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.

Keywords: Disparities; Health Policy; Hospitals; Mortality; Opioids.

Exhibit 1. Mortality Rates Among Hospitalizations for Opioid-Related Primary Diagnoses vs. Among Hospitalizations for other Primary Diagnoses in the United States, 1993–2014

Source: Healthcare Cost and Utilization Project. Notes: Unadjusted nationally representative weighted average in-hospital mortality rate for opioid-driven hospitalizations compared to hospitalizations for other reasons. The “Other Drug/Poison” category comprises all the other hospitalizations with a primary diagnosis in Major Diagnostic Categories 20 (Alcohol/Drug Use or Induced Mental Disorders) and 21 (Injuries, Poison And Toxic Effect of Drugs) outside of opioid-driven hospitalizations. The “All Other” category consists of all other hospitalizations containing all other primary diagnoses.

Exhibit 2. Hospitalizations per 1000 People in the U.S. for Opioid-Related Primary Diagnoses by Type of Opioid-Related Primary Diagnosis, 1993–2014

Sources: Healthcare Cost and Utilization Project, U.S. Census Bureau. Notes: Unadjusted decomposition of the volume of hospitalizations with opioid-related primary diagnoses per 1000 U.S. population by type of opioid-related primary diagnosis: opioid dependence or abuse, opioid poisoning, and heroin poisoning.

Exhibit 3. Volume of Hospitalizations for Opioid Poisoning and Heroin Poisoning by Race, 1993–2014

Source: Healthcare Cost and Utilization Project. Notes: Unadjusted decomposition of the total number of hospitalizations for primary diagnoses of opioid poisoning or heroin poisoning in the U.S., weighted to reflect nationally representative totals.

Exhibit 4. Volume of Hospitalizations for Opioid Poisoning and Heroin Poisoning by Payer, 1993–2014

Source: Healthcare Cost and Utilization Project. Notes: Unadjusted decomposition of the total number of hospitalizations for primary diagnoses of opioid poisoning or heroin poisoning in the U.S., weighted to reflect nationally representative totals.