Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
PLoS One. 2020 Feb 18;15(2):e0229174. doi: 10.1371/journal.pone.0229174. eCollection 2020.
The opioid epidemic is a major public health crisis in the U.S. Contemporary data on opioid use disorder (OUD) related hospitalizations are needed. Our objective was to assess whether OUD hospitalizations and associated mortality are increasing over time and examine the factors associated healthcare utilization and mortality.
We examined the rates of OUD hospitalizations and associated mortality using the U.S. National Inpatient Sample (NIS) data from 1998-2016. Multivariable-adjusted logistic regression assessed the association of demographic, clinical and hospital characteristics with inpatient mortality and healthcare utilization (total hospital charges, discharge to a rehabilitation facility, length of hospital stay) during the index hospitalization for opioid use disorder. We calculated the odds ratio (OR) and 95% confidence intervals (CI). We estimated 781,767 OUD hospitalizations. The rate of OUD hospitalization and associated mortality (/100,000 overall NIS hospitalizations) increased from 59.8 and 1.2 in 1998-2000 to 190.7 and 5.9 in 2015-16, respectively. In the multivariable-adjusted analysis, the following factors were associated with worse outcomes; compared to age <34 years, older age was associated with higher risk of hospital charges above the median and length of stay >3 days, slightly higher risk of discharge to a rehabilitation facility. Higher Deyo-Charlson score was associated with higher hospital charges, length of hospital stay, and inpatient mortality. Women had lower odds of inpatient mortality than men and blacks had lower odds of mortality than whites.
Rising OUD hospitalizations from 1998 to 2016 and increasing associated inpatient mortality are concerning. Certain groups are at higher risk of poor utilization outcomes and inpatient mortality. Resources and healthcare policies need to focus on the high-risk group to reduce mortality and associated utilization.
阿片类药物泛滥在美国是一个主要的公共卫生危机。我们需要当代阿片类药物使用障碍（OUD）相关住院的数据。我们的目的是评估 OUD 住院率和相关死亡率是否随时间增加，并研究与医疗保健利用和死亡率相关的因素。
我们使用美国国家住院患者样本（NIS）数据（1998-2016 年），评估了 OUD 住院率和相关死亡率。多变量调整后的逻辑回归评估了人口统计学、临床和医院特征与阿片类药物使用障碍住院期间的住院死亡率和医疗保健利用（总住院费用、康复设施出院、住院时间）之间的关系。我们计算了比值比（OR）和 95%置信区间（CI）。我们估计了 781,767 例 OUD 住院患者。OUD 住院率和相关死亡率（每 10 万 NIS 住院患者中的发生率）从 1998-2000 年的 59.8 和 1.2 分别增加到 2015-16 年的 190.7 和 5.9。在多变量调整分析中，与年龄<34 岁相比，年龄较大与更高的中位数以上住院费用风险和住院时间>3 天的风险增加相关，与康复设施出院的风险略高相关。Deyo-Charlson 评分较高与住院费用、住院时间和住院死亡率较高相关。女性住院死亡率低于男性，黑人死亡率低于白人。
从 1998 年到 2016 年，OUD 住院率上升，相关住院死亡率上升令人担忧。某些群体在利用效果不佳和住院死亡率方面风险较高。资源和医疗保健政策需要重点关注高风险群体，以降低死亡率和相关利用率。
