title: Medical diagnoses associated with substance dependence among inpatients at a large urban hospital.
abstract: BACKGROUND
  There are limited data on reasons for hospital admission among patients dependent on substances other than alcohol. We compared primary discharge diagnoses for heroin- or cocaine-dependent patients to non-dependent patients.
  
  
  METHODS
  We evaluated a cohort of patients admitted to a general medicine service at a public teaching hospital during July 2005-June 2008. Through bedside interviews, we identified patients who had substance-use disorders. We categorized patients by substance used, route of administration, and dependent or non-dependent use. We grouped diagnostic codes (i.e., ICD-9) using Healthcare Utilization Project categories. We excluded HIV-infected patients.
  
  
  RESULTS
  Of 11,397 patients, 341 (3.0%) were dependent on inhalational heroin, 260 (2.3%) on non-injection cocaine, and 106 (0.9%) on injection heroin. Compared to non-dependent patients, inhalational heroin-dependent patients were over three-fold more likely to have been admitted for respiratory diseases (28% vs. 8%, p<0.01); this association was strongest for asthma exacerbation (OR=7.0; 95% CI, 4.7 to 70.4, p<0.01). Of the 225 admissions for an asthma exacerbation, 44 (19.6%) had co-occurrent heroin-dependence. The most frequent diagnostic category among cocaine-dependent patients was circulatory, which was similar to non-dependent patients (22% vs. 21%, p=0.92).
  
  
  CONCLUSIONS
  There is a strong association between heroin dependence and hospital admission for an asthma exacerbation. Provision of specialized substance-use treatment for inhalational heroin users will be necessary to reduce the frequency of exacerbations and repeat hospital admissions.
authors.affiliation: Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, United States of America.
authors.forename: Humberto
authors.initials: H
authors.lastname: Choi
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Stroger Hospital of Cook County, Rush University Medical Center, Chicago, Illinois, United States of America.
authors.forename: Anne
authors.initials: A
authors.lastname: Krantz
authors.affiliation: Department of Medicine, Stroger Hospital of Cook County, Rush University Medical Center, Chicago, Illinois, United States of America.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Smith
authors.affiliation: Collaborative Research Unit, Department of Medicine, Stroger Hospital of Cook County, Rush University Medical Center, Chicago, Illinois, United States of America.
authors.forename: William
authors.initials: W
authors.lastname: Trick
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D001249:Asthma / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D002641:Chicago; D002947:Cities; D019970:Cocaine-Related Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006556:Heroin Dependence / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010343:Patient Admission