Comorbidities and Risk of Admission Following an Emergency Department Presentation for an Opioid Overdose, United States, 2014 Open Access

Abstract

Opioid overdoses place considerable burden on U.S. hospitals and emergency departments (ED). This study aimed to assess the demographic and clinical factors associated with admission following an ED presentation for an opioid overdose.  Using data from the 2014 National Emergency Department Sample, a retrospective cohort study was conducted. ED visits were classified according to opioid type (non-heroin opioid or heroin). The main outcome measure was admission or other further care following the ED visit. The cohort contained 147,654 total visits for opioid overdoses. 81,631 (55%) presented due to non- heroin opioid overdoses and 66,023 (45%) presented due to heroin overdoses. Non-heroin opioid overdoses occurred more frequently among older populations, females, in the South, and among Medicare enrollees. Non-heroin opioid overdoses had a greater prevalence of comorbid conditions such as diabetes, hypertension, and chronic obstructive pulmonary disease (COPD). Among heroin overdose visits, 57% of patients also had a diagnosis of a substance-related disorder compared to 43% of non-heroin opioid overdose visits. Among non-heroin opioid overdose visits, 67% of patients had at least one mental health condition compared to 64% of heroin overdose visits. The risk of admission following a non-heroin opioid overdose, when controlling for age, sex, hospital region, and primary insurance payer, was 2.14 times the risk of admission following a heroin overdose (95% CI: 2.01, 2.28). When considering interaction with prevalent comorbidities, the risk of admission varied by condition. Allowing for interaction with substance-related disorders, the relative risk of admission was 2.59 (95%CI: 2.40, 2.80). Among overdoses with at least one mental health condition, the risk of admission was 1.92 greater among non-heroin opioid overdoses than heroin overdoses (95% CI: 1.92, 2.06). The study found that patients who presented at U.S. EDs with a non-heroin opioid overdose differed both demographically and clinically from heroin overdose patients and had a greater risk of admission following the ED visit.    

Table of Contents

Chapter I: Manuscript

A.   Title, Authors, Abstract

 

1

B.   Introduction

 

3

C.   Methods

 

5

D.  Results

 

10

E.   Discussion

 

14

F.   References

 

19

G.  Tables

 

23

H.  Figures

 

27

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	heroin overdose opioid overdose emergency department
Committee Chair / Thesis Advisor	Lash, Timothy L., Emory University
Committee Members	Guy Jr., Gery P., CDC
Partnering Agencies	CDC

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