National Trends and Factors Associated With Inpatient Mortality in Adult Patients With Opioid Overdose

Brittany N. Burton, MHS, MAS; Timothy C. Lin, MAS; Engy T. Said, MD; Rodney A. Gabriel, MD, MAS


Anesth Analg. 2019;128(1):152-160. 

In This Article

Abstract and Introduction


Background: The prevalence of opioid misuse and opioid-related mortality has increased dramatically over the past decade. There is limited evidence on factors associated with mortality from opioid overdose in the inpatient setting. The primary objective was to report national trends in opioid overdose and mortality. The secondary objectives were to explore factors associated with inpatient mortality and report differences in prescription opioid overdose (POD) versus illicit opioid overdose (IOD) cohorts.

Methods: Using the 2010–2014 Nationwide Inpatient Sample, we performed a cross-sectional analysis and identified a weighted estimate of 570,987 adult patients with an International Classification of Disease, Ninth Revision, or External Cause of Injury code of POD or IOD. We performed multivariable logistic regression to identify predictors of inpatient mortality. The odds ratio (OR) and their associated 95% confidence interval (CI) are reported.

Results: Of the 570,987 patients with opioid overdose, 13.8% had an admissions diagnosis of IOD, and the remaining had POD. Among all opioid overdose admissions, the adjusted odds of IOD admissions increased by 31% per year (OR, 1.31; 95% CI, 1.29–1.31; P < .001); however, the adjusted odds POD admissions decreased by 24% per year (OR, 0.76; 95% CI, 0.75–0.77; P < .001). The mortality was 4.7% and 2.3% among IOD and POD admissions, respectively. The odds of inpatient mortality increased by 8% per year among IOD admissions (OR, 1.08; 95% CI, 1.02–1.14; P < .007). The odds of inpatient mortality increased by 6% per year among all POD admissions (OR, 1.06; 95% CI, 1.03–1.09; P < .001). Those with IOD compared to POD had higher odds of mortality (OR, 2.03; 95% CI, 1.79–2.29; P < .001). Patients with age ≥80 years of age and those with a diagnosis of a solid tumor malignancy had higher odds of mortality. Odds of inpatient mortality were decreased in African American versus Caucasian patients and in patients undergoing alcohol rehabilitation therapy.

Conclusions: The increase in mortality provides a strong basis for further risk reduction strategies and intervention program implementation. Medical management of not only the opioid overdose but also the comorbidities calls for a multidisciplinary approach that involves policy makers and health care teams.


Death due to opioid overdose has increased dramatically over the past decade. The Centers for Disease Control estimates that 115 Americans die daily of an opioid overdose.[1] Recent data from the Centers for Disease Control suggest that among those 18–44 years of age, unintentional injuries are the leading cause of death, specifically due to unintentional poisoning.[2] The surge in opioid overdose–related deaths began in 1999, and by 2012, opioid overdose–related deaths more than tripled from prescription medications.[3] In the United States, prescription opioid abuse is associated with a $9.5 billion public health burden.[4] During 2015, 63.1% of drug overdose deaths were due to opioids, and more recently, research suggests that the opioid epidemic is driven by widespread illicit (ie, heroin and synthetic opioids) opioid use.[1] Furthermore, there was a 62.5% increase in heroin use in from 2002 to 2013.[5]

Despite the rapid increase in opioid-related deaths, there are limited studies outlining the factors associated with mortality of patients with opioid overdose in the hospital setting. While many studies report findings of a national population–based sample, these studies only evaluate trends in either opioid overdose–related hospitalization rates or mortality. For example, in their evaluation of disparities in opioid overdose, Unick and Ciccarone[6] found that there were racial/ethnic and geographical differences in rates of prescription and heroin-related hospitalizations.[6] Similarly, Hsu et al[7] also used a national database to evaluate rates of hospital admission and inpatient mortality in patients with opioid overdose. The primary objective was to report national trends in opioid overdose and mortality using a large national database. The secondary objectives were to report factors associated with inpatient mortality and explore unadjusted differences in medical history in patients admitted with prescription opioid overdose (POD) or illicit opioid overdose (IOD).