Drug Overdose Deaths, Hospitalizations, and Emergency Department Visits in Kentucky, 2000 - 2012
Kentucky Injury Preven on and Research Center
Drug Overdose Deaths, Hospitaliza ons, and Emergency Department Visits in Kentucky, 2000‐2012 January, 2014
Prepared by Svetla Slavova, PhD Terry L. Bunn, PhD Joshua W. Lambert, MS
Released by Kentucky Injury Preven on and Research Center (KIPRC) 333 Waller Avenue, Suite 242 Lexington, Kentucky 40504 For more informa on contact Svetla Slavova E‐mail:
[email protected]
Table of Contents:
Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Drug overdose deaths, 2000‐2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Drug overdose hospitalizations, 2000‐2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12 Drug overdose emergency department visits, 2008‐2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Medicaid recipient opiate overdose hospitalizations and emergency department visits. . . 27 Opioid‐related disease condition hospitalizations, 2000‐2012. . . . . . . . . . . . . . . . . . . . . . . . .32 Neonatal abstinence syndrome hospitalizations, 2000‐2012. . . . . . . . . . . . . . . . . . . . . . . . . .37 Appendix A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 About this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
1
Execu ve Summary
1.
The total number of Kentucky resident drug overdose deaths leveled off from 2011 to 2012 (1,022 deaths in 2011 and 1,031 deaths in 2012).
2.
The Kentucky resident age‐adjusted drug overdose mortality rate decreased from 24.2 in 2011 to 23.9 in 2012 (1.2% decrease).
3.
Pharmaceu cal opioids remained the primary cause of Kentucky resident drug overdose deaths in 2012; pharmaceu cal opioids accounted for 471 drug overdose deaths.
4.
Heroin contributed to 129 Kentucky resident drug overdose deaths in 2012, a 207% increase from the 42 heroin‐involved deaths recorded in 2011.
5.
Benzodiazepines contributed to 362 Kentucky resident overdose deaths in 2012, decreasing 16% from 2011.
6.
Kentucky age‐adjusted drug overdose hospitaliza on rates decreased 2.4% from 2011 to 2012, from 146.6 hospitaliza ons/100,000 popula on in 2011 to 143.1 in 2012.
7.
Intent to self‐harm was the primary reason for 2012 Kentucky resident inpa ent hospitaliza ons, simi‐ lar to years 2000‐2011.
8.
Benzodiazepines were the primary drugs involved in Kentucky resident inpa ent hospitaliza ons in 2012 decreasing 11% to 1,686 hospitaliza ons in 2012.
9.
Pharmaceu cal opioids were the second leading drug type involved in drug overdose related hospitali‐ za ons in 2012, decreasing 8% from 1,610 hospitaliza ons in 2011 to 1,483 in 2012.
10. Total charges for drug overdose hospitaliza ons rose 7% from $121.1 million in 2011 to $129.3 million in 2012. 11. The primary expected payer source for Kentucky resident drug overdose inpa ent hospitaliza ons was Medicare followed by Medicaid for 2011 and 2012; Medicare was billed $41.3 million and Medicaid was billed $34.1 million in 2012. 12. Casey, Carroll, Nicholas, Powell, and Johnson coun es had the highest Kentucky resident drug over‐ dose emergency department (ED) visit rates, 2008‐2012.
