Chen Lingxiao, Chen Zhuo, Ding Jiaming, Chou Roger, Ashton-James Claire E, Shi Baoyi, Mathieson Stephanie, Radojčić Maja R, Anderson David B, Zheng Ruiyuan, Fu Runhan, Chen Yujie, Qi Lei, Zhou Hengxing, Feng Shiqing, Ferreira Manuela L
Department of Orthopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Orthopaedics, Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, PR China.
Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, PR China.
EClinicalMedicine. 2025 Jul 12;86:103355. doi: 10.1016/j.eclinm.2025.103355. eCollection 2025 Aug.
Understanding trends in opioid-related hospital utilization is crucial for informing public health policies; however, existing research is often limited in scope and methodology. This study provides national estimates from 2016 to 2021, emphasizing the variability in trends across different opioid categories and subpopulations.
This study employed a repeated cross-sectional analysis using data from the National Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS). Analyses were performed in two periods: 2016-2019 and 2019-2021 (during the COVID-19 pandemic). Outcomes included rates of opioid-related diagnoses and three types of opioid use disorder-related clinical events: nonfatal opioid overdose, injection drug use-related acute infection, and substance abuse treatment. Further analyses were conducted by opioid category (e.g., heroin and synthetic opioids as a proxy for fentanyl), as well as subgroup analyses based on predefined demographic characteristics, including age, sex, race/ethnicity, socioeconomic status, and geographic location.
Between 2016 and 2019, in the NIS, there was a significant decrease in the rate of opioid-related diagnoses (relative change: -5.4%, 95% Cl: -9.4 to -1.3), nonfatal opioid overdose (-18.4%, -21.7 to -15.0), and substance abuse treatment (-25.1%, -45.9 to -4.3). Conversely, the rate of injection drug use-related acute infection increased significantly (14.4%, 7.3-21.4). In the NEDS, the rates of these outcomes did not change significantly. Notable variations were observed; for instance, in the NIS, the rate of nonfatal synthetic opioids as a proxy for fentanyl overdose increased by 21.1% (11.6-30.5), and heroin-related adverse event or poisoning increased by 51.8% (16.8-86.8) among adults aged 65-84. Between 2019 and 2021, in both the NIS and NEDS, the rate of nonfatal opioid overdose increased significantly (NIS: 8.1%, 3.5-12.7; NEDS: 24.8%, 11.5-38.0), in the NIS, a significant increase was found in the rate of injection drug use-related acute infection (relative increase: 8.2%, 1.2-15.1), while the rates of the other outcomes did not change significantly. Significant variations were also identified; for example, in the NIS, the rate of nonfatal opioid overdose did not show significant change among females, non-Hispanic whites, and adults with higher socioeconomic status.
The significant variability in opioid-related hospital utilization trends among U.S. adults underscores the need for careful consideration in the design of future policies, especially during crises. Management strategies should be tailored to specific subpopulations, opioid categories, and OUD-related clinical events to maximize success rates.
Taishan Scholars Program of Shandong Province-Pandeng Taishan Scholars.
了解阿片类药物相关住院利用率的趋势对于制定公共卫生政策至关重要；然而，现有研究在范围和方法上往往存在局限性。本研究提供了2016年至2021年的全国估计数据，强调了不同阿片类药物类别和亚人群中趋势的变异性。
本研究采用重复横断面分析，使用来自国家住院样本（NIS）和全国急诊科样本（NEDS）的数据。分析分两个阶段进行：2016 - 2019年和2019 - 2021年（新冠疫情期间）。结果包括阿片类药物相关诊断率以及三种与阿片类药物使用障碍相关的临床事件：非致命性阿片类药物过量、注射吸毒相关急性感染和药物滥用治疗。进一步按阿片类药物类别（例如，将海洛因和合成阿片类药物作为芬太尼的替代物）进行分析，并基于预先定义的人口统计学特征进行亚组分析，包括年龄、性别、种族/族裔、社会经济地位和地理位置。
在2016年至2019年期间，在国家住院样本中，阿片类药物相关诊断率（相对变化：-5.4%，95%可信区间：-9.4至-1.3）、非致命性阿片类药物过量（-18.4%，-21.7至-15.0）和药物滥用治疗（-25.1%，-45.9至-4.3）均显著下降。相反，注射吸毒相关急性感染率显著上升（14.4%，7.3 - 21.4）。在全国急诊科样本中，这些结果的发生率没有显著变化。观察到显著差异；例如，在国家住院样本中，作为芬太尼替代物的非致命性合成阿片类药物过量率在65 - 84岁成年人中上升了21.1%（11.6 - 30.5），与海洛因相关的不良事件或中毒在该年龄段成年人中上升了51.8%（16.8 - 86.8）。在2019年至2021年期间，在国家住院样本和全国急诊科样本中，非致命性阿片类药物过量率均显著上升（国家住院样本：8.1%，3.5 - 12.7；全国急诊科样本：24.8%，11.5 - 38.0），在国家住院样本中，注射吸毒相关急性感染率显著上升（相对上升：8.2%，1.2 - 15.1），而其他结果的发生率没有显著变化。也发现了显著差异；例如，在国家住院样本中，非致命性阿片类药物过量率在女性、非西班牙裔白人以及社会经济地位较高的成年人中没有显著变化。
美国成年人中阿片类药物相关住院利用率趋势的显著变异性强调了在制定未来政策时，尤其是在危机期间，需要仔细考虑。管理策略应针对特定亚人群、阿片类药物类别以及与阿片类药物使用障碍相关的临床事件进行定制，以最大化成功率。
山东省泰山学者计划 - 攀登泰山学者。
