Geographic variation in hospital costs, payments, and length of stay for opioid-related hospital visits in the USA

Figures & data

Figure 1 Attrition diagram.

Note: ICD, ninth and tenth revision (ICD-9/10), diagnosis codes: 304.0x, 304.7x, 305.5x, 965.0x, F11.x, and T40.0x to T40.3x were used to identify principal opioid diagnosis.

Table 1 Patient characteristics

	East North Central		East South Central		Mid-Atlantic		Mountain		New England		Pacific		South Atlantic		West North Central		West South Central
	OP	IP	OP	IP	OP	IP	OP	IP	OP	IP	OP	IP	OP	IP	OP	IP	OP	IP
Total visits
Total	22,069	3,673	10,438	2,866	22,191	3,708	4,292	613	18,407	933	25,426	5,146	38,253	9,030	2,464	528	17,351	5,916
Gender
Male	52%	57%	40%	47%	52%	60%	47%	48%	58%	62%	57%	58%	54%	51%	40%	42%	54%	51%
Female	48%	43%	60%	53%	48%	40%	53%	52%	42%	38%	43%	42%	46%	49%	60%	58%	46%	49%
Age
Age (years) – mean (SD)	36.49	42.6	36.47	40.5	35.05	38.9	37.8	46.5	36.63	43.8	37.65	43.4	38.77	44.7	37.77	48.6	40.23	43.8
	(12.5)	(15.5)	(12.4)	(14.7)	(12.4)	(15.0)	(14.6)	(17.9)	(12.4)	(16.7)	(14.2)	(17.9)	(15.2)	(17.0)	(12.7)	(17.5)	(15.7)	(17.4)
Admission source
Elective	51%	38%	65%	4%	45%	17%	37%	7%	59%	3%	27%	11%	35%	5%	63%	2%	33%	24%
Emergency	40%	55%	28%	64%	38%	71%	61%	83%	35%	83%	43%	59%	53%	70%	26%	51%	52%	55%
Urgent	0%	5%	1%	8%	1%	5%	1%	10%	1%	9%	2%	18%	3%	14%	9%	41%	2%	16%
Missing/unknown	9%	1%	6%	25%	15%	7%	0%	1%	5%	5%	28%	12%	9%	11%	2%	6%	13%	5%
Discharge destination
Home	59%	65%	41%	72%	95%	58%	85%	62%	67%	51%	93%	62%	83%	67%	91%	59%	71%	66%
Post-acute care	0%	6%	0%	5%	0%	16%	1%	13%	0%	14%	0%	15%	1%	12%	1%	15%	1%	12%
Transfer	2%	6%	3%	6%	2%	8%	4%	11%	2%	11%	2%	8%	5%	9%	3%	14%	6%	8%
Left AMA	2%	11%	3%	14%	3%	15%	3%	8%	3%	9%	2%	12%	4%	6%	2%	3%	3%	7%
Others	7%	1%	1%	0%	0%	0%	3%	1%	0%	1%	1%	1%	1%	1%	1%	0%	3%	0%
Missing/unknown	30%	9%	53%	1%	1%	0%	3%	1%	28%	9%	1%	1%	6%	2%	2%	5%	15%	3%
Payer
Commercial	27%	18%	20%	17%	25%	25%	5%	7%	24%	26%	26%	46%	24%	22%	19%	22%	28%	24%
Medicaid	32%	21%	11%	20%	49%	34%	14%	14%	23%	21%	32%	17%	15%	17%	19%	11%	19%	15%
Medicare	10%	18%	12%	23%	7%	15%	5%	13%	16%	29%	12%	24%	14%	24%	20%	35%	18%	25%
Others	4%	3%	10%	10%	8%	5%	4%	3%	1%	1%	2%	3%	15%	12%	4%	2%	10%	9%
Unknown	27%	41%	47%	30%	11%	21%	71%	64%	36%	23%	28%	10%	32%	24%	38%	30%	24%	26%
Charlson comorbidities
CCI – mean (SD)	0.44	1.14	0.53	0.95	0.45	0.96	0.69	1.70	0.67	1.51	0.54	2.2	0.76	2.52	0.52	1.72	0.73	0.73
	(1.2)	(2.1)	(1.5)	(1.9)	(1.4)	(2.1)	(1.8)	(2.5)	(1.6)	(2.5)	(1.5)	(1.5)	(1.8)	(1.7)	(1.2)	(2.6)	(1.8)	(2.4)
Other comorbidities
Alcohol disorders	5%	12%	2%	13%	15%	18%	6%	17%	5%	17%	4%	22%	5%	15%	1%	7%	4%	12%
Anxiety disorders	7%	22%	3%	26%	7%	24%	10%	19%	4%	19%	7%	34%	8%	21%	2%	15%	6%	19%
Bipolar disorder	2%	6%	2%	12%	4%	12%	2%	7%	1%	6%	2%	9%	2%	9%	1%	3%	2%	7%
Depression	6%	25%	3%	23%	4%	23%	8%	20%	4%	23%	6%	31%	7%	25%	2%	19%	6%	21%
Hepatitis (acute and chronic)	3%	14%	1%	17%	2%	12%	4%	16%	3%	21%	3%	13%	3%	10%	0%	4%	3%	14%
History of substance abuse	2%	5%	2%	8%	2%	7%	1%	8%	1%	8%	1%	8%	2%	6%	1%	5%	2%	7%
Mortality
Mortality	0.1%	2.3%	0.1%	1.2%	0.1%	2.2%	0.1%	3.3%	0.1%	4.8%	0.0%	2.0%	0.1%	2.6%	0.1%	2.7%	0.1%	1.9%