2
Execu ve Summary (cont’d)
13. Kentucky resident drug overdose ED visit numbers and rates leveled off in 2012 from 6,496 visits and an age‐adjusted rate of 153.1 visits/100,000 popula on in 2011 to 6,492 visits and an age‐adjusted rate of 153.0 in 2012. 14. Kentucky resident drug overdose ED visit charges increased 5% from $14.6 million in 2011 to $15.3 mil‐ lion in 2012. 15. Self‐pays were the primary payer billed for drug overdose ED admissions in 2012 at $5 million; Medi‐ caid was billed $4.2 million and commercial insurance was billed $3.6 million. 16. Benzodiazepines were the primary drugs involved in Kentucky drug overdose ED visits in 2012 with 856 visits; pharmaceu cal opioid involvement decreased 6% to 721 visits in 2012. 17. Heroin involvement in drug overdose related ED visits increased 197% from 266 ED visits in 2011 to 789 visits in 2012. 18. Medicaid recipient total drug overdose ED charges totaled $740,000 in 2012, a 27% increase from a total of $584,000 charged in 2011. 19. Medicaid recipient total drug overdose inpa ent hospitaliza on charges totaled $11 million in 2012, approximately the same as in 2011. 20. Kentucky resident opioid‐related disease condi on hospitaliza on charges totaled $167 million in 2012; Medicaid was billed for $55 million. 21. There were 824 Kentucky resident neonatal abs nence syndrome hospitaliza ons. Associated charges amounted to $40 million; Medicaid was charged $35 million. 22. Of the 9,713 pharmaceu cal opioid or heroin related hospitaliza ons in 2012, viral hepa
s was co‐
diagnosed for 1,653 (17%) of them with associated charges of $37 million. 23. There were 1,192 hospitaliza ons involving opioid drug dependence and viral hepa increase over the 976 hospitaliza ons in 2011.
3
s in 2012, a 22%
Drug Overdose Deaths 2000‐2012
4
Kentucky Resident Drug Overdose Deaths, 2000‐2012 1200
1000
Total Number
800
711
673
747
746
2008
2009
996
1,022
1,031
2010
2011
2012
621 600
551
525
2003
2004
435 400
339 246
200
0 2000
2001
2002
2005
2006
2007
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
Kentucky Resident Age‐Adjusted Drug Overdose Mortality Rates, 2000‐2012
Mortality Rate (# Deaths /100,000 Population)
30
25
23.3
24.2
23.9
2010
2011
2012
20 16.9 14.8
15
13.4
17.4
17.3
2008
2009
15.8
12.7
10.6 10
8.3 6.1
5
0 2000
2001
2002
2003
2004
2005
2006
2007
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
5
Kentucky Resident Drug Overdose Deaths by Gender, 2000‐2012 622
613
614
700
287
409
382
409
444 303 238
268 220
203
Male Female
158
132
161
206
228
300
200
322
276
322
400
84
Total Number
400
435
443
500
459
600
100
0 2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
Kentucky Resident Age‐Adjusted Drug Overdose Mortality Rates by Gender, 2000‐2012
18.5
19.1
17.6 13.1
13.8
Female
11.0
12.4
10.4
29.2
28.9 21.6
21.3
20.6
19.4 15.7
Male
7.6
6.4
8.0
10.2
10.8
15
9.7
13.7
15.8
20
5
21.5
25
4.0
Mortality Rate (# Deaths/100,000 Population)
30
10
29.3
35
0 2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
6
874
912
1000 900
911
Kentucky Resident Drug Overdose Deaths by Intent, 2000‐2012
800 612
620 546
590
533
265
400 300
Self Harm
355
500
Unintentional
443
472
600
204
Total Number
700
Undetermined
62 58
50 59
55 67
56 78
60 67
67 60
65 54
47 41
46 34
45 33
48 26 9
33
100
59 20
200
0 2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
