Variability in trends of opioid-related hospital utilization among U.S. Adults, 2016-2021 check

Abstract

Background: Understanding trends in opioid-related hospital utilization is crucial for informing public health policies; however, existing research is often limited in scope and methodology. This study provides national estimates from 2016 to 2021, emphasizing the variability in trends across different opioid categories and subpopulations.

Methods: This study employed a repeated cross-sectional analysis using data from the National Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS). Analyses were performed in two periods: 2016-2019 and 2019-2021 (during the COVID-19 pandemic). Outcomes included rates of opioid-related diagnoses and three types of opioid use disorder-related clinical events: nonfatal opioid overdose, injection drug use-related acute infection, and substance abuse treatment. Further analyses were conducted by opioid category (e.g., heroin and synthetic opioids as a proxy for fentanyl), as well as subgroup analyses based on predefined demographic characteristics, including age, sex, race/ethnicity, socioeconomic status, and geographic location.

Findings: Between 2016 and 2019, in the NIS, there was a significant decrease in the rate of opioid-related diagnoses (relative change: -5.4%, 95% Cl: -9.4 to -1.3), nonfatal opioid overdose (-18.4%, -21.7 to -15.0), and substance abuse treatment (-25.1%, -45.9 to -4.3). Conversely, the rate of injection drug use-related acute infection increased significantly (14.4%, 7.3-21.4). In the NEDS, the rates of these outcomes did not change significantly. Notable variations were observed; for instance, in the NIS, the rate of nonfatal synthetic opioids as a proxy for fentanyl overdose increased by 21.1% (11.6-30.5), and heroin-related adverse event or poisoning increased by 51.8% (16.8-86.8) among adults aged 65-84. Between 2019 and 2021, in both the NIS and NEDS, the rate of nonfatal opioid overdose increased significantly (NIS: 8.1%, 3.5-12.7; NEDS: 24.8%, 11.5-38.0), in the NIS, a significant increase was found in the rate of injection drug use-related acute infection (relative increase: 8.2%, 1.2-15.1), while the rates of the other outcomes did not change significantly. Significant variations were also identified; for example, in the NIS, the rate of nonfatal opioid overdose did not show significant change among females, non-Hispanic whites, and adults with higher socioeconomic status.

Interpretation: The significant variability in opioid-related hospital utilization trends among U.S. adults underscores the need for careful consideration in the design of future policies, especially during crises. Management strategies should be tailored to specific subpopulations, opioid categories, and OUD-related clinical events to maximize success rates.

Funding: Taishan Scholars Program of Shandong Province-Pandeng Taishan Scholars.

Keywords: COVID-19 pandemic; Hospital utilization; Opioid; Pain; Variability.

Fig. 1

Flow chart and analysis framework.

Fig. 2

Opioid-related diagnoses (2016–2021) overall and for subtypes involving opioid categories of adverse event or poisoning in the national Inpatient Sample (A, B) and nationwide emergency department sample (C, D). Note: Panel A. Opioid-related diagnoses overall in National Inpatient Sample, Panel B. Opioid categories of adverse event or poisoning in National Inpatient Sample, Panel C. Opioid-related diagnoses overall in Nationwide Emergency Department Sample, Panel D. Opioid categories of adverse event or poisoning in Nationwide Emergency Department Sample.

Fig. 3

Opioid use disorder-related clinical events (2016–2021) overall and for subtypes in the National Inpatient Sample (A–C) and nationwide emergency department sample (D–F). Note: Panel A. Nonfatal opioid overdose overall and for Subtypes in National Inpatient Sample, Panel B. Injection drug-use related acute infection overall and for Subtypes in National Inpatient Sample, Panel C. Substance abuse treatment overall and for Subtypes in National Inpatient Sample, Panel D. Nonfatal opioid overdose overall and for Subtypes in Nationwide Emergency Department Sample, Panel E. Injection drug-use related acute infection overall and for Subtypes in Nationwide Emergency Department Sample, Panel F. Substance abuse treatment overall and for Subtypes in Nationwide Emergency Department Sample.