Region-Wise Distribution of Schizophrenia With Cannabis Abuse and Medication Non-Compliance in the United States: A Nationwide Analysis of 51,975 Hospitalizations

Abstract

To understand the region-wise differences in demographics, comorbid substance abuse, and hospital outcomes in adult schizophrenia inpatients with cannabis abuse and medication non-compliance. MethodsWe included 51,975 adults (18-65 years) from the Nationwide Inpatient Sample (2012 to 2014) with a primary diagnosis of schizophrenia and comorbid diagnosis of cannabis abuse and medication non-compliance. We used descriptive statistics and linear-by-linear association to evaluate the region-wise differences in demographics and comorbid substance abuse. Analysis of variance was used for continuous variables such as length of stay (LOS) and total charges during hospitalization to measure the differences across the regions. ResultsOur study inpatients were from the United States regions: northeast ([NE] 30.4%), midwest ([MW] 24.3%), south (27.3%), and west (18%). A higher proportion of young adults (age: 18-35 years; overall total: 62.4%) were from the south (65.1%) and the NE (64.3%) regions. The study population comprised majorly of males in all the regions, ranging from 78.6% to 82.2% (overall total: 80.5%). The west region comprised majorly of whites (42.6%), whereas all other regions majorly had blacks, with the highest seen in the MW (63.2%) and south (63%) regions. The most prevalent comorbid substances in the study inpatients were tobacco (46.3%) and alcohol (32.3%). The mean LOS and total charges for the hospitalization were much higher in the NE region (LOS: 15.8 days; total charges: $44,336). ConclusionCannabis abuse and medication non-compliance in schizophrenia patients were prevalent in the NE region of the United States and in the overall regions, and affects young adults, males, and Blacks from low-income families. This is associated with higher hospitalization stay and cost, which indirectly increase the healthcare burden.

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“…Psychoses occur 2 years earlier, on average, in daily cannabis users than in peers with psychotic illnesses who have not used cannabis [53]. Prospective studies show that young people with a psychotic illness who continue to use cannabis are hospitalized more often and function more poorly than peers with the illness who either did not use cannabis, or who ceased using cannabis after diagnosis [54,55]. Double-blind challenge studies show that the intravenous administration of tetrahydrocannabinol produces psychotic symptoms in people with this illness, and there are case reports of psychoses in individuals who use highly potent synthetic cannabinoid agonists [52].…”

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“…Cannabis use is also common in people with schizophrenia, with an estimated prevalence rate of about 26% [11]. In addition to the observation that cannabis abuse is associated with medication nonadherence [12], catatonia has also been reported [13 & ] which can cause substantial diagnostic confusion with psychomotor signs that range from stupor to agitation [14 && ], and is considered a neurological emergency [15]. Some of the biological research regarding the effects of cannabis on the brain in psychotic patients has focused on the role of IL-6, an inflammatory cytokine [16 && ].…”