Spencer Merianne R, Flagg Lee A, Jackson Geoff, DeFrances Carol, Hedegaard Holly
Natl Health Stat Report. 2020 Jun(141):1-19.
Objective-This report demonstrates the utility of linking the restricted-use 2014 National Hospital Care Survey (NHCS), 2014-2015 National Death Index (NDI), and 2014-2015 Drug-Involved Mortality (DIM) data to study opioid-involved emergency department (ED) visits, hospitalizations, and mortality within 1 year post-discharge. Example research questions and unweighted results are presented. Results are not nationally representative. Methods-Patient records from the 2014 NHCS with sufficient identifying information were linked to the 2014-2015 NDI and DIM data. Visits were considered opioid-involved if they had International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes 304.00-304.02, 304.70-304.72, 305.50-305.52, 760.72, 965.00-965.02, 965.09, 970.1, or E850.0-E850.2 in any diagnosis or external cause of injury code field. Opioid-involved drug overdose deaths were deaths with an International Classification of Diseases, 10th Revision (ICD-10) underlying cause-of-death code of X40-44, X60-64, X85, or Y10-Y14 and a multiple cause code of T40.0-T40.4 or T40.6. Results-In the 2014 NHCS, there were 15,495 patients with an opioid-involved ED-only visit and 24,059 patients with an opioid-involved hospitalization. Of the 20,962 patients with an opioid-involved hospitalization eligible to be linked to NDI, 1,805 died (9%) within 1 year of discharge. Of these deaths, 341 (19%) resulted from a drug overdose. Of drug overdose deaths, 243 (71%) involved an opioid, where 12% died within 30 days post-discharge, 19% within 31-90 days, and 69% within 91-365 days. Opioids most frequently mentioned included heroin (46%), fentanyl (20%), oxycodone (13%), methadone (12%), and morphine (12%). These categories are not mutually exclusive because a death may involve more than one drug. For approximately 22% of patients who died of an opioid-involved drug overdose in 2014, their last ED-only visit or hospitalization was opioid-involved. Conclusion-While the NHCS data are not nationally representative, these unlinked and linked National Center for Health Statistics data allow for exploratory analyses of ED visits, hospitalizations, and associated mortality outcomes.
目的——本报告展示了将受限使用的2014年全国医院护理调查（NHCS）、2014 - 2015年全国死亡指数（NDI）以及2014 - 2015年药物相关死亡率（DIM）数据相链接，以研究出院后1年内涉及阿片类药物的急诊科（ED）就诊、住院情况及死亡率的效用。文中给出了示例研究问题及未加权结果。结果不具有全国代表性。方法——将2014年NHCS中具有足够识别信息的患者记录与2014 - 2015年NDI和DIM数据相链接。若就诊在任何诊断或损伤外部原因编码字段中具有国际疾病分类第九版临床修订本（ICD - 9 - CM）诊断代码304.00 - 304.02、304.70 - 304.72、305.50 - 305.52、760.72、965.00 - 965.02、965.09、970.1或E850.0 - E850.2，则被视为涉及阿片类药物。涉及阿片类药物的药物过量死亡是指国际疾病分类第十版（ICD - 10）根本死因编码为X40 - 44、X60 - 64、X85或Y10 - Y14且多重死因编码为T40.0 - T40.4或T40.6的死亡。结果——在2014年NHCS中，有15495例患者仅因涉及阿片类药物而到急诊科就诊，24059例患者因涉及阿片类药物而住院。在20962例因涉及阿片类药物而住院且符合与NDI相链接条件的患者中，1805例（9%）在出院后1年内死亡。在这些死亡病例中，341例（19%）死于药物过量。在药物过量死亡病例中，243例（71%）涉及阿片类药物，其中12%在出院后30天内死亡，19%在31 - 90天内死亡，69%在91 - 365天内死亡。最常提及的阿片类药物包括海洛因（46%）、芬太尼（20%）、羟考酮（13%）、美沙酮（12%）和吗啡（12%）。这些类别并非相互排斥，因为一次死亡可能涉及不止一种药物。在2014年死于涉及阿片类药物的药物过量的患者中，约22%的患者最后一次仅到急诊科就诊或住院是涉及阿片类药物的。结论——虽然NHCS数据不具有全国代表性，但这些未链接和已链接的国家卫生统计中心数据允许对急诊科就诊、住院情况及相关死亡结局进行探索性分析。
