Substance Use Disorders Are Prevalent in Adults With Congenital Heart Disease and Are Associated With Increased Healthcare Use

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Adults with congenital heart disease (CHD) represent a heterogeneous group with significant long-term health risks. Previous studies have demonstrated a high prevalence of psychiatric disorders among adults with CHD; however, little is known about the frequency of co-morbid substance use disorders (SUDs) in patients with CHD. The Oregon All Payer All Claims (APAC) database for the years 2014 to 2017 was queried for adults aged 18 to 65 years with International Classification of Diseases, Ninth or Tenth Revision codes consistent with CHD. Alcohol and substance use were identified by International Classification of Diseases codes for use or dependence and classified in mutually exclusive categories of none, alcohol only, and other drugs (with or without alcohol). Descriptive statistics were used to characterize prevalence and chi-square tests were used to test for associations between variables. A total of 12,366 adults with CHD were identified. The prevalence of substance use was 15.7%. The prevalence of isolated alcohol use was 3.9%. A total of 19% of patients used tobacco. Insurance type, presence of a concurrent mental health diagnosis, and age were associated with substance use, whereas CHD complexity was not. Cardiovascular co-morbidities were more common in patients with reported substance use. Inpatient and emergency care use were higher in those with SUD. In conclusion, this study of substance and alcohol use among adults with CHD demonstrates high rates of co-morbid SUD, particularly among patients with mental health disorders and Medicaid insurance, associated with increased healthcare utilization. We identify a population in need of targeted interventions to improve long-term health.

Section snippets

Methods

The Oregon APAC database from January 2014 to October 2017 was queried to identify patients between the ages of 18 and 65 with an International Classification of Diseases (ICD) Ninth Revision (ICD-9) and ICD-Tenth Revision (ICD-10) code consistent with CHD (codes 745 to 747, Q20-Q25, I27.83). In evaluating CHD, we considered diagnosis codes from any year in the dataset and all claims. We applied a hierarchical algorithm to (1) exclude patients who only had evidence of diagnoses with low

Results

A total of 12,366 adults with CHD were identified, 51.9% of whom were women. A total of 3,243 patients (26.2%) had moderate-complex CHD; others had CHD of mild complexity. The overall prevalence of SUD was 15.7% (n = 1,945). A total of 477 adults with CHD (3.9%) had isolated disordered alcohol use, 608 used opioids (4.9%), 414 used amphetamines (3.3%), 80 used cocaine (0.6%; Table 1).

Compared with those without SUD, those with SUD were more likely to be men (RR 1.35, 95% confidence interval

Discussion

There are 3 major findings of this investigation. First, 15.7% of adults with CHD in this statewide sample have concomitant SUD. This proportion is representative of a population which is engaged with healthcare and likely underestimates the true prevalence of SUD. Second, those with SUD constitute a complex population with both medical and socioeconomic challenges, as evidenced by a high burden of co-morbidities and greater reliance on Medicaid insurance. Third, adults with CHD and SUD are

Disclosures

The authors have no conflicts of interest to declare.

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    Funding: none.

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