20.8
20.9
20.1
25
14.2
14.5
12.8
12.7
Unintentional
10.7
11.5
15
14.0
20
8.7
Self Harm Undetermined
5.0
6.5
10
1.4 1.3
1.1 1.4
1.3 1.5
1.3 1.8
1.4 1.6
1.6 1.4
1.5 1.3
1.1 1.0
1.1 0.8
1.1 0.8
1.4 0.5
1.2 0.6
5 0.8 0.2
Crude Mortality Rate (# Deaths/100,000 Population)
Kentucky Resident Crude Drug Overdose Mortality Rates by Intent, 2000‐2012
0 2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
7
8
Opiates/opioids Heroin Pharmaceutical Opioids Methadone Cocaine Other and unspecified narcotics Drugs not elsewhere classified or unspecified
Nonopioid analgesics Antiepileptic, sedative‐hypnotic, anti‐ Parkinsonism, antidepressant, and other psychotropic drugs, not elsewhere classified. Benzodiazepines Narcotics and psychodysleptics not elsewhere classified 149 0 149 73 30 22 222 173
193 1 192 116 27 23 284 218
229
188
T40(.0‐.4) T40.1 T40.0, T40(.2‐.4) T40.3 T40.5 T40.6 T50.9 T50.9 Only
29
45
T42.4 T36‐T38.9, T40(.0‐.9), T41, T44, T45(.0‐.4), T45(.6‐.9), T46‐T50.8
25 87
16 87
190 0 190 118 32 26 284 205
231
31
23 78
239 0 239 136 53 28 327 233
300
41
28 84
248 1 247 126 48 15 274 222
296
23
33 51
243 0 243 106 36 14 281 221
282
33
27 64
265 4 262 89 36 17 279 232
299
54
36 93
285 14 271 53 15 22 273 215
312
84
9 98
480 34 449 96 31 30 606 289
522
279
7 307
568 42 538 95 25 79 793 307
656
430
7 467
569 129 471 76 50 89 796 299
677
362
8 405
Year 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
T39 T42, T43
Kentucky Resident Drug Overdose Deaths by Contributing Drugs Contributing Drug ICD‐10 code
9
Occurrences of Specific Drugs among the Contributing Causes for Kentucky Resident Drug Overdose Deaths, 2011‐2012
15 24
Hydromorphone
20 16
Tramadol
34
Fentanyl Clonazepam Cocaine
25
54
2012
50 54
2011
50 64
Diazepam Morphine
52
78
66 66
Oxymorphone
90 76
Methadone Heroin
92 129
42
173
Hydrocodone
203 188
Oxycodone
257 205
Alprazolam 0
50
100
150 Total Number
200
276 250
300
Produced by the Kentucky Injury Prevention and Research Center, November 2013. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
10
11
Drug Overdose Hospitaliza ons 2000‐2012
12
Kentucky Resident Drug Overdose Hospitalizations, 2000‐2012 7,000 6,000 4,963
5,000
Total Number
4,024
4,312
4,531
4,626
4,524
2002
2003
2004
2005
5,244
5,320
2007
2008
5,626
5,749
2009
2010
6,422
6,296
2011
2012
4,000 3,372 3,000 2,000 1,000 0 2000
2001
2006
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Age‐Adjusted Rate (# hospitalizations/ 100,000 population)
160
Kentucky Resident Age‐Adjusted Drug Overdose Hospitalization Rates, 2000‐2012 146.6
140 117.6
120 98.4
100
105.1
110
111.6
2002
2003
2004
123.3
124
2007
2008
129.7
132.1
2009
2010
143.1
108.1
82.6 80 60 40 20 0 2000
2001
2005
2006
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
13
1,933
2003
2004
2005
2,619
2,688
2,410
3,290 2,336
3,147 2,173
3,100
2,836 2,144
1,909
2,127
2,591
2,678 1,853
1,724
1,581
2,000 1,500
2,588
2,443 1,989
2,500
1,383
Total Number
3,000
2,717
3,500
3,339
4,000
3,677
3,734
Kentucky Resident Drug Overdose Hospitalizations by Gender, 2000‐2012
Male Female
1,000 500 0 2000
2001
2002
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
163.6
167.3
121.8
125.6
113.7
150
148.9 110.8
104.1
121.5
131.8 102.7
2004
103.3
2003
94.8
127.2
123.1
94.4
80
91.9
100
79.6
95
120
86.5
116.7
140
128.8
160
143.2
143.3
180
69.7
