Epidemiology of Substance-Related Admissions to ICUs in the United States

To determine the prevalence, demographic characteristics, and predictors of in-hospital mortality for substance-related ICU admissions in the United States.

Multicenter, retrospective cohort study.

U.S. ICUs reporting data to the nationally representative Premier Healthcare Database between 2016 and 2019.

Adult ICU admissions with an International Classification of Diseases , 10th Revision diagnosis of a substance-related disorder not in remission.

None.

Among 4,740,799 ICU admissions, a substance-related diagnosis was present in 760,153 (mean age 51.8 yr, 65.5% male, 73.7% White, 74.5% non-Hispanic), representing 16.0% (95% CI, 16.00-16.07%) of all ICU admissions or approximately one of every six ICU admissions. Alcohol was the most common substance associated with ICU admission (8.9% of all encounters; 95% CI, 8.87-8.92%), followed by opioids and stimulants (4.0%; 95% CI, 3.97-4.01% and 2.9%; 95% CI, 2.91-2.94%, respectively). Rates of nearly all substance-related ICU admissions were higher in patients 55-64 years old and in patients who identified as male, non-Hispanic, and "Other" race (not identified as White, Black, or Asian). In comparing White and Black patients, the two largest racial groups within our cohort, opioid-related ICU admission rates were higher in White patients while stimulant-related ICU admission rates were higher in Black patients. Only 6.5% (95% CI, 6.37-6.60%) of opioid-related ICU admissions identified heroin use. In multivariable analysis adjusting for relevant covariates, odds of in-hospital mortality following a substance-related ICU admission were higher for encounters that included alcohol-related diagnoses (adjusted odds ratio [aOR], 1.12; 95% CI, 1.06-1.19), female sex (aOR, 1.07; 95% CI, 1.04-1.09), and non-Hispanic ethnicity (aOR, 1.08; 95% CI, 1.01-1.16).

A substantial burden of substance-related diagnoses exists in patients admitted to ICUs. Alcohol use was most common and associated with increased hospital mortality relative to other substances. Rates of substance-related ICU admission differed by age, sex, race, and ethnicity. These findings may have implications for effective allocation of resources toward addiction-related diagnoses, treatment, and secondary prevention for ICU patients.