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. 2018 Oct 5;1(6):e183758.
doi: 10.1001/jamanetworkopen.2018.3758.

Evaluation of Amphetamine-Related Hospitalizations and Associated Clinical Outcomes and Costs in the United States

Tyler N A Winkelman  1   2 , Lindsay K Admon  3   4 , Latasha Jennings  2 , Nathan D Shippee  5 , Caroline R Richardson  4   6 , Gavin Bart  2   7
Affiliations

Evaluation of Amphetamine-Related Hospitalizations and Associated Clinical Outcomes and Costs in the United States

Tyler N A Winkelman et al. JAMA Netw Open. .

Abstract

Importance: Despite indications of increasing amphetamine availability and psychostimulant deaths in the United States, evidence across data sources is mixed, and data on amphetamine-related hospitalizations are lacking.

Objective: To clarify trends in amphetamine-related hospitalizations and their clinical outcomes and costs in the United States.

Design, setting, and participants: This repeated, cross-sectional study used hospital discharge data from the Healthcare Cost and Utilization Project National Inpatient Sample. The nationally representative sample included US adults (n = 1 292 300) who had amphetamine-related hospitalizations between January 1, 2003, and December 31, 2015. Multivariable logistic and Poisson regression models were used to examine in-hospital mortality and length of stay. Analysis of these data was conducted from November 2017 to August 2018.

Exposure: Amphetamine dependence or abuse or amphetamine poisoning.

Main outcomes and measures: Annual hospitalizations, in-hospital mortality, length of stay, transfer to another facility, and costs.

Results: Over the 2003 to 2015 study period, there were 1 292 300 weighted amphetamine-related hospitalizations. Of this population, 541 199 (41.9%) were female and 749 392 (58.1%) were male, with a mean age of 37.5 years (95% CI, 37.4-37.7 years). Amphetamine-related hospitalizations, compared with other hospitalizations, were associated with age younger than 65 years (98.0% vs 58.0%; P < .001), male sex (60.3% [95% CI, 59.7%-60.8%] vs 41.1% [95% CI, 40.9%-41.3%]), Medicaid coverage (51.2% [95% CI, 49.8%-52.7%] vs 17.8% [95% CI, 17.5%-18.1%]), and residence in the western United States (58.5% [95% CI, 55.9%-61.0%] vs 18.9% [95% CI, 18.0%-19.8%]). Amphetamine-related hospitalizations declined between 2005 and 2008, and then increased from 55 447 hospitalizations (95% CI, 44 936-65 959) in 2008 to 206 180 hospitalizations (95% CI, 95% CI, 189 188-223 172) in 2015. Amphetamine-related hospitalizations increased to a greater degree than hospitalizations associated with other substances. Adjusted mean length of stay (5.9 [95% CI, 5.8-6.0] vs 4.7 [95% CI, 4.7-4.8] days; P < .001), transfer to another facility (26.0% [95% CI, 25.3%-26.8%] vs 18.5% [95% CI, 18.3%-18.6%]; P < .001), and mean in-hospital mortality (28.3 [95% CI, 26.2-30.4] vs 21.9 [95% CI, 21.6-22.1] deaths per 1000 hospitalizations; P < .001) were higher for amphetamine-related than other hospitalizations. Annual hospital costs related to amphetamines increased from $436 million (95% CI, $312 million-$559 million) in 2003 to $2.17 billion (95% CI, $1.95 billion-$2.39 billion) by 2015.

Conclusions and relevance: Given that amphetamine-related hospitalizations and costs substantially increased between 2003 and 2015, pharmacologic and nonpharmacologic therapies for amphetamine use disorders and a coordinated public health response are needed to curb these rising rates.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Winkelman reported receiving grants from Hennepin Healthcare during the conduct of the study and being a staff physician at the Hennepin County Adult Detention Center. Dr Bart reported receiving grants from National Institute on Drug Abuse outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Amphetamine-Related Hospitalizations in the United States, 2003 to 2015
Figure 2.
Figure 2.. Amphetamine-Related Hospitalizations by US Census Region, 2003 to 2015
See this image and copyright information in PMC

References

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