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Drug overdose surveillance using hospital discharge data
Svetla Slavova1, Terry L Bunn2, Jeffery Talbert3
1Kentucky Injury Prevention and Research Center, Lexington, KY ; University of Kentucky, College of Public Health, Department of Biostatistics, Lexington, KY.
Public Health Reports (Washington, D.C. : 1974)
|September 2, 2014
Summary
A broader drug overdose definition (Definition 3) identified nearly 50% more hospitalizations than a narrower one (Definition 1). This enhanced case identification is crucial for accurate drug overdose surveillance and resource allocation.
Area of Science:
- Public Health
- Epidemiology
- Health Informatics
Background:
- Accurate identification of drug overdose hospitalizations is essential for public health surveillance and resource allocation.
- Existing methods for case identification in hospital discharge data vary in sensitivity and specificity.
- Standardized definitions are needed for reliable trend analysis and policy evaluation.
Purpose of the Study:
- To compare the performance of three International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code-based case definitions for identifying drug overdose cases in inpatient hospital discharge data.
- To evaluate the ability of these definitions to classify drug overdoses by intent and specific drug types involved.
Main Methods:
- Comparison of three ICD-9-CM code-based case definitions using Kentucky hospital discharge data from 2000-2011.
- Definition 1: External-cause-of-injury (E-code) matrix.
- Definitions 2 and 3: Injury Surveillance Workgroup on Poisoning (ISW7) recommendations, using principal diagnosis/first E-code (Definition 2) or any diagnosis/E-code (Definition 3).
Main Results:
- Definition 3 identified approximately 50% more drug overdose cases than Definition 1, primarily by including cases with non-overdose principal diagnoses.
- Over 53% of hospitalizations were self-inflicted drug overdoses, with benzodiazepines involved in about 30%.
- The 2011 age-adjusted drug overdose hospitalization rate was 146/100,000 population using Definition 3 versus 107/100,000 using Definition 1.
Conclusions:
- The ISW7 definition utilizing any drug poisoning diagnosis/E-code (Definition 3) offers potentially higher sensitivity for counting drug overdose hospitalizations.
- Standardized definitions are critical for accurate reporting, trend analysis, policy evaluation, and state-to-state comparisons in drug overdose surveillance.
- Adoption of a sensitive and specific definition like Definition 3 can improve public health response to drug overdoses.
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