Mortality Quadrupled Among Opioid-Driven Hospitalizations, Notably Within Lower-Income And Disabled White Populations

Abstract

Hospitals play an important role in caring for patients in the current opioid crisis, but data on the outcomes and composition of opioid-driven hospitalizations in the United States have been lacking. Nationally representative all-payer data for the period 1993–2014 from the National Inpatient Sample were used to compare the mortality rates and composition of hospitalizations with opioid-related primary diagnoses and those of hospitalizations for other drugs and for all other causes. Mortality among opioid-driven hospitalizations increased from 0.43 percent before 2000 to 2.02 percent in 2014, an average increase of 0.12 percentage points per year relative to the mortality of hospitalizations due to other drugs—which was unchanged. While the total volume of opioid-driven hospitalizations remained relatively stable, it shifted from diagnoses mostly involving opioid dependence or abuse to those centered on opioid or heroin poisoning (the latter have higher case fatality rates). After 2000, hospitalizations for opioid/heroin poisoning grew by 0.01 per 1,000 people per year, while hospitalizations for opioid dependence or abuse declined by 0.01 per 1,000 people per year. Patients admitted for opioid/heroin poisoning were more likely to be white, ages 50–64, Medicare beneficiaries with disabilities, and residents of lower-income areas. As the United States combats the opioid epidemic, efforts to help hospitals respond to the increasing severity of opioid intoxication are needed, especially in vulnerable populations.

Assessment of Racial/Ethnic and Income Disparities in the Prescription of Opioids and Other Controlled Medications in California

“…This racial/ethnic and income gradient is consistent with prior research describing the unique concentration of the opioid epidemic in low-income and majority-white areas. 2,3 …”

Prescription Opioids and Labor Market Pains: The Effect of Schedule II Opioids on Labor Force Participation and Unemployment

“…Previous research has shown that adverse labor market conditions may contribute to higher disability rates (Black et al, 2002;Autor and Duggan, 2003;Erceg and Levin, 2014;Hall, 2015). Similarly, as chronic diagnosed pain is by itself grounds for disability, the direction of causation between opioid use and disability may run in either direction (GAO, 2011;Morden et al, 2014;Meara et al, 2016;Buchmueller and Carey, 2017;Song, 2017).…”

National U.S. time-trends in opioid use disorder hospitalizations and associated healthcare utilization and mortality

“…A previous CDC analysis of drug overdose deaths (prescription opioids and heroin were the main causes) using the 2013 and 2014 national data found that age-adjusted mortality rates for Whites, Blacks and Hispanics were 19, 10.5 and 6.7 per 100,000 [3]. In a study of OUD-hospitalization mortality, Whites, ages 50-64, Medicare beneficiaries with disabilities, and residents of lower-income areas were noted to have higher odds of opioid/heroin poisoning [26]. These studies provide one potential reason for higher mortality in Whites and are consistent with our observation of an independent association of White race with higher mortality during OUD-hospitalization, adjusted for age, sex, insurance, income, comorbidity, hospital region (rural/urban) and teaching status, location or bed size.…”