Hospitalization Rate (#hospitalizations/ 100,000 population)
Kentucky Resident Age‐Adjusted Drug Overdose Hospitalization Rates by Gender, 2000‐2012
Male Female
60 40 20 0 2000
2001
2002
2005
2006
2007
2008
2009
2010
2011
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
14
2012
2,642 2,221
2,252
1,018 445
1,014 441
409
2,530
333
407
719
823
1,691 726
1,497 665 558
1,404 610 549
1,955
1,999
2,497
2,566
2,521
2,398
2,186 1,271
560 569
542 525
1,080
1,147
2,281
2,254
486 523
536 561
957
987
500
751
1,000
509 660
1,738
1,500
404 477
Total Number
2,000
2,027
2,500
2,346
3,000
2,708
Kentucky Resident Drug Overdose Hospitalizations by Intent, 2000‐2012
0 2,000
2,001
2,002
2,003
2,004
Unintentional
2,005
2,006
Self Harm
2,007
Undetermined
2,008
2,009
2,010
2,011
2,012
No Ecode
45.0
50.7
51.5
60.3
62.0
58.2
57.9
59.8
23.2
23.2 10.2
16.7
18.9 10.1
9.3
10.0
9.4
7.8
16.9
39.4 15.6 13.1
35.2 14.5 13.0
13.0 12.6
30.4 13.5 13.7
27.7
26.2 12.4 16.0
11.9 12.9
10.0 11.8
13.1 13.7
23.4
24.3
30.0
33.3
40.0
20.0
59.2
56.8
42.9
50.0
46.3
49.8
60.0
52.3
55.4
55.1
70.0
56.6
Kentucky Resident Drug Overdose Hospitalization Rates by Intent , 2000‐2012
18.5
Hospitalization Rate (# hospitalizations/100,000 population)
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
0.0 2000
2001
2002
Unintentional
2003
2004
Self/Harm
2005
2006
2007
Undetermined
2008
2009
2010
2011
No Ecode
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
15
2012
16
Other Unspecified
Anticoagulants
Psychostimulants
Benzodiazepines
Antidepressants
Cocaine
Methadone
Pharmaceutical Opioids
Heroin
Opiates/opioids
4‐Aminophenol
Nonopioid analgesics
DRUG
ICD‐ 9‐CM Codes
For ICD‐9‐CM codes see Appendix A
Kentucky Resident Drug Overdose Related Hospitalizations Drug Type 2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
118
67
509
10
112
147
577
16
591
404
714
73
184
658
21
677
414
723
75
206
718
14
731
430
740
81
163
717
11
728
438
731
85
215
921
41
957
562
830
587
875
608
906
546
826
587
880
496
793
39
62
48
62
170
93
226
72
201
81
190
104
189
213
194
217
168
961 1,030 1,201 1,254 1,610 1,483
30
988 1,065 1,259 1,298 1,668 1,637
571
877
67
93 74
93
90
96
110
107
90
106
90
102
106
94
110
84
125
111
135
112
80
203
77
180
1,755 1,972 2,190 2,198 2,231 2,212 2,489 2,546 2,769 2,845 3,009 3,369 3,410
87
63
793 1,120 1,181 1,181 1,245 1,196 1,386 1,511 1,561 1,661 1,645 1,885 1,686
1,781 2,275 2,389 2,487 2,529 2,461 2,667 2,849 2,973 3,032 3,044 3,479 3,250
90
31
332
8
519
379
351 339
644
590
3,372 4,024 4,312 4,531 4,626 4,524 4,963 5,244 5,320 5,626 5,749 6,422 6,296
2000
Year
Total Charges for Drug Overdose Hospitalizations, 2000‐2012 $140.0
$129.3 $121.1
$120.0
$100.0
Dollars (in millions)
$87.8
$93.0
$77.4
$80.0
$69.3 $61.3
$60.0 $43.8 $40.0
$48.2
$50.6
$33.7 $21.1
$26.2
$20.0
$0.0 2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Drug Overdose Hospitalizations by Total Length of Stay, 2000‐2012 25,000 21,594 21,344 20,000 17,802 17,832
19,004 18,664
15,839
Total Days of Hospital Stay
15,000
13,768
15,061
14,635 14,285
12,367 10,385 10,000
5,000
0 2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
17
Kentucky Resident Drug Overdose Hospitalizations by Expected Payer, 2000‐2012 2,000 1,800 1,600 Total Number
1,400 1,200 1,000 800 600 400 200 0 2000
2001
2002
2003
Commercial
2004
2005
Medicaid
2006
Medicare
2007
2008
Other
2009
2010
2011
