Adult Congenital Heart Disease Program, Knight Cardiovascular Institute.
Division of Cardiothoracic Surgery, Department of Surgery.
Am J Cardiol. 2023 Apr 1;192:24-30. doi: 10.1016/j.amjcard.2023.01.008. Epub 2023 Jan 28.
Adults with congenital heart disease (CHD) represent a heterogeneous group with significant long-term health risks. Previous studies have demonstrated a high prevalence of psychiatric disorders among adults with CHD; however, little is known about the frequency of co-morbid substance use disorders (SUDs) in patients with CHD. The Oregon All Payer All Claims (APAC) database for the years 2014 to 2017 was queried for adults aged 18 to 65 years with International Classification of Diseases, Ninth or Tenth Revision codes consistent with CHD. Alcohol and substance use were identified by International Classification of Diseases codes for use or dependence and classified in mutually exclusive categories of none, alcohol only, and other drugs (with or without alcohol). Descriptive statistics were used to characterize prevalence and chi-square tests were used to test for associations between variables. A total of 12,366 adults with CHD were identified. The prevalence of substance use was 15.7%. The prevalence of isolated alcohol use was 3.9%. A total of 19% of patients used tobacco. Insurance type, presence of a concurrent mental health diagnosis, and age were associated with substance use, whereas CHD complexity was not. Cardiovascular co-morbidities were more common in patients with reported substance use. Inpatient and emergency care use were higher in those with SUD. In conclusion, this study of substance and alcohol use among adults with CHD demonstrates high rates of co-morbid SUD, particularly among patients with mental health disorders and Medicaid insurance, associated with increased healthcare utilization. We identify a population in need of targeted interventions to improve long-term health.
患有先天性心脏病 (CHD) 的成年人是一组具有显著长期健康风险的异质群体。先前的研究表明，CHD 成年人中精神障碍的患病率很高；然而，关于 CHD 患者合并物质使用障碍 (SUD) 的频率知之甚少。2014 年至 2017 年，使用国际疾病分类第 9 或 10 版编码符合 CHD 的 18 至 65 岁成年人的俄勒冈州所有支付者所有索赔 (APAC) 数据库进行了查询。通过国际疾病分类编码识别酒精和物质使用情况，用于使用或依赖，并分为无、仅酒精和其他药物（有或没有酒精）相互排斥的类别。使用描述性统计来描述流行率，并使用卡方检验来检验变量之间的关联。共确定了 12366 名患有 CHD 的成年人。物质使用的患病率为 15.7%。孤立性酒精使用的患病率为 3.9%。共有 19%的患者使用烟草。保险类型、同时存在心理健康诊断和年龄与物质使用有关，而 CHD 复杂性则没有。有报告物质使用的患者更常伴有心血管合并症。在有 SUD 的患者中，住院和急诊护理的使用率更高。总之，这项对 CHD 成年人物质和酒精使用的研究表明，共病 SUD 的发生率很高，特别是在患有精神疾病和医疗补助保险的患者中，与增加医疗保健利用有关。我们确定了一个需要针对性干预措施来改善长期健康的人群。
