Impact of Cocaine Use on Acute Ischemic Stroke Patients: Insights from Nationwide Inpatient Sample in the United States

Cocaine is the third most common substance of abuse after cannabis and alcohol. The use of cocaine as an illicit substance is implicated as a causative factor for multisystem derangements ranging from an acute crisis to chronic complications. Vasospasm is the proposed mechanism behind adverse events resulting from cocaine abuse, acute ischemic strokes (AIS) being one of the few. Our study looked into in-hospital outcomes owing to cocaine use in the large population based study of AIS patients. Using the national inpatient sample (NIS) database from 2014 of United States of America, we identified AIS patients with cocaine use using International Classification of Disease, Ninth Revision (ICD-9) codes. We compared demographics, mortality, in-hospital outcomes and comorbidities between AIS with cocaine use cohort versus AIS without cocaine use cohort. Acute ischemic strokes (AIS) with cocaine group consisted of higher number of older patients (\u3e 85 years) (25.6% versus 18.7%, p \u3c 0.001) and females (52.4% versus 51.0%, p \u3c 0.001). Cocaine cohort had higher incidence of valvular disorders (13.2% versus 9.7%, p \u3c 0.001), venous thromboembolism (3.5% versus 2.6%, p \u3c 0.03), vasculitis (0.9% versus 0.4%, p \u3c 0.003), sudden cardiac death (0.4% versus 0.2%, p \u3c 0.02), epilepsy (10.1% versus 7.4%, p \u3c 0.001) and major depression (13.2% versus 10.7%, p \u3c 0.007). The multivariate logistic regression analysis found cocaine use to be the major risk factor for hospitalization in AIS cohort. In-hospital mortality (odds ratio (OR)= 1.4, 95% confidence interval= 1.1-1.9, p \u3c 0.003) and the disposition to short-term hospitals (odds ratio (OR)= 2.6, 95% confidence interval = 2.1-3.3, p \u3c 0.001) were also higher in cocaine cohort. Venous thromboembolism was observed to be linked with cocaine use (OR= 1.5, 95% confidence interval= 1.0-2.1, p \u3c 0.01) but less severely than vasculitis (OR= 3.0, 95% confidence interval= 1.6-5.8, p \u3c 0.001). Further prospective research is warranted in this direction to improve the outcomes for AIS and lessen the financial burden on the healthcare system of the United States

Burden of Persistent Vomiting With Cannabis Use Disorder: Report From 55,549 Hospitalizations in the United States

Background With increase in incidence rate of persistent vomiting (PV) in the post-legalization period it is important to understand adverse effects of cannabis use and its relationship with PV. Objective We investigated the relationship between cannabis use disorder (CUD) and PV-related hospitalization. Methods A Nationwide Inpatient Sample was analyzed from 2010 to 2014 for patients (aged 15–54 y) with a primary diagnosis of PV (N = 55,549), and a comparison was made between patients with the International Classification of Diseases, Ninth Edition classification of CUD versus non-CUD cohorts. We used logistic regression to study the odds ratio between CUD and PV. Results The number of PV-related hospitalizations with CUD had a significantly increased trend (P < 0.001), with a 286% increase over 5 years. A higher proportion of these patients with CUD were younger (15–24 y), female, and African American/Hispanic. In regression analysis, cannabis was associated with a seven-fold higher odds (95% confidence interval: 6.931–7.260) of PV-related hospitalization. Conclusions This study found that CUD was independently associated with a 609% increased likelihood of PV-related hospitalization, and this association persisted even after adjusting for known risk factors and other substances

Pros and Cons of Marijuana in Treatment of Parkinson's Disease

Parkinson's disease (PD) is the second most common neurodegenerative disorder of adult onset in the United States. It is a debilitating condition and presents with both motor and non-motor symptoms. Current treatment options are scarce and include replacement of dopamine deficiency with levodopa which targets only motor symptoms of the disorder, does not halt its progression, and is associated with side effects of its own, including dyskinesia. With medical marijuana gaining popularity and being legalized in the United States, we examined the pros and cons of marijuana in the treatment of Parkinson's disease

Medical and Psychiatric Comorbidities in Bipolar Disorder: Insights from National Inpatient Population-based Study

