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Substance Use Disorder among Hospitalized Adolescents in North Carolina.
South Med J. 2022 08; 115(8):616-621.SM

Abstract

OBJECTIVES

Individuals who began using alcohol or other drugs before the age of 15 are 7 times more likely to develop a substance use disorder (SUD) in adulthood. This study sought to determine the common characteristics of SUD-related hospitalizations and patterns of discharge diagnoses among adolescents in North Carolina.

METHODS

Using the 2014 State Inpatient Database (SID), discharge records associated with the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes for SUD were identified. Adolescents between the ages of 13 and 19 years were included. SUD and non-SUD groups were compared using the Student t test for continuous variables and the χ2 test for categorical variables. A total of 1.1 million hospital discharges were analyzed. A uniform and standardized coding system called Clinical Classifications Software was used to identify cases. The Clinical Classifications Software collapses the ICD-9-CM codes into 679 clinically meaningful categories. A cluster of 3900 ICD-9-CM procedure codes also was used to identify clinically relevant groups of procedures performed during hospitalization.

RESULTS

An estimated 3276 adolescents associated with SUD were discharged from North Carolina hospitals during the study year. Discharged patients with a SUD spent a total of 21,242 inpatient days, at a cost of $62 million. Among the adolescents with a SUD, 53% were boys, 62% were White, 24% were Black, 8% were Hispanic (8%), and 6% were of other races. Compared with patients without a SUD, those with a SUD had longer mean hospital stays (6.5 days vs 4.7 days; P < 0.0001) and lower mean hospital charge per hospitalization ($18,932 vs 24,532; P < 0.0001). Adolescents with a SUD also were diagnosed primarily as having mood disorders (44.78%), followed by schizophrenia and other psychological disorders, upon discharge. Approximately 37% of the SUD-related discharges occurred in areas, denoted in this study using ZIP code designations, with mean household annual incomes <$38,999. A large proportion of the SUD-related hospitalizations (44%) were billed to Medicaid. Frequently observed diagnoses associated with adolescents with a SUD were mood disorders (45%), schizophrenia (7%), and poisoning by other medications and drugs (4%). In 16% of hospitalized adolescents with a SUD, there were at least 2 procedures performed. There was a statistically significant mean hospital charge difference of $5600 between SUD and non-SUD teens.

CONCLUSIONS

The literature reflects the connection between adolescent use and the propensity for diagnosis with a SUD in adulthood; it is evident that this is a growing public health crisis. This study identified patterns of adolescent substance use that, based on the current literature, are indicative of problematic futures for these individuals. The concerning data and literature identify a significant need to address prevention, treatment, and recovery services for adolescents, not only in North Carolina but throughout the United States. The need for focused interventions, access to care, and funding of substance-specific adolescent education and services is greatly needed to change the trajectory of these adolescents' lives.

Authors+Show Affiliations

From the Health Sciences Program School of Health Sciences, and the Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina, the Department of Research Programs, Fort Belvoir Community Hospital, Department of Defense, Fort Belvoir, Virginia, and the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.From the Health Sciences Program School of Health Sciences, and the Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina, the Department of Research Programs, Fort Belvoir Community Hospital, Department of Defense, Fort Belvoir, Virginia, and the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.From the Health Sciences Program School of Health Sciences, and the Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina, the Department of Research Programs, Fort Belvoir Community Hospital, Department of Defense, Fort Belvoir, Virginia, and the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.From the Health Sciences Program School of Health Sciences, and the Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina, the Department of Research Programs, Fort Belvoir Community Hospital, Department of Defense, Fort Belvoir, Virginia, and the Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

