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Time trends in hospitalizations with anxiolytic, sedative, or hypnotic drug use disorder: a 17-year U.S. national study

Abstract Background Limited epidemiological national data are available for anxiolytic, sedative, or hypnotic drug (ASH) use disorder hospitalizations. Objective To examine the time-trends in and outcomes of ASH use disorder hospitalizations. Methods Rates of ASH use disorder hospitalizations and associated healthcare utilization and mortality were examined using the U.S. National Inpatient Sample data (NIS) from 1998 to 2014. Multivariable-adjusted logistic regression assessed the association of demographic, medical comorbidity (using validated composite score of 17 conditions, the Deyo-Charlson index), and hospital characteristics with healthcare utilization (total hospital charges, length of hospital stay [LOS], and discharge to a non-home setting) and inpatient mortality for hospitalizations with ASH use disorder. Results There were an estimated 1,171,673 weighted ASH use disorder hospitalizations. The ASH use disorder hospitalization rates increased 3.12-fold from 96 to 299 per 100,000 NIS hospitalizations from 1998–2000 to 2013–2014. In the same period, associated non-home discharge rate increased 3.33-fold from 12.9 to 43 and in-hospital mortality rate increased 3.17-fold from 0.46 to 1.46 per 100,000 (all p values ≤ .002). In the multivariable-adjusted analyses, older age, black race/ethnicity, Deyo-Charlson index score of 2 or higher, non-private insurance payer, higher income, hospital region, urban setting hospital and a larger hospital bed size, were significantly associated with higher healthcare utilization outcomes and/or mortality. Female sex was associated with higher healthcare utilization outcomes, but lower in-hospital mortality. Conclusions This study confirmed the rising ASH use disorder hospitalization burden in the United States. An increasing inpatient mortality and non-home discharge rate for hospitalizations with ASH use disorder are concerning. The identification of modifiable and non-modifiable risk factors associated with outcomes should allow prognostication and designing of interventions to improve outcomes.