Objectives The objective of this study was to analyze the differences in the prevalence and association of medical and psychiatric comorbidities in bipolar disorder (BD) patients versus the general inpatient population. Methods A cross-sectional analysis was conducted using the national inpatient sample (NIS). Using the international classification of diseases, ninth revision (ICD-9) diagnostic codes, we extracted the BD inpatients and then obtained information about comorbidities. The odds ratio (OR) of comorbidities in BD inpatients were evaluated using a logistic regression model. Results Hypertension (31.1%), asthma (11.7%) and diabetes, obesity, and hypothyroidism (11% each) were the prevalent medical comorbidities found in BD inpatients. Hypothyroidism, asthma, and migraine were seen in BD inpatients (OR 1.59, OR 1.37 and OR 1.23; respectively) compared to general inpatients. Drug abuse (33.5%), anxiety disorders (31.8%), and alcohol abuse (18.3%) were the most prevalent psychiatric comorbidities in BD inpatients. They had a seven-fold higher likelihood of comorbid borderline personality disorders compared to general inpatients. Among other psychiatric comorbidities, the odds of the association were higher for drug abuse (OR 4.33), ADHD (OR 3.06), and PTSD (2.44). Conclusion A higher burden of medical and psychiatric comorbidities is seen in BD inpatients compare to the general inpatient population. A collaborative care model is required for early diagnosis and management of these comorbidities to improve the health-related quality of life

Arrhythmia-related Hospitalization and Comorbid Cannabis Use Disorder: Trend Analysis in US Hospitals (2010-2014)

Objective To study the trends of arrhythmia hospitalizations with cannabis use disorders (CUDs) in terms of demographic characteristics and inpatient outcomes. Methods We used the nationwide inpatient sample (NIS) data during the post-legalization period (2010-2014) and included 570,556 arrhythmia inpatients (age, 15-54 years), and 14,426 inpatients had comorbid CUD (2.53%). We used the linear-by-linear association test and independent-sample T-test for assessing the change in hospital outcomes in inpatients with CUD. Results Arrhythmia hospitalizations with CUD increased by 31% (2010-2014). This increasing trend was seen in adults (45-54 years, P < 0.001) and was predominant in males (77.6%). Hypertension (40.6%), hyperlipidemia (17.6%), and obesity (15%) were prevalent medical comorbidities with variable trends over the five years. Among substance use disorders, tobacco (50.9%), and alcohol (31.4%) were major comorbidities with a variable trend (P = 0.003 for each). There was a 71.4% increase in the inpatient mortality rate between 2010 (0.7%) and 2014 (1.2%). The mean length of stay was three days, and the total hospitalization charges have been increasing (P < 0.001), averaging $35,812 per hospital admission. Conclusion Chronic cannabis use or abuse worsens hospitalization outcomes in arrhythmic patients, and more clinical studies are needed to study the causal association between these conditions due to the rising mortality risk

Problematic Cannabis Use and Risk of Complications in Patients with Chronic Hepatitis C

Objectives To evaluate the risk of complication in hospitalized chronic hepatitis C (CHC), patients with cannabis use disorder (CUD). Methods We conducted a retrospective study using the nationwide inpatient sample (NIS), and included 31,623 patients (age 15-54) with a primary international classification of diseases, ninth revision (ICD-9) diagnosis for CHC and grouped by co-diagnosis of CUD (1101, 3.5%). Logistic regression model adjusted for confounders was used to evaluate the odds ratio (OR) of CUD and complications during CHC hospitalization. Results Comorbid CUD was prevalent in males (73.2%), Caucasians (59.9%), and from low-income families (65.7%). The most prevalent complications in patients with CUD were ascites (44.9%), alcoholic cirrhosis (42.8%) and non-alcoholic cirrhosis (41.1%). The odds of association for hepatic encephalopathy was 2.2 times higher (95% CI 1.477-3.350) in 2.8% CHC inpatients with CUD compared to 1.2% non-CUD inpatients. Hepatic encephalopathy had higher odds of association with a male by 1.4 times (95% CI 1.094-1.760), and African American by 1.7 times (95% CI 1.293-2.259). Conclusion CUD is significantly associated with 122% increased likelihood for hepatic encephalopathy that may worsen overall hospitalization outcomes in CHC patients. Hence, we need to consider the complex relationship between CUD and CHC and manage them optimally to improve the health-related quality of life

Comorbid Depression and Psychosis in Parkinson's Disease: A Report of 62,783 Hospitalizations in the United States

Background Depression and psychosis are common comorbidities that significantly affects the quality of life and disease outcomes in Parkinson's disease (PD) patients. Objective The aim of this study was to analyze and discern the differences in the hospitalization outcomes, comorbidities, and utilization of deep brain stimulation (DBS) in PD patients with comorbid depression and comorbid psychosis. Methods We used the Nationwide Inpatient Sample (2010-2014) and identified PD as a primary diagnosis (N = 62,783), and depression (N = 11,358) and psychosis (N = 2,475) as co-diagnosis using the International Classification of Diseases, Ninth Revision (ICD-9) codes. Pearson's chi-square test and independent-sample t-test were used for categorical data and continuous data, respectively. Results White male, older age, and comorbid psychosis were significantly associated with higher odds of having major severity of illness in PD inpatients. The mean length of stay (LOS) was higher in PD patients with psychosis compared to PD with depression (7.32 days vs. 4.23 days; P < 0.001), though the mean total charges of hospitalization were lower in psychosis ($31,240 vs.$38,581; P < 0.001). Utilization of DBS was lower in PD patients with psychosis versus with depression (3.9% vs. 24.3%; P < 0.001). Conclusion Psychiatric comorbidities are prevalent in PD patients and are associated with more disease severity, impaired quality of life, and increased use of healthcare resources (higher LOS and cost). They should be considered an integral part of the disease, and a multidisciplinary approach to managing this disease is crucial to improve the health-related quality of life of PD patients

