Hospitalizations, costs and outcomes associated with heroin and prescription opioid overdoses in the United States 2001-12
Hospitalizations, costs and outcomes associated with heroin and prescription opioid overdoses in the United States 2001-12
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DOI：
10.1111/add.13795
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发表时间：
2017-09-01
期刊：
影响因子：
6
通讯作者：
Mukamal, Kenneth J.
中科院分区：
文献类型：
--
作者：
Hsu, Douglas J.;McCarthy, Ellen P.;Mukamal, Kenneth J.
背景和目的尚未描述阿片类药物流行对美国医院的全部负担。我们的目的是估计howheroin（HOD）和处方阿片类药物（POD）过量相关的入院，成本，结果和患者特征从2001年到2012年发生了变化。研究设计：回顾性队列研究，从全国住院患者样本（NIS）中选取住院患者。设置美利坚合众国。参与者18岁或以上的HOD或POD诊断的患者入院。NIS样本包括2001年至2012年的94492438例住院病例。最终未加权的研究样本包括138610例入院（POD：122147和HOD：16463）。主要结果是使用美国人口普查局年度估计的每10万人的入学率。其他结局包括住院患者死亡率、住院时间、累积和平均住院费用以及患者人口统计学资料。所有分析都经过加权，以提供国家估计数。结果在2001年至2012年期间，估计有663 715例POD和HOD入院。HOD入院率每年每10万人增加0.11例[95%置信区间（CI）= 0.04，0.17]，而POD入院率每年每10万人增加1.25例（95% CI = 1.15，1.34）。HOD入院的总住院费用每年增加410万美元（95% CI = 2.7，5.5），POD入院的总住院费用每年增加4600万美元（95% CI = 43.1，48.9），相关的住院费用每年增加超过7亿美元。POD组的调整后死亡率每年适度下降[比值比（OR）= 0.98，95%CI = 0.97，0.99]，HOD死亡率或住院时间无差异。与HOD患者相比，POD患者年龄较大，更有可能是女性，也更有可能是白色。结论：2001年至2012年，美国海洛因和处方阿片类药物过量相关入院率和费用大幅增加。住院人数及其费用的快速和持续增长表明，POD的负担可能会威胁到美国医院的基础设施和财务状况。
Background and aims The full burden of the opioid epidemic on US hospitals has not been described. We aimed to estimate howheroin (HOD) and prescription opioid (POD) overdose-associated admissions, costs, outcomes and patient characteristics have changed from 2001 to 2012. Design Retrospective cohort study of hospital admissions from the National Inpatient Sample (NIS). Setting United States of America. Participants Hospital admissions in patients aged 18 years or older admitted with a diagnosis of HOD or POD. The NIS sample included 94492 438 admissions from 2001 to 2012. The final unweighted study sample included 138 610 admissions (POD: 122 147 and HOD: 16 463). Measurements Primary outcomes were rates of admissions per 100 000 people using US Census Bureau annual estimates. Other outcomes included in-patient mortality, hospital length-of-stay, cumulative and mean hospital costs and patient demographics. All analyses were weighted to provide national estimates. Findings Between 2001 and 2012, an estimated 663 715 POD and HOD admissions occurred nation-wide. HOD admissions increased 0.11 per 100 000 people per year [95% confidence interval (CI) = 0.04, 0.17], while POD admissions increased 1.25 per 100 000 people per year (95% CI = 1.15, 1.34). Total in-patient costs increased by $4.1 million dollars per year (95% CI = 2.7, 5.5) for HOD admissions and by $46.0 million dollars per year (95% CI = 43.1, 48.9) for POD admissions, with an associated increase in hospitalization costs to more than $700 million annually. The adjusted odds of death in the POD group declined modestly per year [odds ratio (OR) = 0.98, 95% CI = 0.97, 0.99], with no difference in HOD mortality or length-of-stay. Patients with POD were older, more likely to be female and more likely to be white compared with HOD patients. Conclusions Rates and costs of heroin and prescription opioid overdose related admissions in the United States increased substantially from 2001 to 2012. The rapid and ongoing rise in both numbers of hospitalizations and their costs suggests that the burden of POD may threaten the infrastructure and finances of US hospitals.