2012
Self Pay or Charity
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Kentucky Resident Total Drug Overdose Hospitalization Charges by Expected Payer, 2000‐2012 $45 $40 $35
Dollars (in millions)
$30 $25 $20 $15 $10 $5 $0 2000
2001
2002
2003
Commercial
2004
2005
Medicaid
2006
Medicare
2007
Other
2008
2009
2010
2011
Self Pay or Charity
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
18
2012
19
Drug Overdose Emergency Department Visits 2008‐2012
20
Kentucky Resident Drug Overdose Emergency Department Visits, 2008‐2012 7,000 6,000
5,917
5,778
2009
2010
6,496
6,492
2011
2012
5,414
Total Number
5,000 4,000 3,000 2,000 1,000 0 2008
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Age‐adjusted rate (# ED visits/ 100,000 population)
Kentucky Resident Age‐Adjusted Drug Overdose Emergency Department Visit Rates, 2008‐2012 170 150 130
139.5
136.5
2009
2010
129.4
153.1
153.0
2011
2012
110 90 70 50 30 10 ‐10
2008
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
21
Kentucky Resident Drug Overdose Emergency Department Visits by Gender, 2008‐2012 3,479
3,024
3,017
3,120 2,658
2,659
2,362
Total Number
3,000 2,500
3,258
3,052
3,500
3,468
4,000
2,000 Male
1,500
Female
1,000 500 0 2008
2009
2010
2011
2012
Kentucky Resident Age‐Adjusted Drug Overdose Emergency Department Visit Rates by Gender, 2008‐2012
120
163.1 142.6
142.4
147 125.7
125.9
140
145
160
153.3
180
163.2
200
113.5
Age‐adjusted rate (# ED visits/100,000 population)
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
100 Male
80
Female 60 40 20 0 2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
22
Kentucky Resident Drug Overdose Emergency Department Visits by Intent, 2008‐2012 3,157
1,092 490
596
599
900
690
869
634
766
1,500 1,000
1,547 1,084
1,642
1,742
1,715
1,646
2,608
2,289
Total Number
3,000
2,000
2,629
3,500
2,500
3,354
4,000
500 0 2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Unintentional
Self Harm
Undetermined
No Ecode
72.3
24.9
35.3 24.7
11.2
13.7
13.7
20.6
16.0
14.8
20
17.9
30
20.1
40
37.7
37.8
40.4
40.0
50
60.5
70
60.6
80
60
76.6
90
53.4
Crude rate (# ED visits/100,000 population)
Kentucky Resident Crude Drug Overdose Emergency Department Visit Rates by Intent, 2008‐2012
10 0 2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Unintentional
Self Harm
23
Undetermined
No Ecode
Kentucky Resident Total Drug Overdose Emergency Department Visit Charges, 2008‐2012 $18 $16
$15.3 $14.6
$14
Dollars (in millions)
$12.0
$11.4
$12 $9.4
$10 $8 $6 $4 $2 $0
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
$5.0
$6
Kentucky Resident Total Drug Overdose Emergency Department Visit Charges by Expected Payer, 2008‐2012
$1.8
$2.3
$2.5
$3.6
$4.2
$4.3
$3.8 $3.7 $0.3
$0.3
$0.2
$0.3
$3.1 $3.2
$1.7
$0.3
$1
$3.3
$2.9 $3.4 $1.9
$2
$1.5
$3
$2.9 $2.8
Dollars (in millions)
$4
$3.6
$5
$0 2008
2009
Commercial
2010
Medicaid
Medicare
2011
Other
2012
Self Pay or Charity
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
24
Kentucky Resident Drug Overdose Related ED Visits 2008 5,414
2009 5,917
Year 2010 5,778
Nonopioid analgesics, Antipyretics, and Antirheumatics
805
831
776
764
737
4‐Aminophenol derivatives
428
462
418
420
379
590
725
816
73
142
211
266
789
518
585
614
769
721
54
48
52
43
58
42
37
45
67
88
2,033
2,179
2,075
804
907
866
939
856
133
143
140
199
172
65
104
88
57
54
3,195
3,500
3,455
