Trends in Hospitalization for Opioid Overdose among Rural Compared to Urban Residents of the United States, 2007-2014
Hospitalizations and deaths due to opioid overdose have increased over the last decades. We used data from the National Inpatient Sample and the American Community Survey to describe trends in hospitalization rates for opioid overdose among rural residents compared with urban residents in the United States from 2007 to 2014. Hospitalization rates for heroin overdose increased in all years and were higher in urban residents compared with rural residents (5.5 per 100,000 in large urban populations vs 2.1 per 100,000 in rural populations in 2014). In contrast, hospitalization rates for prescription opioid overdose were 20% to 30% higher in rural populations compared with large urban populations between 2007 and 2012, before declining in rural populations in 2013 and 2014. The proportion of rural patients admitted for overdose who are cared for in urban hospitals increased from 23.1% in 2007 to 41.2% in 2014. These trends are clinically relevant as rural patients and urban patients may have different discharge needs.
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CONCLUSION
Hospitals can expect to continue to treat patients presenting with opioid overdose. As overdose is likely to suggest either an underlying substance use disorder or a chronic pain condition requiring risky levels of prescribed opioids, there will be a need for treatment models and transition care systems to provide adequate care for these populations both in the acute setting and following hospital discharge. Rates of admission among rural residents declined during the last 2 years of the study period, and rural residents who were hospitalized for opioid overdose were increasingly receiving care in urban hospitals. While factors driving these trends remain to be elucidated, the trends themselves highlight a need to consider the differential challenges facing rural and urban residents who overdose. Access to resources and transportation and other challenges are distinct in urban and rural areas, with rural areas being less likely to have providers in addiction medicine, psychiatry, and pain specialties. Efforts to address these challenges will need to explore models and solutions applicable to differentially resourced hospital and postdischarge settings.
Disclosure
The work reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center-Central Region, and the Health Services Research and Development Service through the Comprehensive Access and Delivery Research and Evaluation Center (HFP 04-149). This manuscript is not under review elsewhere and there is no prior publication or presentation of manuscript contents. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. The authors report no conflict of interest in regards to this study. Data: Available to researchers with VA accreditation. Statistical Code: Available to interested readers by contacting Dr. Ohl. Protocol: Available to interested readers by contacting Dr. Ohl.
