Primary Causes of Hospitalizations and Procedures, Predictors of In-hospital Mortality, and Trends in Cardiovascular and Cerebrovascular Events Among Recreational Marijuana Users: A Five-year Nationwide Inpatient Assessment in the United States

Abstract

BackgroundRecent trends in the legalization of marijuana in many states are increasing the popularity of recreational marijuana use. Since current data on hospitalizations in marijuana users is sparse, we evaluated the primary reasons for admissions, procedures and associated healthcare burden in hospitalized recreational marijuana users.MethodsThe National Inpatient Sample (NIS) for the years 2010–2014 was queried for the hospitalizations with a history of recreational marijuana usage using applicable ICD-9 CM codes. Descriptive statistics were used to report frequency (N) and percentage (%). Discharge weights were applied to achieve national estimates. The predictors of in-hospital mortality in recreational marijuana users were assessed using a two-way hierarchical multivariate regression after adjusting for the confounders.Results We analyzed 465,959 (weighted n=2,317,343) hospitalizations with a history of recreational marijuana use. Among psychiatric disorders, most prominent primary discharge diagnoses were mood disorders (20.6%), schizophrenia/other psychotic disorders (10.6%), and substance/alcohol-related disorders (10.4%). Suicide and intentional self-inflicted injury (3.6%) was the leading cause of emergency admission. The most common non-psychiatric primary discharge diagnoses were diabetes mellitus with chronic complications (2.2%), acute myocardial infarction (AMI) (1.2%), nonspecific chest pain (1.1%), congestive cardiac failure (CHF) (1%), arrhythmia (0.8%), and hypertension (0.8%). Acute cerebrovascular diseases were noted in 1.1% and epilepsy in 1.8% of patients. Alcohol/drug rehabilitation and detoxification (6.9%) and psychiatric evaluation/therapy (3.9%) were the most evident psychiatric procedures whereas most frequent non-psychiatric procedures were diagnostic coronary arteriography (1%), percutaneous transluminal coronary angioplasty (0.7%), and echocardiogram (0.7%). Top independent predictors of in-hospital mortality were coagulopathy (OR 5.94), AMI (OR 4.59), pulmonary circulation disorder (OR 2.95), CHF (OR 2.02), renal failure (OR 1.91), coronary atherosclerosis (OR 1.34) and peripheral vascular disorder (OR 1.31). Major cardiovascular and cerebrovascular events also showed increasing trends among users.ConclusionWe established the most frequent psychiatric and non-psychiatric causes of admissions and procedures in recreational marijuana users, which may pose a significant healthcare burden and increase the odds of in-hospital mortality.

Temporal Trends in the Prevalence of Diabetes Decompensation (Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State) Among Adult Patients Hospitalized with Diabetes Mellitus: A Nationwide Analysis Stratified by Age, Gender, and Race

“…Studies suggest a high burden (15-20%) of substance abuse among adults with DKA-related hospitalizations [16-17]. Rising trends in drug abuse especially cocaine and marijuana have been concerning as these substances have the potential to increase the odds of MI, arrhythmia, and stroke as noted in prior studies [18-21]. Such practices make these patients prone towards discontinuation of insulin therapy, dietary transgressions, behavioral issues, stress and could alter metabolism leading to an increased risk of decompensation [8, 16].…”

In-hospital outcomes of inflammatory bowel disease in cannabis users: a nationwide propensity-matched analysis in the United States

“…We identified ≥18 years IBD (both CD and UC) patients using ICD-9 CM codes 555.x (CD or regional enteritis) 556.x (UC). Among these patients, cannabis use was identified using ICD-9 CM codes 304.30, 304.31, 304.32, 305.20, 305.21, and 305.22 also used in our previous studies (5)(6)(7). We recognized associated in-hospital complications from the secondary discharge diagnoses/procedures.…”

Adding a US Perspective for Stroke Risk in Noncompliant Older Adults

“…Nevertheless, we acknowledge that through combining and triangulating results of different methodological approaches, stronger claims toward causality may be supported. 3 The report of Amraotkar et al highlights the need to replicate our findings in other settings and through various study designs.…”

“…PAD-related admissions, comorbidities, and stroke events in hospitalized older adult (≥65 years) patients were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, as detailed in our earlier studies. [2][3][4] Medication noncompliance was identified using ICD-9 code V15.81, as previously validated. 5 Our analysis of 2014 nationwide US hospitalized patients (N = 337 800) showed that older adult noncompliant PAD patients with coexistent diabetes and dyslipidemia were frequently males, African Americans, and Hispanics, and from a lower quartile median household income (Table 1).…”