For ICD‐9‐CM codes see Appendix A
DRUG Involved
Opiates/opioids Heroin Pharmaceutical Opioids Methadone Cocaine Antidepressants, barbiturates and other antiepileptics, sedative‐ hypnotics, and psychotropic drugs not elsewhere classified Benzodiazepines Psychostimulants with abuse potential including methamphetamine, MDMA (Ecstasy) Anticoagulants Other specified and unspecified drugs
2011 2012 6,496 6,492
1,026 1,488
2,320 2,200
3,864 3,651
Kentucky Resident Drug Overdose Emergency Department Visits by Drugs Involved, 2008‐2012
518
721
789
856
614
585
700
‐100
2008
Benzodiazepine
2009
2010
Pharmaceutical Opioids
88
45
67
211 37
42
142
300
100
266
500
73
Total Number
939 769
804
900
866
907
1,100
2011
Heroin
2012
Cocaine
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
25
26
Medicaid Recipient Opiate Overdose Hospitaliza ons and Emergency Department Visits
27
Medicaid Recipient Opiate Overdose Hospitalizations by Gender, 2000‐2012 280
350
2004
148
128
2007
Female
102
128
188 55
2003
90
80 51
2002
Male
153
139
2006
90
83 52
2001
70
75
80 41
2000
100
112
121
150
137
200
50
198
250
32 42
Total Number
254
300
0 2005
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Medicaid Recipient Opiate Overdose Hospitalizations by Intent, 2000‐2012 191
250
173 101 110
92
104 61
73 64
87 83
96 74
63
24
15
12
15
25
20
45 29
19
17
76
77 61 59
72 47 49
64 59 36
46 45 23 17
17
38 46 33
16 13
49 43
100
50
136
138
150
18 28 15 13
Total Number
200
0 2,000
2,001
2,002
2,003
Unintentional
2,004
2,005
Self Harm
2,006
2,007
Undetermined
2,008
2,009
2,010
2,011
No Ecode
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
28
2,012
Medicaid Recipient Total Opiate Overdose Inpatient Hospitalization Charges, 2008‐2012 $12 $11.4 $11.1
$10
$8
Dollars (in millions)
Total Charges $6.7
Operating Room Charges Other Charges
$6
Oncology Charges $5.6
Pharmacy Charges Radiology Charges Room & Board Charges Labor & Delivery Charges
$4.1
Anesthesia Charges
$4
Ancillary Charges
$2
$0 2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
29
Medicaid Recipient Opiate Overdose Emergency Department Visits by Gender, 2008‐2012 146
160
101
77
89
94
100
63
71
80 60
Male
53
Total Number
120
108
114
140
Female
40 20 0 2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Medicaid Recipient Opiate Overdose Emergency Department Visits by Intent, 2008‐2012 136
160 140
101
120
12
27
35
40
55
56
71
73 52 38
36
8
7
7
20
7
40
33
60
68
80 54
Total Number
100
0 2008
2009 Unintentional
2010 Self Harm
Undetermined
2011
2012
No Ecode
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
30
Medicaid Recipient Opiate Overdose Total Emergency Department Charges, 2008‐2012 $900 $800
$740
$700 $584
Dollars (in thousands)
$600 $472
$500 $405 $400 $306 $300 $200 $100 $0 2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
31
Opioid‐Related Disease Condi on Hospitaliza ons 2000‐2012
32
Kentucky Resident Opioid‐Related Disease Condition Hospitalizations, 2000‐2012 9,000
8,465 7,891
8,000
7,389 6,909
7,000
6,400
Total Number
6,000
5,464
5,725
4,677
5,000 4,385 4,000 3,142
3,357
3,860
3,000 2,209 2,000 1,000 0 2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Note: 6.7% of all opioid‐related disease condi on hospitaliza ons listed also an ICD‐9‐CM code for drug overdose
2008
5,757
5,572
5,220
4,578
4,356
2007
2010
2011
2,005
1,850
2006
1,771
2005
1,661
890
