overdoses_in_the_United_States_2001_12_ L2 - https://doi.org/10.1111/add.13795 DB - PRIME DP - Unbound Medicine ER -