(122) Prevalent Comorbidities Associated with Substance Use Disorder in East Texas (2021-2024)

Background &

Introduction: Substance use disorders (SUD) in the United States represent a significant public health concern. In 2022, 48.7 million individuals aged 12 or older reported having an SUD within the past year. The prevalence of psychiatric comorbidities among patients with SUD is substantial, with approximately 35% of adults aged 18 and older who have a mental disorder also experiencing SUD. The most reported psychiatric comorbidities in the literature include mood and anxiety disorders, post-traumatic stress disorder (PTSD), psychosis, bipolar disorder, and personality disorders. SUD is also associated with numerous physical health comorbidities, including cardiovascular and respiratory diseases, sexually transmitted infections (STIs), and chronic pain. Individuals who inject drugs face an elevated risk of contracting HIV or Hepatitis C. Additionally, due to compromised immune function, these individuals are more vulnerable to opportunistic infections and tuberculosis. Patients with SUD are also disproportionately involved in trauma-related injuries, such as blunt and penetrating trauma sustained during motor vehicle collisions, accidents, and incidents of interpersonal violence. We aim to determine whether these comorbidities are prevalent among SUD patients in East Texas to develop targeted prevention strategies, enhance education efforts, and implement effective treatment programs in the region.

Methods: We reviewed data from the Anderson and Cherokee Counties Opioid Response (ANCHOR) Project, which included all emergency department (ED) visits for substance use disorders (SUD) in East Texas from September 1, 2021, to December 31, 2024. We used codes from the International Classification of Diseases, 10th Revision (ICD-10-CM) to define the study population. Patients with alcohol use disorder (AUD), opioid use disorder (OUD), stimulant use disorder, and drug overdose (OD) were identified. The top 200 comorbidities were categorized into 12 groups to further examine their association with mortality. Descriptive statistics were used to characterize demographics, AUD, OUD, SUD, and OD characteristics, as well as vital signs, by mortality status. Categorical variables were expressed as frequencies and percentages and analyzed for associations using the Chi-square test. Continuous variables were tested for normality and presented as means (standard deviation) for normally distributed data or medians (interquartile ranges) otherwise, with differences assessed using t-tests or Mann-Whitney U tests, as appropriate. Logistic regression was performed to identify factors associated with mortality risk. Statistical significance was determined at a two-sided p-value of < 0.05. All analyses were conducted using SAS, Version 9.4 (SAS Institute Inc., Cary, NC).

Results: A total of 65,054 patients seen in the emergency department (ED) were included in this analysis. The median age was 50 years, with 54.2% identified as male and 74.2% as white. Most patients were presented with substance use disorder (SUD) (n = 60,078; 92.4%), followed by alcohol use disorder (AUD) (n = 8,086; 12.4%) and opioid use disorder (OUD) (n = 2,120; 3.3%). Patients with overdose (OD) comprised 2.2% (n = 1,452) of the sample. Mortality proportions were higher in males compared to females (1.6% vs. 1.2%), in AUD (3.0% vs. 1.2%), in OUD (3.7% vs. 1.4%), and in SUD (1.8% vs. 1.4%), especially in those with cocaine use disorder (3.5% vs. 1.4%) and overdose (2.7% vs. 1.4%); all p-values were < 0.0001. Twelve groups of comorbidities identify from the top 200 highest prevalence from this cohort: Most prevalence of primary comorbidity was infectious diseases (7.6%, n=4940), followed by cardiovascular diseases (7.0%, n=4541), metabolic and renal disorder (5.2%, n=3354), nutrition disorders (4.4%, n=2880), then respiratory diseases (4.2%, n=2759), neurology diseases (3.3%, n=2176), GI (3.0%, n=1922), and other less prevalence. Morbidity was found associated with the risk of mortality. Comorbidities were also found to significantly increase mortality risk, 22 times higher in those with metabolic or renal diseases, 11 times higher in those with musculoskeletal diseases, and 14 times higher in those with respiratory diseases. AUD, OUD, SUD, and OD were associated with 2.5-fold (OR = 2.49; 95% CI, 2.15–2.88), 2.6-fold (OR = 2.76; 95% CI, 1.82–3.81), 2.2-fold (OR = 2.22; 95% CI, 1.80–2.71), and 1.9-fold (OR = 1.91; 95% CI, 1.38–2.65) higher odds of mortality, respectively.

Conclusions &

Discussion: The most prevalent comorbidities found in the population from the ANCHOR project were infectious diseases (7.6%, n=4940), followed by cardiovascular diseases (7.0%, n=4541), and metabolic and renal disorders (5.2%, n=3354) in substance use abusers and associated with a higher risk of mortality. Identifying the most common comorbidities in patients with substance use disorders will help design effective prevention and treatment management to reduce mortality and morbidity.

References:
1. Common Comorbidities with Substance Use Disorders Research Report. Bethesda (MD): National Institutes on Drug Abuse (US); 2020 Apr. Available from: https://www.ncbi.nlm.nih.gov/books/NBK571451/
2. Substance Abuse and Mental Health Services Administration. (2023). Key substance uses and mental health indicators in the United States: Results from the 2022 National Survey on Drug Use and Health (HHS Publication No. PEP23-07-01-006, NSDUH Series H-58). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/report/2022-nsduh-annual-national-report
3. United Nations. Office on Drugs and Crime. Comorbidities in drug use disorders: No wrong door; March 2022. Available from: https://www.unodc.org/unodc/drug-prevention-and-treatment/publications/data/2022/march/comorbidities-in-drug-use-disorders-no-wrong-door.html