Development of an Indicator of Hospitalizations Attributable to Alcohol and Other Drugs with the Potential for Abuse and Dependence

BACKGROUND:  The use of alcohol and other drugs (AOD) causes a significant number of deaths and non-fatal health conditions each year. As of 2010, standard surveillance measures existed for AOD mortality, but not morbidity. In addition, there was no surveillance indicator specific to drugs with potential for abuse and dependence.

METHODS:  From December 2010 to May 2014, a Council for State and Territorial Epidemiologists subcommittee comprised of individuals from state health departments and national health agencies collaborated via monthly conference calls to formulate an indicator of hospitalizations attributable to alcohol and other drugs with potential for abuse and dependence. Two sub-indicators - one for alcohol and one for other drugs - were also developed. Step-by-step instructions for generating AOD indicator data were written. Eight states (California, Florida, Michigan, New Mexico, North Carolina, Oregon, Virginia, Washington) used these instructions to generate data for hospitalizations occurring in 2012.

RESULTS: The subcommittee defined a case as a hospitalization attributable to alcohol or other drugs excluding substances that cause adverse effects in therapeutic use. "Other drugs" were further limited to those with the potential for abuse or dependence as identified by Food and Drug Administration (FDA) guidelines and consistent with criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). A case may be identified using either the principal diagnosis code or the first-listed cause of injury code per ICD9CM. Hospitals were limited to in-state acute care facilities. Among the eight states that generated data for 2012, age-adjusted rates of AOD hospitalization ranged from 122 to 184 per 100,000. The median rate for males was 1.6 times the median rate for females. For each state, rates were highest among those aged 45-54 years. The results for the alcohol sub-indicator were similar: the median rate for males was 2.4 times that for females and those aged 45-54 years had the highest rate in each state. For the other drug sub-indicator, the median rate for females exceeded the median rate for males by 9% and in six of the states, those aged 25-34 years had the highest rates.

CONCLUSIONS:  The step-by-step instructions are not difficult to follow and can be used to generate data to allow jurisdictions to characterize hospitalizations due to AOD and track trends. This indicator may be of special interest to researchers and practitioners in both the injury and substance use disorder fields.