Trends in Substance-Related Visits Among Youth to US Children's Hospitals, 2016-2021: An Analysis of the Pediatric Health Information System Database

J Adolesc Health. 2024 Jul;75(1):76-84. doi: 10.1016/j.jadohealth.2024.02.016. Epub 2024 Mar 25.


Purpose: This study evaluates recent trends in substance-related visits among youth visiting children's hospitals.

Methods: We conducted a cross-sectional study of substance-related visits to pediatric hospitals within the Pediatric Health Information System database of youth aged 12-21 years from 2016 through 2021. Substance-related visits were defined as acute visits for International Classification of Diseases, 10th Revision Clinical Modification codes related to substance 'use', dependence, or overdoses for alcohol, cannabis, nicotine, opioids, sedatives, stimulants, hallucinogens, or other substances. Cumulative growth rate and stratified substance-related trends were calculated using generalized estimating equations. Predicted number of visits during the COVID-19 pandemic was generated using an auto-regressive time series analysis.

Results: There were 106,793 substance-related visits involving 84,632 youth. From 2016 to 2021, substance-related visits increased by 47.9% and increased across all ages, demographics, regions, and payors. Visits of Hispanic youth experienced the greatest percentage growth (63.3%, p < .05) when compared to Non-Hispanic (NH) White (46.2%) or NH Black (49.8%) youth. All substances except sedatives experienced an increase in growth in visits. Cannabis accounted for the largest percentage of visits (52.2%) and experienced the greatest percentage growth during the study period (82.4%, p < .001). During the pandemic, publicly insured, female, NH Black, and Hispanic youth experienced a greater-than-predicted number of substance-related visits.

Discussion: Substance-related visits to children's hospitals are increasing for all demographics and nearly all substances. There were substantial increases in visits for most minoritized youth with a disproportionate rise among Hispanic youth. Visits over the pandemic were concentrated among publicly insured, female, NH Black, and Hispanic youth. Equitable large-scale investment is needed to address the rising morbidity of substance use among adolescents.

Keywords: Adolescence; Alcohol; Cannabis; Drugs; Nicotine; Opioids; Overdoses; Substance use; Substance use disorders; Youth.

MeSH terms

  • Adolescent
  • COVID-19* / epidemiology
  • Child
  • Cross-Sectional Studies
  • Databases, Factual
  • Female
  • Hospitals, Pediatric*
  • Humans
  • Male
  • SARS-CoV-2
  • Substance-Related Disorders* / epidemiology
  • United States / epidemiology
  • Young Adult