National trends in opioid-related hospitalizations among adult cancer patients: 2000-2022.

Abstract

11147 Background: Opioid use disorder is increasingly prevalent among cancer patients. Since mid-2010s, heightened attention to the opioid crisis has led to restrictive opioid prescribing policies; however, national trends in opioid-related hospitalizations (ORH) among cancer patients following these policies remain underreported. This study examines ORH trends from 2000 to 2022 and associated factors among adult cancer patients. Methods: We identified hospitalizations among adult patients (age ≥18 years) with any cancer in the National Inpatient Sample (2000-2022). Outcomes included: 1) primary ORH (PORH), defined as admissions with a primary diagnosis indicating opioid poisoning, dependence or abuse, and 2) any ORH (AORH), capturing these conditions in any diagnostic field. The risks of PORH and AORH were calculated as the number of cases per 10,000 hospitalizations, respectively. Join-point regression assessed trends in risks of PORH and AORH, reporting annual percentage changes (APCs). Multivariable logistic regression identified factors associated with PORH and AORH, with adjusted odds ratio (aORs) reported. Results: Overall, among 59,682,271 weighted hospitalizations in cancer patients (median age 66.8 years, IQR 56.5-76.3), PORH occurred in 5.5 per 10,000 hospitalizations (n = 32,641) and AORH in 200 per 10,000 hospitalizations (n = 1,192,358). The risk of PORH increased non-significantly from 2.2 per 10,000 hospitalizations in 2000 to 4.8 in 2014 (APC = 5.6, p > 0.05), then rose sharply to 10.6 in 2017 (APC = 25.1, p < .001), before declining significantly to 6.8 in 2022 (APC = -9.7, p < .001). The risk of AORH also increased non-significantly from 45 per 10,000 hospitalizations in 2000 to 60.8 in 2014 (APC = 0.2, p > 0.05), then rose to 594.4 in 2019 (APC = 118.2 for 2013-2016 and 11.7 for 2016-2019; both p < .001), before decreasing non-significantly to 476.8 in 2022 (APC = -7.8, p > .05). Higher PORH risk was associated with younger age ( < 65 vs. ≥ 65: aOR = 2.53, p < .001), race and ethnicity (Native American: aOR = 2.07, Black: aOR = 1.85, White: aOR = 1.79, relative to Asian/Pacific Islanders; all p < .001), public or no health insurance, lower income, co-occurring substance use disorders (SUD) (e.g., sedative aOR = 35.19, cocaine aOR = 3.57, both p < .001), depression (aOR = 2.46, p < .001), anxiety, chronic pain, metastases, and care in small, non-teaching, rural hospitals and the West region. Similarly, AORH were associated with younger age, race and ethnicity, insurance, low income, co-occurring SUD, mental health condition, chronic pain, metastases, comorbidity burden, and the West region. Conclusions: Opioid-related hospitalizations decreased substantially in recent years following heightened attention and clinical/policy efforts in the mid-2010s. Elevated risks were primarily associated with patient demographics, co-occurring substance use disorder, mental health conditions, and chronic pain.