Background: Limited epidemiological national data are available for anxiolytic, sedative, or hypnotic drug (ASH) use disorder hospitalizations.
Objective: To examine the time-trends in and outcomes of ASH use disorder hospitalizations.
Methods: Rates of ASH use disorder hospitalizations and associated healthcare utilization and mortality were examined using the U.S. National Inpatient Sample data (NIS) from 1998 to 2014. Multivariable-adjusted logistic regression assessed the association of demographic, medical comorbidity (using validated composite score of 17 conditions, the Deyo-Charlson index), and hospital characteristics with healthcare utilization (total hospital charges, length of hospital stay [LOS], and discharge to a non-home setting) and inpatient mortality for hospitalizations with ASH use disorder.
Results: There were an estimated 1,171,673 weighted ASH use disorder hospitalizations. The ASH use disorder hospitalization rates increased 3.12-fold from 96 to 299 per 100,000 NIS hospitalizations from 1998-2000 to 2013-2014. In the same period, associated non-home discharge rate increased 3.33-fold from 12.9 to 43 and in-hospital mortality rate increased 3.17-fold from 0.46 to 1.46 per 100,000 (all p values ≤ .002). In the multivariable-adjusted analyses, older age, black race/ethnicity, Deyo-Charlson index score of 2 or higher, non-private insurance payer, higher income, hospital region, urban setting hospital and a larger hospital bed size, were significantly associated with higher healthcare utilization outcomes and/or mortality. Female sex was associated with higher healthcare utilization outcomes, but lower in-hospital mortality.
Conclusions: This study confirmed the rising ASH use disorder hospitalization burden in the United States. An increasing inpatient mortality and non-home discharge rate for hospitalizations with ASH use disorder are concerning. The identification of modifiable and non-modifiable risk factors associated with outcomes should allow prognostication and designing of interventions to improve outcomes.
Keywords: Anxiolytic; epidemiology; healthcare utilization; hospitalization; hypnotic drug use disorder; mortality; sedative; time-trends.