35922048

Citation

Alemu, Brook T., et al. "Substance Use Disorder Among Hospitalized Adolescents in North Carolina." Southern Medical Journal, vol. 115, no. 8, 2022, pp. 616-621.
Alemu BT, Young B, Beydoun HA, et al. Substance Use Disorder among Hospitalized Adolescents in North Carolina. South Med J. 2022;115(8):616-621.
Alemu, B. T., Young, B., Beydoun, H. A., & Olayinka, O. (2022). Substance Use Disorder among Hospitalized Adolescents in North Carolina. Southern Medical Journal, 115(8), 616-621. https://doi.org/10.14423/SMJ.0000000000001426
Alemu BT, et al. Substance Use Disorder Among Hospitalized Adolescents in North Carolina. South Med J. 2022;115(8):616-621. PubMed PMID: 35922048.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Substance Use Disorder among Hospitalized Adolescents in North Carolina. AU - Alemu,Brook T, AU - Young,Beth, AU - Beydoun,Hind A, AU - Olayinka,Olaniyi, PY - 2022/8/3/entrez PY - 2022/8/4/pubmed PY - 2022/8/6/medline SP - 616 EP - 621 JF - Southern medical journal JO - South Med J VL - 115 IS - 8 N2 - OBJECTIVES: Individuals who began using alcohol or other drugs before the age of 15 are 7 times more likely to develop a substance use disorder (SUD) in adulthood. This study sought to determine the common characteristics of SUD-related hospitalizations and patterns of discharge diagnoses among adolescents in North Carolina. METHODS: Using the 2014 State Inpatient Database (SID), discharge records associated with the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes for SUD were identified. Adolescents between the ages of 13 and 19 years were included. SUD and non-SUD groups were compared using the Student t test for continuous variables and the χ2 test for categorical variables. A total of 1.1 million hospital discharges were analyzed. A uniform and standardized coding system called Clinical Classifications Software was used to identify cases. The Clinical Classifications Software collapses the ICD-9-CM codes into 679 clinically meaningful categories. A cluster of 3900 ICD-9-CM procedure codes also was used to identify clinically relevant groups of procedures performed during hospitalization. RESULTS: An estimated 3276 adolescents associated with SUD were discharged from North Carolina hospitals during the study year. Discharged patients with a SUD spent a total of 21,242 inpatient days, at a cost of $62 million. Among the adolescents with a SUD, 53% were boys, 62% were White, 24% were Black, 8% were Hispanic (8%), and 6% were of other races. Compared with patients without a SUD, those with a SUD had longer mean hospital stays (6.5 days vs 4.7 days; P < 0.0001) and lower mean hospital charge per hospitalization ($18,932 vs 24,532; P < 0.0001). Adolescents with a SUD also were diagnosed primarily as having mood disorders (44.78%), followed by schizophrenia and other psychological disorders, upon discharge. Approximately 37% of the SUD-related discharges occurred in areas, denoted in this study using ZIP code designations, with mean household annual incomes <$38,999. A large proportion of the SUD-related hospitalizations (44%) were billed to Medicaid. Frequently observed diagnoses associated with adolescents with a SUD were mood disorders (45%), schizophrenia (7%), and poisoning by other medications and drugs (4%). In 16% of hospitalized adolescents with a SUD, there were at least 2 procedures performed. There was a statistically significant mean hospital charge difference of $5600 between SUD and non-SUD teens. CONCLUSIONS: The literature reflects the connection between adolescent use and the propensity for diagnosis with a SUD in adulthood; it is evident that this is a growing public health crisis. This study identified patterns of adolescent substance use that, based on the current literature, are indicative of problematic futures for these individuals. The concerning data and literature identify a significant need to address prevention, treatment, and recovery services for adolescents, not only in North Carolina but throughout the United States. The need for focused interventions, access to care, and funding of substance-specific adolescent education and services is greatly needed to change the trajectory of these adolescents' lives. SN - 1541-8243 UR - https://www.unboundmedicine.com/medline/citation/35922048/Substance_Use_Disorder_among_Hospitalized_Adolescents_in_North_Carolina_ DB - PRIME DP - Unbound Medicine ER -