Note: Only comorbid conditions occurring in at least 5% of visits in one or more regions are given.

Abbreviations: AMA, against medical advice; CCI, Charlson Comorbidity Index; IP, inpatient; OP, outpatient.

Table 2 Hospital characteristics

	East North Central		East South Central		Mid-Atlantic		Mountain		New England		Pacific		South Atlantic		West North Central		West South Central
	OP	IP	OP	IP	OP	IP	OP	IP	OP	IP	OP	IP	OP	IP	OP	IP	OP	IP
Total hospitals
Total	52	45	26	25	34	34	10	10	18	18	64	64	125	116	18	18	100	93
Hospital bed size
<100 beds	27%	29%	23%	24%	24%	24%	20%	20%	33%	33%	31%	30%	25%	27%	44%	44%	21%	20%
100–199 beds	19%	20%	12%	16%	12%	12%	20%	20%	22%	22%	16%	16%	13%	14%	17%	17%	18%	18%
200–299 beds	15%	18%	31%	32%	35%	35%	0%	0%	17%	17%	31%	33%	17%	17%	17%	17%	16%	17%
300–499 beds	10%	11%	15%	16%	24%	24%	40%	40%	6%	6%	6%	5%	19%	21%	11%	11%	18%	19%
≥500 beds	29%	22%	19%	12%	3%	3%	20%	20%	22%	22%	14%	16%	25%	22%	11%	11%	27%	25%
Unknown	0%	0%	0%	0%	3%	3%	0%	0%	0%	0%	2%	2%	2%	0%	0%	0%	0%	0%
Hospital teaching status
Nonteaching	69%	67%	42%	40%	56%	56%	70%	70%	61%	61%	72%	70%	70%	68%	50%	50%	70%	68%
Teaching	31%	33%	58%	60%	44%	44%	30%	30%	39%	39%	28%	30%	30%	32%	50%	50%	30%	32%
Hospital urban/rural location
Rural	13%	9%	8%	4%	0%	0%	10%	10%	11%	11%	2%	2%	18%	18%	17%	17%	9%	9%
Urban	87%	91%	92%	96%	100%	100%	90%	90%	89%	89%	98%	98%	82%	82%	83%	83%	91%	91%
Hospital ownership
For-profit	2%	0%	4%	4%	6%	6%	20%	20%	17%	17%	17%	17%	2%	2%	6%	6%	23%	20%
Government	6%	4%	31%	32%	3%	3%	20%	20%	0%	0%	9%	9%	19%	18%	17%	17%	12%	13%
Not for-profit	87%	89%	65%	60%	85%	85%	60%	60%	83%	83%	66%	66%	72%	75%	72%	72%	57%	58%
Unknown	6%	7%	0%	4%	6%	6%	0%	0%	0%	0%	8%	8%	6%	5%	6%	6%	8%	9%

Abbreviations: IP, inpatient; OP, outpatient.

