Jain Akhil, Gandhi Zainab, Desai Rupak, Mansuri Uvesh, Rizvi Bisharah, Alvarez Melissa, Gupta Puneet
Internal Medicine, Mercy Catholic Medical Center, Darby, USA.
Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes Barre, USA.
Cureus. 2022 Mar 6;14(3):e22897. doi: 10.7759/cureus.22897. eCollection 2022 Mar.
Background and objective The use of cannabis through smoking and vaping has increased significantly over the past decade. However, the prevalence of pulmonary circulation disorder (PCD)-related hospitalizations among cannabis users and their outcomes remain poorly understood. In this study, we used a nationally representative sample to assess the prevalence and trends of hospitalization among cannabis users with PCD. Methods The National Inpatient Sample (NIS) datasets (2007-2014) were used to analyze hospitalizations of patients with cannabis user disorder with PCD (C-PCD arm) versus those without PCD (C-non-PCD arm) to ascertain demographics, comorbidities, and in-hospital outcomes including all-cause mortality and healthcare resource utilization. Results A total of 3,307,310 hospitalizations involving cannabis users were reported, of which 20,328 (0.61%) were related to PCD. We noted a 200% relative increase in hospitalizations in the C-PCD arm (linearly increasing from 0.3% to 0.9% from 2007 to 2014, p<0.001). When compared to the C-non-PCD arm, patients in the C-PCD arm tended to be older (mean age: 47 vs. 34 years), predominantly males (65.6% vs. 62.9%), with significantly higher rates of congestive heart failure (CHF, 28.8%), hypertension (HTN, 22%), chronic obstructive pulmonary disease (COPD, 21.5%), deficiency anemia (19.4%), and valvular heart disease (17.7%). The C-PCD arm had a statistically higher proportion of tobacco and amphetamine abusers (p<0.01) while the C-non-PCD arm had more cocaine and alcohol abusers (p<0.01). Urban teaching hospital admissions were more commonly associated with the PCD arm than the non-PCD arm (65.4% vs. 56.9%). In terms of hospital resource utilization, patients in the C-PCD arm had higher median hospital stay (six vs. three days) and more frequent discharges to a skilled nursing facility or home healthcare than the C-non-PCD group. All-cause mortality during hospitalization was found to be much higher in the C-PCD arm than the C-non-PCD arm (4.1% vs. 0.5%, p<0.001). Multivariable analysis revealed a two-fold higher risk for all-cause mortality with an adjusted odds ratio (OR) of 2.17 (95% CI: 1.99-2.36, p<0.001) with PCD. Conclusion The findings of this nationwide study revealed significantly increased rates of hospitalizations among cannabis users with PCD with two times higher odds of all-cause in-hospital mortality. Further prospective studies are warranted in this subgroup of patients to confirm these findings and facilitate the management of these patients.
背景与目的 在过去十年中，通过吸烟和雾化使用大麻的情况显著增加。然而，大麻使用者中与肺循环障碍（PCD）相关的住院率及其后果仍知之甚少。在本研究中，我们使用具有全国代表性的样本评估患有PCD的大麻使用者的住院率和趋势。
方法 使用国家住院样本（NIS）数据集（2007 - 2014年）分析患有PCD的大麻使用者障碍患者（C - PCD组）与未患有PCD的患者（C - non - PCD组）的住院情况，以确定人口统计学、合并症以及包括全因死亡率和医疗资源利用在内的住院结局。
结果 共报告了3307310例涉及大麻使用者的住院病例，其中20328例（0.61%）与PCD相关。我们注意到C - PCD组的住院率相对增加了200%（从2007年到2014年从0.3%线性增加到0.9%，p<0.001）。与C - non - PCD组相比，C - PCD组的患者往往年龄更大（平均年龄：47岁对34岁），男性占主导（65.6%对62.9%），充血性心力衰竭（CHF，28.8%）、高血压（HTN，22%）、慢性阻塞性肺疾病（COPD，21.5%）、缺铁性贫血（19.4%）和瓣膜性心脏病（17.7%）的发生率显著更高。C - PCD组烟草和苯丙胺滥用者的比例在统计学上更高（p<0.01），而C - non - PCD组可卡因和酒精滥用者更多（p<0.01）。城市教学医院的入院病例与PCD组的关联比非PCD组更常见（65.4%对56.9%）。在医院资源利用方面，C - PCD组患者的住院中位时间更长（6天对3天），与C - non - PCD组相比，更频繁地出院到专业护理机构或家庭医疗保健机构。发现C - PCD组住院期间的全因死亡率远高于C - non - PCD组（4.1%对0.5%，p<0.001）。多变量分析显示，PCD导致全因死亡率的风险高出两倍，调整后的优势比（OR）为2.17（95%CI：1.99 - 2.36，p<0.001）。
结论 这项全国性研究的结果显示，患有PCD的大麻使用者的住院率显著增加，全因住院死亡率高出两倍。有必要对这一亚组患者进行进一步的前瞻性研究，以证实这些发现并促进对这些患者的管理。
