Shen Chan, Thornton James Douglas, Li Ning, Zhou Shouhao, Wang Li, Leslie Douglas L, Kawasaki Sarah S
Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
Subst Use. 2024 Jan 10;18:11782218231222343. doi: 10.1177/11782218231222343. eCollection 2024 Jan-Dec.
The COVID-19 pandemic placed extreme burden on hospitals, while opioid overdose is another challenging public health issue. This study aimed to examine the trends and outcomes of opioid overdose hospitalizations in Pennsylvania during 2018 to 2021.
We identified opioid overdose hospitalizations in the state of Pennsylvania using the state-wide hospital discharge database (PHC4) 2018 to 2021. We examined the number of opioid overdose hospitalizations, the corresponding mortality and discharges against medical advice comparing the pre-COVID period (2018-2019) and the COVID period (2020-2021). We also assessed what patient and hospital characteristics were associated with in-hospital death or leaving against medical advice.
A total of 13 446 opioid-related hospitalizations were identified in 2018 to 2021. Compared to pre-pandemic, a higher percentage of cases involving synthetics (17.0%vs 10.3%, < .0001) were observed during COVID. After controlling for covariates, there was no significant difference in opioid overdose in-hospital deaths in the years 2020 to 2021 compared to 2018 to 2019 (OR = 0.846, 95% CI: 0.71-1.01, = .065). The COVID period was significantly associated with more leaving against medical advice compared to years 2018 to 2019 (OR = 1.265, 95% CI: 1.11-1.44, = .0003). Compared to commercial insurance, Medicaid insurance was associated with higher odds of both in-hospital death (OR = 1.383, 95% CI: 1.06-1.81, = .0176) and leaving against medical advice (OR = 1.903, 95% CI: 1.56-2.33, < .0001).
There were no substantial changes in the number of overall opioid overdose cases and deaths at hospitals following the outbreak of COVID-19 in Pennsylvania. This observation suggests that an increased number of patients may have succumbed to overdoses outside of hospital settings, possibly due to a higher severity of overdoses. Further, we found that patients were more likely to leave against medical advice during the COVID-19 pandemic.
新冠疫情给医院带来了极大负担，而阿片类药物过量使用是另一个具有挑战性的公共卫生问题。本研究旨在调查2018年至2021年宾夕法尼亚州阿片类药物过量使用住院治疗的趋势和结果。
我们使用2018年至2021年全州医院出院数据库（PHC4）确定了宾夕法尼亚州阿片类药物过量使用的住院病例。我们比较了新冠疫情前时期（2018 - 2019年）和新冠疫情时期（2020 - 2021年）阿片类药物过量使用的住院人数、相应的死亡率以及违反医嘱出院的情况。我们还评估了哪些患者和医院特征与院内死亡或违反医嘱出院有关。
2018年至2021年共确定了13446例与阿片类药物相关的住院病例。与疫情前相比，在新冠疫情期间观察到涉及合成阿片类药物的病例百分比更高（17.0%对10.3%，P <.0001）。在控制协变量后，2020年至2021年阿片类药物过量使用的院内死亡人数与2018年至2019年相比无显著差异（OR = 0.846，95%CI：0.71 - 1.01，P = 0.065）。与2018年至2019年相比，新冠疫情期间违反医嘱出院的情况显著增加（OR = 1.265，95%CI：1.11 - 1.44，P = 0.0003）。与商业保险相比，医疗补助保险与院内死亡（OR = 1.383，95%CI：1.06 - 1.81，P = 0.0176）和违反医嘱出院（OR = 1.903，95%CI：1.56 - 2.33，P <.0001）的较高几率相关。
宾夕法尼亚州新冠疫情爆发后，医院总体阿片类药物过量使用病例数和死亡人数没有实质性变化。这一观察结果表明，可能由于过量使用的严重程度增加，更多患者可能在院外死于过量使用。此外，我们发现患者在新冠疫情期间更有可能违反医嘱出院。
