The Effect of Cannabis Use Disorder on Mortality and Other Outcomes in Asthma: A Nationwide Analysis (2016-2021)

Background Asthma, a chronic respiratory disease affecting over 300 million individuals globally, significantly impacts the quality of life and healthcare systems. In recent years, cannabis use disorder (CUD) has emerged as a potential complicating factor. Cannabis, though increasingly legalized and perceived as benign, poses risks to respiratory health. This study explores the relationship between CUD and asthma outcomes, focusing on mortality and morbidity trends from 2016 to 2021 in a nationwide context. Objective The objective of this study is to evaluate the impact of CUD on in-hospital mortality, severe asthma exacerbations, and healthcare resource utilization among patients hospitalized for asthma. Methods A retrospective cohort analysis of nationwide asthma admissions between 2016 and 2021 was conducted using the Nationwide Inpatient Sample database. A total of 552,160 cases were stratified into CUD and non-CUD cases. A logistic regression analysis was used to examine the association between CUD and in-hospital mortality as well as the severity of exacerbations among asthmatic patients. We utilized linear regression models to assess the impact of CUD on total charges and length of stay for asthma admissions, adjusting for demographic and hospital-level confounders. Results Of the 552,160 asthma hospitalizations, 4.2% (N = 23,300) of patients had comorbid CUD. CUD patients were younger (a mean age of 35.3 years compared to 51.4 years in non-CUD patients) and predominantly male. Our study showed the odds of in-hospital mortality were significantly greater in patients with CUD (adjusted OR 2.40, 95% CI 1.62-3.55, p < 0.01). CUD was associated with increased odds of severe asthma exacerbations/status asthmaticus (OR 2.39, 95% CI 1.92-2.99, p <.01). However, the adjusted odds ratio (OR) was attenuated (adjusted OR 1.35, 95% CI 1.07-1.71, p = 0.012). Total hospital charges were significantly higher in the CUD group after adjustment (coefficient 2091.31, 95% CI 660.71-3521.9, p = 0.004). There was no significant difference in length of stay between groups (adjusted coefficient -0.06, 95% CI -0.1-0.06, p = 0.7). Conclusion Patients hospitalized for asthma with CUD are associated with higher mortality, increased risk of severe asthma exacerbations, and higher hospital charges. These findings underline the need for targeted interventions in asthmatic patients with CUD to improve clinical outcomes and reduce healthcare burden.