Opioid use disorder among hospitalized adults in North Carolina: Comparative analysis of national and statewide trends

Abstract

Objective: Hospital resource utilization is reported to be higher among patients with opioid use disorder (OUD) compared with those without OUD at national and local levels. However, utilization of healthcare services associated with OUD in North Carolina (NC) has not been adequately characterized. We describe inpatient hospital resource utilization among adults with an OUD—diagnosed in NC and the United States (US). We hypothesize that hospitalized adults with OUD will have longer hospital stays, more frequent use of emergency services, a higher number of diagnoses, and comparable hospital charges compared with hospitalized adults without OUD.

Design: A retrospective cross-sectional study analyzing hospital discharge abstracts included in the 2016 NC State Inpatient Databases (SIDs) and the 2016 National Inpatient Sample (NIS). OUD and non-OUD groups were compared using the Student's t-test for continuous variables and the χ2 test for categorical variables.

Participants: Adults 18 years and older from SID (n = 25,871) and NIS (n = 148,255) databases were included in the analysis.

Main outcome measures: Length of stay (LOS), use of emergency services, discharge diagnosis, and hospital charge among hospitalized adults with OUD.

Results: In NC, patients with OUD were younger (age 18-35), more likely to be white, and more likely to be hospitalized in areas with the lowest median income compared with patients without OUD. Compared to the US, twice as many NC OUD patients were self-payers. Hispanic patients, Medicare beneficiaries, and those in the highest income areas experienced the longest LOS and highest hospital charge. Patients with OUD were more likely to have five or more diagnoses and those with five or more diagnoses had higher LOS and hospital charges. OUD hospitalizations were also associated with more frequent use of emergency services. The most common co-occurring diagnoses were psychoses, substance abuse or dependence, and septicemia or severe sepsis.

Conclusion: High percentages of self-payers and lower-income OUD patients indicate the need for Medicaid eligibility outreach programs in NC. High LOS and hospital charges among Hispanic, Medicare-covered, and high-income OUD patients call for a more detailed examination to identify underlying causes of disproportionate resource utilization in NC hospitals.