Sulley Saanie, Ndanga Memory
Health & Biomedical Informatics, National Healthy Start Association, Washington DC, USA.
Health Information Management, Rutgers University, Piscataway, USA.
Cureus. 2020 Nov 3;12(11):e11311. doi: 10.7759/cureus.11311.
Objective To evaluate the trends and relationship of inpatient presentations of Social Determinant of Health (SDOH) with superimposed Opioid Use Disorder (OUD), comparing 2012-2014 (ICD-9) and 2016-2017(ICD-10). Methods We used the Nationwide Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP). We identified OUD among patients with any record of SDOH as the primary or secondary diagnosis using the International Classification of Diseases (ICD)-9/10 codes. A weighted SDOH sample size of 3,002,558 (2.8%) and 1,254,899(1.8%) was included for 2012-2014 and 2016-2017, respectively. The main predictors include census division, race, gender, and covariates, including age, income, disposition, payer, rural-urban classification, and combined SDOH indicator, which was used as a control variable in the regression analysis. The study provides a descriptive analysis of the social determinant of health in relation to OUD. We also evaluated the rate of the presentation by age group and race. Results A sample of 367,960 (12%) and 153,535 (12%) OUD presentations with SDOH indicators were identified for 2012-2014 and 2016-2017, respectively. An increase in housing difficulties between 2016-2017 (45%) as compared to 2012-2014 (20%) was observed. A statistically significant higher odds of presentation among black and other races were observed. There was significant variance in the presentation by region with Middle Atlantic with OR-2.04, 95 C. I (1.98, 2.10) and East North Central with OR-1.94, 95 C. I (1.89, 1.99). Higher admissions were observed for both 2012-2014 and 2016-2017 among patients without any payment method classified as no charge. Statistically significant relationships (p<0.05) were also observed among low income <$54,000 OR-1.01, 95 C. I (0.99, 1.04), Housing OR-1.49, 95 C. I (1.47, 1.52), Primary Support OR-0.93, 95 C. I (0.90, 0.95), Employment OR-1.37, 95 C. I (1.35, 1.39), Psychosocial OR-1.63, 95 C. I (1.59, 1.67), Age group 25-34 OR-15.64, 95 C. I (14.20, 17.22), 35-44 OR-29.07, 95 C. I (26.45, 31.95) in both 2012-2014 and 2016-2017. Conclusion SDOH has a direct impact on inpatient OUD presentations. Socio-economic disparities exist in all census regions, race, sex, and rural-urban demographics. Interventions aimed at reducing the incidence and risk of OUD should focus on specific local dynamics using a multidisciplinary, data-driven quality improvement (QI) approach to address the root cause of presentations effectively. A community-based approach to addressing SDOH through collaboration with care providers could play a substantial role in decreasing length of stay (LOS), cost, and potential readmission among these populations.
目的 评估健康社会决定因素（SDOH）合并阿片类物质使用障碍（OUD）的住院情况趋势及关系，比较2012 - 2014年（ICD - 9）和2016 - 2017年（ICD - 10）。方法 我们使用了医疗成本和利用项目（HCUP）中的全国住院样本（NIS）。我们通过国际疾病分类（ICD）-9/10编码，在有任何SDOH记录的患者中确定OUD作为主要或次要诊断。2012 - 2014年和2016 - 2017年分别纳入加权SDOH样本量3,002,558（2.8%）和1,254,899（1.8%）。主要预测因素包括人口普查区、种族、性别以及协变量，包括年龄、收入、出院情况、支付方、城乡分类和综合SDOH指标，后者在回归分析中用作控制变量。本研究对与OUD相关的健康社会决定因素进行了描述性分析。我们还按年龄组和种族评估了就诊率。结果 2012 - 2014年和2016 - 2017年分别确定了367,960（12%）和153,535（12%）例有SDOH指标的OUD就诊病例。观察到2016 - 2017年住房困难（45%）相较于2012 - 2014年（20%）有所增加。观察到黑人和其他种族的就诊几率在统计学上显著更高。各地区就诊情况存在显著差异，中大西洋地区比值比（OR）为-2.04，95%置信区间（CI）为（1.98，2.10），东中北部地区OR为-1.94，95%CI为（1.89，1.99）。2012 - 2014年和2016 - 2017年，在无任何付费方式分类为免费的患者中观察到较高的入院率。在2012 - 2014年和2016 - 2017年，在低收入<$54,000（OR为-1.01，95%CI为（0.99，1.04））、住房（OR为-1.49，95%CI为（1.47，1.52））、主要支持（OR为-0.93，95%CI为（0.90，0.95））、就业（OR为-1.37，95%CI为（1.35，1.39））、心理社会因素（OR为-1.63，95%CI为（1.59，1.67））、25 - 34岁年龄组（OR为-15.64，95%CI为（14.20，17.22））、35 - 44岁年龄组（OR为-29.07，95%CI为（26.45，31.95））之间也观察到统计学上显著的关系（p<0.05）。结论 SDOH对住院OUD就诊情况有直接影响。在所有人口普查区、种族、性别和城乡人口统计学中都存在社会经济差异。旨在降低OUD发病率和风险的干预措施应采用多学科、数据驱动的质量改进（QI）方法，关注特定的地方动态，以有效解决就诊的根本原因。通过与护理提供者合作以解决SDOH的基于社区的方法，在缩短这些人群的住院时间（LOS）、降低成本和减少潜在再入院方面可能发挥重要作用。
