Geographic Variations of Intensive Care Unit Admissions with Substance-Related Diagnoses in the United States

BackgroundSubstance use is an important contributor to morbidity, mortality, and healthcare utilization in the United States. While prior research has explored regional differences in substance use and related hospitalizations, the geographic variation in substance-related ICU admissions remains underexplored. We sought to compare the prevalence of ICU admissions involving substance use across geographic divisions and between urban and rural ICUs in the United States.MethodsUsing the national PINC AI Healthcare Database, we performed a retrospective observational study of adult ICU admissions between January 1, 2016 and December 31, 2019 with a substance-related ICD-10 diagnosis. We calculated the proportion of all ICU admissions with diagnoses related to any substance, and separately for alcohol, opioids, and stimulants and compared these across U.S. Census divisions and between urban and rural ICUs.ResultsOut of 4,740,799 ICU admissions, 760,153 (16.0%) included at least one substance-related diagnosis. The highest burden of substance-related diagnoses was observed in the New England, Pacific, and Mountain divisions, where alcohol and opioid-related ICU admissions were most prevalent. Stimulant-related ICU admissions were disproportionately higher in the Pacific division. Urban ICUs generally reported a higher proportion of substance-related admissions compared to rural ICUs, with certain regional exceptions.ConclusionThere are substantial geographic and urban-rural differences in substance-related ICU admissions across the United States. Our findings suggest a need for region-specific strategies to address distinct substance use patterns and reduce the burden on critical care resources.