Nationwide Trends in Hospitalizations and Outcomes of Pulmonary Circulation Disorders Among Patients With Cannabis Use Disorder in the United States

Akhil Jain; Zainab Gandhi; Rupak Desai; Uvesh Mansuri; Bisharah Rizvi; Melissa Alvarez; Puneet Gupta

doi:10.7759/cureus.22897

Nationwide Trends in Hospitalizations and Outcomes of Pulmonary Circulation Disorders Among Patients With Cannabis Use Disorder in the United States

Cureus. 2022 Mar 6;14(3):e22897. doi: 10.7759/cureus.22897. eCollection 2022 Mar.

Authors

Akhil Jain¹, Zainab Gandhi², Rupak Desai³, Uvesh Mansuri⁴, Bisharah Rizvi⁵, Melissa Alvarez⁶, Puneet Gupta⁷

Affiliations

¹ Internal Medicine, Mercy Catholic Medical Center, Darby, USA.
² Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes Barre, USA.
³ Outcomes Research, Independent Researcher, Atlanta, USA.
⁴ Critical Care Medicine, Medstar Good Samaritan Hospital, Baltimore, USA.
⁵ Internal Medicine, Saint Agnes Medical Center, Fresno, USA.
⁶ Cardiology, Danbury Hospital, Danbury, USA.
⁷ Cardiology, Baptist Hospital, Madisonville, USA.

Abstract

Background and objective The use of cannabis through smoking and vaping has increased significantly over the past decade. However, the prevalence of pulmonary circulation disorder (PCD)-related hospitalizations among cannabis users and their outcomes remain poorly understood. In this study, we used a nationally representative sample to assess the prevalence and trends of hospitalization among cannabis users with PCD. Methods The National Inpatient Sample (NIS) datasets (2007-2014) were used to analyze hospitalizations of patients with cannabis user disorder with PCD (C-PCD arm) versus those without PCD (C-non-PCD arm) to ascertain demographics, comorbidities, and in-hospital outcomes including all-cause mortality and healthcare resource utilization. Results A total of 3,307,310 hospitalizations involving cannabis users were reported, of which 20,328 (0.61%) were related to PCD. We noted a 200% relative increase in hospitalizations in the C-PCD arm (linearly increasing from 0.3% to 0.9% from 2007 to 2014, p_trend<0.001). When compared to the C-non-PCD arm, patients in the C-PCD arm tended to be older (mean age: 47 vs. 34 years), predominantly males (65.6% vs. 62.9%), with significantly higher rates of congestive heart failure (CHF, 28.8%), hypertension (HTN, 22%), chronic obstructive pulmonary disease (COPD, 21.5%), deficiency anemia (19.4%), and valvular heart disease (17.7%). The C-PCD arm had a statistically higher proportion of tobacco and amphetamine abusers (p<0.01) while the C-non-PCD arm had more cocaine and alcohol abusers (p<0.01). Urban teaching hospital admissions were more commonly associated with the PCD arm than the non-PCD arm (65.4% vs. 56.9%). In terms of hospital resource utilization, patients in the C-PCD arm had higher median hospital stay (six vs. three days) and more frequent discharges to a skilled nursing facility or home healthcare than the C-non-PCD group. All-cause mortality during hospitalization was found to be much higher in the C-PCD arm than the C-non-PCD arm (4.1% vs. 0.5%, p<0.001). Multivariable analysis revealed a two-fold higher risk for all-cause mortality with an adjusted odds ratio (OR) of 2.17 (95% CI: 1.99-2.36, p<0.001) with PCD. Conclusion The findings of this nationwide study revealed significantly increased rates of hospitalizations among cannabis users with PCD with two times higher odds of all-cause in-hospital mortality. Further prospective studies are warranted in this subgroup of patients to confirm these findings and facilitate the management of these patients.

Keywords: cannabis; in-hospital outcomes; marijuana; pulmonary circulation disorder; pulmonary hypertension.