Jessica A Meisner1,2, Judith Anesi3,4, Xinwei Chen4, David Grande2,4. 1. Department of Medicine, University of Texas-Southwestern Medical Center, Dallas, Texas, USA. 2. Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Philadelphia, Pennsylvania, USA. 3. Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 4. Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Abstract
BACKGROUND: With the current opioid crisis in the United States, infectious complications related to injection drug use are increasingly reported. Pennsylvania is at the epicenter of the opioid crisis, with the third highest rate of drug overdose deaths in the United States. METHODS: A retrospective cohort study was performed using the Pennsylvania Health Care Cost Containment Council database of all residents hospitalized for infective endocarditis (IE) in an acute care hospital from 1 January 2013 through 31 March 2017. Patients were separated into those with and those without substance use via diagnosis codes. The primary outcome was length of stay. Secondarily, we evaluated demographics, infection history, hospital charges, and insurance status. RESULTS: Of the 17 224 hospitalizations, 1921 (11.1%) were in patients with drug use-associated IE (DU-IE). Total quarterly IE admissions increased 20%, with a 6.5% increase in non-drug use-associated IE (non-DU-IE) admissions and a 238% increase in DU-IE admissions. In adjusted models, DU-IE was not associated with significant changes in length of stay (incidence rate ratio, 1.02; 95% confidence interval, .975-1.072; P = .36). Patients with DU-IE were predominantly insured by Medicaid (68.3% vs 13.4% for non-DU-IE), they had higher hospital charges ($86 622 vs $66 802), and they were more likely to leave against medical advice (15.7% vs 1.1%) (all P < .001). CONCLUSIONS: Our study demonstrates an increase in IE admissions, driven by an increase in admissions for DU-IE. The higher charges, proportion of patients on Medicaid, and rates of leaving against medical advice among the DU-IE group shows the downstream effects of the opioid crisis.
BACKGROUND: With the current opioid crisis in the United States, infectious complications related to injection drug use are increasingly reported. Pennsylvania is at the epicenter of the opioid crisis, with the third highest rate of drug overdose deaths in the United States. METHODS: A retrospective cohort study was performed using the Pennsylvania Health Care Cost Containment Council database of all residents hospitalized for infective endocarditis (IE) in an acute care hospital from 1 January 2013 through 31 March 2017. Patients were separated into those with and those without substance use via diagnosis codes. The primary outcome was length of stay. Secondarily, we evaluated demographics, infection history, hospital charges, and insurance status. RESULTS: Of the 17 224 hospitalizations, 1921 (11.1%) were in patients with drug use-associated IE (DU-IE). Total quarterly IE admissions increased 20%, with a 6.5% increase in non-drug use-associated IE (non-DU-IE) admissions and a 238% increase in DU-IE admissions. In adjusted models, DU-IE was not associated with significant changes in length of stay (incidence rate ratio, 1.02; 95% confidence interval, .975-1.072; P = .36). Patients with DU-IE were predominantly insured by Medicaid (68.3% vs 13.4% for non-DU-IE), they had higher hospital charges ($86 622 vs $66 802), and they were more likely to leave against medical advice (15.7% vs 1.1%) (all P < .001). CONCLUSIONS: Our study demonstrates an increase in IE admissions, driven by an increase in admissions for DU-IE. The higher charges, proportion of patients on Medicaid, and rates of leaving against medical advice among the DU-IE group shows the downstream effects of the opioid crisis.
Authors: Laura J Ball; Adeel Sherazi; Dora Laczko; Kaveri Gupta; Sharon Koivu; Matthew A Weir; Tina Mele; Rommel Tirona; John K McCormick; Michael Silverman Journal: Med Care Date: 2018-10 Impact factor: 2.983
Authors: Naveed Zafar Janjua; Nazrul Islam; Margot Kuo; Amanda Yu; Stanley Wong; Zahid A Butt; Mark Gilbert; Jane Buxton; Nuria Chapinal; Hasina Samji; Mei Chong; Maria Alvarez; Jason Wong; Mark W Tyndall; Mel Krajden Journal: Int J Drug Policy Date: 2018-02-23
Authors: Lauren Hartman; Erin Barnes; Laura Bachmann; Katherine Schafer; James Lovato; Daniel Clark Files Journal: Am J Med Sci Date: 2016-08-23 Impact factor: 2.378
Authors: Alysse G Wurcel; Jordan E Anderson; Kenneth K H Chui; Sally Skinner; Tamsin A Knox; David R Snydman; Thomas J Stopka Journal: Open Forum Infect Dis Date: 2016-07-26 Impact factor: 3.835
Authors: Arnar Geirsson; Asher Schranz; Oliver Jawitz; Makoto Mori; Liqi Feng; Brittany A Zwischenberger; Alexander Iribarne; Joseph Dearani; Gregory Rushing; Vinay Badhwar; Juan A Crestanello Journal: Ann Thorac Surg Date: 2020-05-06 Impact factor: 4.330
Authors: Thomas D Brothers; Dan Lewer; Nicola Jones; Samantha Colledge-Frisby; Michael Farrell; Matthew Hickman; Duncan Webster; Andrew Hayward; Louisa Degenhardt Journal: PLoS Med Date: 2022-07-19 Impact factor: 11.613
Authors: Ruchi Bhandari; Talia Alexander; Frank H Annie; Umar Kaleem; Affan Irfan; Sudarshan Balla; R Constance Wiener; Chris Cook; Aravinda Nanjundappa; Mark Bates; Ellen Thompson; Gordon S Smith; Judith Feinberg; Melanie A Fisher Journal: PLoS One Date: 2022-07-15 Impact factor: 3.752
Authors: Joëlla W Adams; Alexandra Savinkina; James C Hudspeth; Mam Jarra Gai; Raagini Jawa; Laura R Marks; Benjamin P Linas; Alison Hill; Jason Flood; Simeon Kimmel; Joshua A Barocas Journal: JAMA Netw Open Date: 2022-02-01
Authors: Michael M Dagher; Emily M Eichenberger; Kateena L Addae-Konadu; Sarah K Dotters-Katz; Celia L Kohler; Vance G Fowler; Jerome J Federspiel Journal: Clin Infect Dis Date: 2021-11-02 Impact factor: 20.999
Authors: Sophia Lewis; Stephen Y Liang; Evan S Schwarz; David B Liss; Rachel P Winograd; Nathanial S Nolan; Michael J Durkin; Laura R Marks Journal: Open Forum Infect Dis Date: 2022-01-06 Impact factor: 3.835