Hospitalizations for alcohol and drug overdoses in young adults ages 18-24 in the United States, 1999-2008: results from the Nationwide Inpatient Sample

Abstract

Objective: Recent reports indicate an increase in rates of hospitalizations for drug overdoses in the United States. The role of alcohol in hospitalizations for drug overdoses remains unclear. Excessive consumption of alcohol and drugs is prevalent in young adults ages 18-24. The present study explores rates and costs of inpatient hospital stays for alcohol overdoses, drug overdoses, and their co-occurrence in young adults ages 18-24 and changes in these rates between 1999 and 2008.

Method: Data from the Nationwide Inpatient Sample were used to estimate numbers, rates, and costs of inpatient hospital stays stemming from alcohol overdoses (and their subcategories, alcohol poisonings and excessive consumption of alcohol), drug overdoses (and their subcategories, drug poisonings and nondependent abuse of drugs), and their co-occurrence in 18- to 24-year-olds.

Results: Hospitalization rates for alcohol overdoses alone increased 25% from 1999 to 2008, reaching 29,412 cases in 2008 at a cost of $266 million. Hospitalization rates for drug overdoses alone increased 55%, totaling 113,907 cases in 2008 at a cost of $737 million. Hospitalization rates for combined alcohol and drug overdoses increased 76%, with 29,202 cases in 2008 at a cost of $198 million.

Conclusions: Rates of hospitalizations for alcohol overdoses, drug overdoses, and their combination all increased from 1999 to 2008 among 18- to 24-year-olds. The cost of such hospitalizations now exceeds $1.2 billion annually. The steepest increase occurred among cases of combined alcohol and drug overdoses. Stronger efforts are needed to educate medical practitioners and the public about the risk of overdoses, particularly when alcohol is combined with other drugs.

Figure 1

Alcohol overdoses. (a) All alcohol overdoses. Rates of hospitalizations increased among 18- to 24-year-olds in the United States between 1999 and 2008 (25%, trend p < .0001) and were higher in men than in women (p < .001). (b) Subcategory: excessive consumption of alcohol. Rates increased over time (25%, trend p = .001) and were higher in men than in women (p < .001). (c) Subcategory: alcohol poisoning. Rates did not increase significantly overtime (31%, trend p = .12) and were higher for men than for women (p < .001). Alcohol poisonings comprised 2% and excessive consumption of alcohol comprised 98% of alcohol overdoses in 2008.

Figure 2

Drug overdoses. (a) All drug overdoses. Rates increased among 18- to 24-year-olds in the United States between 1999 and 2008 (55%, trend p < .0001). Rates were higher (p < .0001) and increased faster over time (p < .01) for women than for men. (b) Subcategory: excessive consumption of drugs. Rates increased over time (79%, trend p < .0001). Rates were similar for women and for men (p > .05) but increased faster over time for women (p < .01). (c) Subcategory: drug poisoning. Rates increased over time (19%, trend p < .05) and were higher for women than for men (p < .0001). Drug poisonings comprised 30% and excessive consumption of drugs comprised 70% of all drug overdoses in 2008.

Figure 3

Combined alcohol and drug overdoses. (a) Rates of hospitalizations for combined alcohol and drug overdoses increased among 18- to 24-year-olds in the United States between 1999 and 2008 (76%, trend p < .0001). Overall rates were higher (p < .0001) and increased faster over time (p < .05) for men than for women. (b) Rates of hospitalizations for excessive consumption of both alcohol and drugs increased (80%, trend p < .0001). Overall rates were higher (p < .0001) and increased faster over time (p < .01) for men than for women. (c) Rates of hospitalizations for combined alcohol poisoning and drug poisoning increased (45%, trend p < .05). No gender differences were observed for combined alcohol poisoning and drug poisoning (p > .05).

Figure 4

Role of alcohol in overdoses on opioid pain medications. (a) Rates of hospitalizations for overdoses (poisonings and excessive consumption) on opioid pain medications and related narcotics increased 122% between 1999 and 2008 (trend p < .0001). No gender differences were noted (p > .05). (b) Alcohol overdoses were involved in approximately 20% of overdoses on opioids and related narcotics. Men were more likely than women to be hospitalized for the co-occurrence of an overdose on opioids and alcohol (p < .0001). Overall, the percentage of overdoses on opioids and related narcotics in which an alcohol overdose co-occurred did not change over the years (trend p > .05).

Figure 5

Overdoses in 18- to 24-year-olds compared with adults ages 25 and older. (a) Overall rates of alcohol overdoses were higher (p < .0001) and increased more steeply over time (p < .001) among subjects ages 25 and older than those 18–24 from 1999 to 2008. (b) Overall rates of drug overdoses were higher in those 18–24 than in those 25 or older (p < .025). (c) Overall rates of combined alcohol and drug overdoses were higher in those ages 25 and older than in those ages 18–24 (p < .05).