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Sex Differences in Prevalence of Emergency Department Patient Substance Use
Authors:Robert D Cannon  Gillian A Beauchamp  Paige Roth  Jennifer Stephens  David B Burmeister  David M Richardson  Alanna M Balbi  Tennessee D Park  Stephen W Dusza  Marna Rayl Greenberg
Institution:1. Department of Emergency and Hospital Medicine, Lehigh Valley Hospital and Health Network/University of South Florida Morsani College of Medicine Allentown, Pennsylvania;2. Department of Internal Medicine, Lehigh Valley Hospital and Health Network/University of South Florida Morsani College of Medicine Allentown, Pennsylvania
Abstract:

Purpose

Substance use and misuse is prevalent in emergency department (ED) populations. While the prevalence of substance use and misuse is reported, sex-specific trends in ED populations have not been documented. We set out to determine the sex-specific prevalence of ED patient substance use during this current epidemic.

Methods

A retrospective electronic data abstraction tool, developed for quality-improvement purposes, was used to assess ED visits in 3 hospitals in northeastern Pennsylvania. All patients with ED diagnosis codes for substance use F10.000 through F 19.999 (excluding F17 codes for nicotine) were abstracted for network ED visits at all 3 hospitals. Data points included ED clinical enrollment site, primary substance used, sex, date of ED visit, disposition (including left without being seen, left against medical advice, discharged, admitted, and treatment in rehabilitation) for 18 months (January 1, 2016 through July 31, 2017). The categorical parameters of sex, clinical enrollment site, diagnosis, date of ED visit, and disposition status were summarized as a proportion of the subject group. Time series analysis was used to assess trends in substance use and misuse visits by patient sex.

Findings

A total of 10,511 patients presented to the EDs during the study time period with a final diagnosis of a substance use?related reason and were included in the analysis. The mean age for these patients was 43.6 (SD 16.4) years, and the majority was male (65.6%, n = 6900). The most common substance in the final diagnosis for the ED visit was alcohol (54.3%; 95% CI, 53.3–55.2), followed by opioids (19.2%; 95% CI, 18.4–19.9) and cannabis (14.4%; 95% CI, 13.7–15.0). Females tended to be younger than males (42.4 years vs 44.3 years; P < 0.001), and were more likely to be discharged after the ED visit than males (36.1% vs 32.3%; P < 0.001). When exploring differences in age by sex and substance, males with a final diagnosis including alcohol- and cannabis-related issues were older than females, whereas females diagnosed with opioid-related reasons were older than males (41.3 vs 38.9 years; P < 0.001).

Implications

There are sex-specific differences in prevalence of patients presenting with substance use in the ED setting.
Keywords:opioids  prevalence  sex differences  substance use
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