A new study analyzing data from a large database on hospital inpatients reveals that there is no relationship between opioid use and death in patients who are hospitalized for sickle cell disease (SCD).
Attacks of excruciating pain are the most common cause of hospital admission among patients with SCD and opioid medications are a mainstay of treatment for these attacks, known as pain crises. Researchers at Boston University School of Medicine wanted to know whether the U.S. opioid epidemic, which has resulted in a marked increase in opioid-related overdoses and deaths over the past two decades, may have affected the death rate among people with SCD who were treated with opioids in the hospital to relieve these pain crises.
In this study data from the National Inpatient Sample – the largest publicly available all-payer inpatient health care database in the United States, which contains data from more than 7 million hospital stays each year – were analyzed. More than 1,7 million hospitalizations for patients with SCD were identified between 1998–2013. The rates of hospitalization and in-hospital death were analyzed, both for this entire patient population and for specific age groups (0–17 years, 18–44 years, 45–64 years, and 65 years and over) and by the region of the country where patients were hospitalized (Northeast, Midwest, South, or West).
The analysis found no significant increase in the rate of in-hospital death among those with SCD over the 15-year period examined. By contrast, the death rate related to prescription opioids among the U.S. population without SCD increased 350% between 1999–2013.
Overall, the hospitalization rate for patients with SCD declined from 39 per 100 000 people in 1998 to 27 per 100 000 in 2002 and did not change significantly from 2002–2013. Among adults in the 18–44 age group, however, the hospitalization rate increased significantly, from 43 per 100 000 in 2002 to 71 per 100 000 in 2013. For adults ages 65 and over, the hospitalization rate also increased significantly, from 2,7 per 100 000 in 1998 to 5,4 per 100 000 in 2013.
According to subgroup analysis, the rates of opioid-related hospitalizations relative to the total number of hospitalizations in the sickle cell population were stable over time and similar to the relative rates in the general population. However, unlike in the general population in which inpatient deaths from opioid-related admissions increased over time, inpatient deaths related to opioid toxicity and/or overdose were almost non-existent over the entire study period. This further reinforces the study conclusions that opioid use for pain control should be considered safe in the sickle cell disease population, said lead investigator Oladimeji A. Akinboro, MBBS, of the Boston University School of Medicine.
Further research is needed to clarify the reasons why hospitalization rates climbed in these two age groups, but he suspects one reason may be lack of coordination of medical care for adults with SCD. Another possible explanation is that people with SCD are now living longer than they did in the past and are developing other health problems as they age, Akinboro said.
Akinboro OA et al.: Opioid use is not associated with in-hospital mortality among patients with sickle cell disease in the United States: Findings from the national inpatient sample. ASH Annual Meeting 2018, abstract #315