Understanding the Demographic Predictors and Associated Comorbidities in Children Hospitalized with Conduct Disorder

Objective: To determine the demographic predictors and comorbidities in hospitalized children with conduct disorder. Methods: A retrospective analysis was performed using the Nationwide Inpatient Sample (2012&ndash;2014). All patients were &le;18 years old and cases with a primary diagnosis of conduct disorder (n = 32,345), and a comparison group with another psychiatric diagnosis (n = 410,479) were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)diagnosis codes. A logistic regression model was used to generate the odds ratio (OR) between both groups. Results: Children &lt; 11 years old have a five times greater chance of admission for conduct disorder than adolescents (OR = 5.339). African American males are more likely to be admitted for conduct disorder. Children with conduct disorder from low-income families have a 1.5 times higher likelihood of inpatient admission compared to high-income families. These children have an about eleven times higher odds of comorbid psychosis (OR = 11.810) and seven times higher odds of depression (OR = 7.093) compared to the comparison group. Conclusion: Conduct disorders are more debilitating for children and families than many providers realize. African American males under 11 years are at the highest risk of inpatient management for conduct disorder. These patients have a higher risk of comorbid psychosis and depression, which may further deteriorate the severity of illness and require acute inpatient care

Gender Differences and Comorbidities in U.S. Adults with Bipolar Disorder

Background: Past studies have evaluated the association of various comorbidities with bipolar disorder. This study analyzes differences in the prevalence and association of medical and psychiatric comorbidities in bipolar patients by gender. Methods: A retrospective analysis was conducted using the Nationwide Inpatient Sample (2010&ndash;2014). Using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes, we narrowed the study population to comprise those with a primary diagnosis of bipolar disorder and then obtained information about comorbidities. The differences in comorbidities by gender were quantified using chi-square tests and the logistic regression model (odds ratio (OR)). Results: Hypertension (20.5%), asthma (12.5%) and hypothyroidism (8.1%) were the top medical comorbidities found in bipolar patients. Migraine and hypothyroidism were seen three times higher in females (OR = 3.074 and OR = 3.001; respectively). Females with bipolar disorder had higher odds of comorbid inflammatory disorders like asthma (OR = 1.755), Crohn&rsquo;s disease (OR = 1.197) and multiple sclerosis (OR = 2.440) compared to males. Females had a two-fold higher likelihood of comorbid post-traumatic stress disorder (PTSD) (OR = 2.253) followed by personality disorders (OR = 1.692) and anxiety disorders (OR = 1.663) compared to males. Conclusion: Women with bipolar disorder have a much higher medical comorbidity burden than men and may highly benefit from an integrated team of physicians to manage their condition and improve their health-related quality of life

Comorbid Anxiety Increases Suicidal Risk in Bipolar Depression: Analysis of 9720 Adolescent Inpatients

Objective: To evaluate the risk of association between suicidal behaviors and comorbid anxiety disorders in adolescents with bipolar depression. Methods: We conducted a cross-sectional study using the nationwide inpatient sample (NIS) from the United States. This study included 9720 adolescent inpatients with bipolar depression and further grouped by co-diagnosis of anxiety disorders. Logistic regression analysis was used to evaluate the odds ratio (OR) of suicidal behaviors due to comorbid anxiety after controlling demographic confounders and psychiatric comorbidities. Results: Out of total inpatients, 34.8% (n = 3385) had comorbid anxiety disorders with a predominance in females (70.3%) and White patients (67.7%). About 54.1% of inpatients with comorbid anxiety had suicidal behaviors versus 44.6% in the non-anxiety cohort (p &lt; 0.001). Comorbid anxiety disorders were associated with 1.35 times higher odds (95% CI 1.23&ndash;1.47, p &lt; 0.001) for suicidal behaviors. Conclusion: Suicidal behaviors are significantly prevalent in bipolar depression adolescents with comorbid anxiety disorders. Anxiety disorders are an independent risk factor in bipolar depression that increase the risk of suicidal behaviors by 35%. This necessitates careful assessment and management of comorbid anxiety disorders in bipolar youth to mitigate suicidality