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Classifications, re-visits, and mortality for opioid-related hospitalizations in Pennsylvania and their associations with HCV and HIV discharges

Liu, Stephen (2018) Classifications, re-visits, and mortality for opioid-related hospitalizations in Pennsylvania and their associations with HCV and HIV discharges. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Abstract

The opioid epidemic started in 1990s in the USA. Pennsylvania ranks 9th in the nation in the rate of long-acting pain reliever prescriptions. The objective of this dissertation is to (1) classify opioid-related hospitalizations and discharges of consequences of opioid use: HIV and Hepatitis C virus (HCV) among these classes. By HCV, HIV, and urbanicity, (2) we compared re-hospitalization rates, and (3) compared survival length.
We used hospital discharges from the Pennsylvania Health Care Cost Containment Council and included primary and/or secondary discharge codes for opioid-related visits. Cancer-related visits, patients ages ≤8 years, and out-of-state residents were excluded. Latent class analysis (LCA) was performed using sociodemographics, substances, mental disorders, and pregnancy; logistic regression was used to compare HCV and HIV co-discharges among visits by latent class. We used semi-parametric mixed Poisson regression to compare re-hospitalization rates, and used accelerated failure time models to compare survival length, controlling for demographics, mental disorder, and other substance discharges. For these analyses, discharges after the first opioid-related hospitalization during 2000-2010 (opioid cohort) were used.
LCA used 430,569 visits (202,126 individuals) with opioid-related codes during 2000-2014. Of the 5 latent classes (LCs), the LC Pregnant women, OUD had the highest percentage of HCV co-discharges: 5,273 visits (26.3%); Black, OUD, cocaine had the most visits with HIV: 6,490 (6.9%). Of 136,463 patients in the opioid cohort, there was a median of 4 visits per patient; those who died had a median survival of 92 weeks. Those with HCV had a 1.11 times higher re-hospitalization rate compared to non-HCV visits, and shorter survival lengths starting after age 30 years at index opioid visit. Those with HIV had a 1.38 times higher rate and 0.31 the length of survival.
Although screening for HCV and HIV are not uniform for all opioid-related visits, it is important to specifically target pregnancy visits in high risk groups to be screened/treated for these diseases. This study has public health relevance, as higher re-hospitalization rates and shorter time to death in persons with the diseases indicates that increase in opioid-related hospitalizations, increases health issues due to HCV and HIV.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Liu, Stephenstl45@pitt.edustl45
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairTalbott, Evelyneot1@pitt.edueot1
Committee MemberSonger, Thomastjs@pitt.edutjs
Committee MemberWahed, Abduswahed@pitt.eduWahed
Committee MemberKrans, Elizabethkransee@mail.magee.edu
Committee MemberMair, Christinacmair@pitt.educmair
Date: 30 January 2018
Date Type: Publication
Defense Date: 28 November 2017
Approval Date: 30 January 2018
Submission Date: 27 November 2017
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Number of Pages: 152
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Opioid; Hospital; Linked Datasets; Hepatitis C; HIV
Date Deposited: 30 Jan 2018 22:44
Last Modified: 30 Jan 2018 22:44
URI: http://d-scholarship.pitt.edu/id/eprint/33630

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