Non-fatal drug overdose surveillance using hospital discharge data: a comparison between the Drug Overdose Surveillance and Epidemiology (DOSE) system and the Healthcare Cost and Utilisation Project, 18 states, 2018-2020.

BACKGROUND

The Centers for Disease Control and Prevention's Drug Overdose Surveillance and Epidemiology (DOSE) system captures non-fatal overdose data from health departments' emergency department (ED) and inpatient hospitalisation discharge data; however, these data have not been compared with other established state-level surveillance systems, which may lag by several years depending on the state. This analysis compared non-fatal overdose rates from DOSE discharge data with rates from the Healthcare Cost and Utilization Project (HCUP) in order to compare DOSE data against an established dataset.

METHODS

DOSE discharge data case definitions (ie, International Classification of Diseases, 10th revision, Clinical Modification codes) for non-fatal unintentional/undetermined intent all drug, all opioid-involved, heroin-involved and stimulant-involved overdoses were applied to HCUP's 2018-2020 State Emergency Department Databases (SEDD) and State Inpatient Databases (SID). Quarterly crude rates (per 100 000 population) and rate differences of four overdose categories were calculated for ED and inpatient data sources across 18 states included in DOSE and HCUP datasets for at least 2 consecutive years. Joinpoint regression models examined trends from 2018 through 2020, estimating average quarterly percentage change (AQPC) and 95% CIs.

RESULTS

Quarterly crude rate differences between DOSE ED and SEDD data (across 12 states) and DOSE inpatient and SID data (across 16 states) indicated that 82% and 93% of rates, respectively, were within ±0.5 non-fatal overdoses per 100 000 population of each other. AQPC across states and drug categories were similar between the two data sources for both ED and inpatient data.

DISCUSSION

Non-fatal overdose surveillance through DOSE discharge data may be a valid and timely source for estimating non-fatal overdoses at the state level.