2004
1,358
828
2003
1,193
787
2002
1,158
2,707 658
2001
2,000
1,124
3,564
2,673 481
2000
3,000
1,000
3,083
4,000
3,795
5,000
361
Total Number
6,000
6,147
7,000
6,491
Kentucky Resident Opioid‐Related Disease Condition Hospitalizations by Condition Type, 2000‐2012
0
Nondependent opioid abuse
2009
Opioid type drug dependence
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Note: 0.3% of all opioid‐related disease condi on hospitaliza ons listed both condi on types 33
2012
4,610
Kentucky Resident Opioid‐Related Disease Condition Hospitalizations by Gender, 2000‐2012
1,216 993
2,000 1,500
2001
2002
3,855
3,711 3,678
3,231 3,168
2,890 2,835
2,770 2,694
2,241 2,144
1,793 1,564
2,500
2,013 1,847
3,000
2,355 2,322
3,500
1,718 1,424
Total Number
4,000
3,430 3,479
4,500
3,803 4,088
5,000
Male Female
1,000 500 0 2000
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Kentucky Resident Opioid‐Related Disease Condition Hospitalization Charges, 2000‐2012 $180.0
$166.6
$160.0 $144.1
Dollars (in millions)
$140.0 $122.1 $120.0 $104.0 $100.0 $84.5 $80.0 $62.1 $60.0
$48.6
$40.0 $21.6 $20.0
$66.1
$27.7
$34.7
2002
2003
$41.6
$13.9
$0.0 2000
2001
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
34
Kentucky Resident Opioid‐Related Disease Condition Hospitalization Charges by Expected Payer, 2000‐2012 $45.9
$2.9
2012
$39.6
$55.4
$22.8 $41.4
$1.2
2011
$31.3
$49.3
$20.8 $37.3
$2.0
2010
$23.7
$41.4
$17.7 $30.3
$1.4
2009
$21.7
$36.9
$13.8 $20.5 $17.0 $17.3
$2.7
2008
$15.0 $13.2
$6.3
2007
$22.7
$8.8 $6.9
2006
$12.7 $12.8 $10.3
$10.0 $8.2 $9.8 $5.6
2005
$8.7 $5.5 $7.8 $5.2
2004
$27.0
$19.4
$15.0
Self Pay or Charity
$14.4
Other Medicare
$6.0 $3.5 $6.8 $10.8 $7.5
2003
$3.8 $2.2 $5.2
2002
Medicaid Commercial
$8.3 $8.3
$3.3 $2.3 $4.2 $6.7 $5.2 $1.2 $1.0 $2.5 $5.0 $4.1
2001
2000
$0.0
$10.0
$20.0
$30.0
$40.0
$50.0
$60.0
Dollars (in millions) Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
35
$70.0
Kentucky Resident Hospitalizations Involving Opioid Drug Overdose or an Opioid‐Related Disease Condition AND Viral Hepatitis, 2000‐2012 2012
144
2011
2004
65 43
2003
59 34
35 20
2001
29 20
2000
24
8 0
277
89
33
2002
Year
394
113
56
2005
435
108
45
2006
545
135
53
2007
633
157
85
2008
702
208
85
2009
976
293
114
2010
1,192
378
210
Opioid type drug dependence & Viral hepatitis
203
Nondependent opioid abuse & Viral hepatitis 138
Drug overdoses due to the effect of opiates and related narcotics &Viral hepatitis
118
72
200
400
600
800
1,000
1,200
Total Number Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
36
Neonatal Abs nence Syndrome Hospitaliza ons 2000‐2012
37
Kentucky Resident Neonatal Abstinence Syndrome Hospitalizations, 2000‐2012 900
824
800 678
700
Total Number
600 485
500
435
400
329 275
300
227
200 100
28
62
93
128
2002
2003
166
175
0 2000
2001
2004
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Kentucky Resident Neonatal Abstinence Syndrome Hospitalization Charges, 2000‐2012 $45.0 $40.2 $40.0 $36.0 $35.0
Dollars (in millions)
$30.0 $23.8
$25.0
$25.0
$20.0 $15.0 $15.0 $10.0
$7.5
$5.0 $0.2
$1.5
$1.3
$2.4
$3.2
2001
2002
2003
2004
$4.0
$5.2
$0.0 2000
2005
2006
2007
2008
2009
2010
2011
2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
38
Kentucky Resident Neonatal Abstinence Syndrome Hospitalizations by Expected Payer, 2000‐2012 Self‐Pay or Commercial Medicaid Other Charity 2000 5 20
