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(Unpublished)
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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| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| 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: |
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: |
01 Jan 2023 06:15 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/33630 |
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