Table 3 Adjusted cost, payment, and LOS

	Outpatient			Inpatient
	Mean	95%	CI	Mean	95%	CI
Costs
East North Central	$488	$387	$616	$3,336	$2,705	$4,115
East South Central	$408	$323	$515	$2,894	$2,347	$3,569
Mid-Atlantic	$395	$313	$499	$5,835	$4,733	$7,195
Mountain	$569	$450	$720	$4,472	$3,596	$5,562
New England	$429	$340	$541	$4,885	$3,953	$6,035
Pacific	$610	$483	$769	$6,671	$5,412	$8,224
South Atlantic	$698	$553	$881	$3,979	$3,231	$4,900
West North Central	$530	$419	$672	$5,192	$4,169	$6,467
West South Central	$802	$635	$1,012	$3,520	$2,857	$4,337
Overall	$533	$422	$673	$4,383	$3,561	$5,394
Payment
East North Central	$281	$157	$502	$7,984	$6,111	$10,431
East South Central	$527	$293	$949	$4,038	$3,090	$5,278
Mid-Atlantic	$187	$104	$334	$7,070	$5,428	$9,209
Mountain	$319	$175	$580	$9,001	$6,406	$12,647
New England	$245	$137	$438	$7,897	$6,051	$10,305
Pacific	$574	$321	$1,028	$8,183	$6,291	$10,644
South Atlantic	$434	$242	$776	$5,551	$4,271	$7,216
West North Central	$567	$311	$1,034	$6,490	$4,760	$8,850
West South Central	$476	$266	$852	$5,617	$4,319	$7,305
Overall	$374	$209	$670	$6,689	$5,146	$8,696
LOS, days
East North Central				3.8	3.2	4.4
East South Central				4.4	3.8	5.2
Mid-Atlantic				5.7	4.9	6.7
Mountain				3.8	3.3	4.5
New England				4.4	3.8	5.2
Pacific				5.0	4.2	5.8
South Atlantic				4.2	3.6	5.0
West North Central				4.0	3.4	4.7
West South Central				4.1	3.5	4.9
Overall				4.4	3.7	5.1

Abbreviation: LOS, length of stay.

Figure 2 Hospital net benefit/loss based on adjusted mean results.

Table S1 Unadjusted cost, payment, and LOS

	Outpatient				Inpatient
	Visits	Median	Mean	SD	Visits	Median	Mean	SD
Costs
East North Central	22,069	$229	$463	$739	3,673	$2,686	$5,068	$8,409
East South Central	10,438	$138	$341	$548	2,866	$2,868	$4,314	$6,882
Mid-Atlantic	22,191	$172	$364	$557	3,708	$4,966	$8,445	$12,101
Mountain	4,292	$195	$480	$764	613	$4,972	$7,710	$8,757
New England	18,407	$195	$402	$590	933	$4,990	$7,827	$9,905
Pacific	25,426	$260	$596	$944	5,146	$6,592	$9,873	$12,783
South Atlantic	38,253	$418	$650	$918	9,030	$3,775	$6,432	$10,910
West North Central	2,464	$78	$428	$743	528	$5,503	$8,462	$11,072
West South Central	17,361	$423	$746	$1,676	5,916	$3,554	$5,820	$8,609
Overall	160,901	$255	$532	$931	32,413	$4,114	$6,853	$10,528
Payment
East North Central	22,069	$152	$506	$1,289	3,673	$5,835	$10,105	$21,617
East South Central	10,438	$465	$839	$1,154	2,866	$3,644	$4,781	$5,867
Mid-Atlantic	22,191	$120	$313	$558	3,708	$5,997	$9,284	$14,430
Mountain	4,292	$186	$538	$1,064	613	$7,145	$12,062	$21,070
New England	18,407	$289	$380	$648	933	$7,685	$9,668	$9,833
Pacific	25,426	$322	$1,012	$1,988	5,146	$7,575	$10,701	$15,849
South Atlantic	38,253	$245	$691	$1,322	9,030	$5,250	$7,829	$12,588
West North Central	2,464	$498	$815	$1,053	528	$6,145	$7,567	$6,933
West South Central	17,361	$254	$747	$1,920	5,916	$5,704	$7,788	$12,484
Overall	160,901	$220	$585	$1,353	32,413	$6,114	$8,731	$14,069
LOS
East North Central					3,673	4.0	4.3	3.3
East South Central					2,866	5.0	5.2	3.8
Mid-Atlantic					3,708	5.0	7.1	6.8
Mountain					613	4.0	5.0	4.1
New England					933	4.0	5.2	5.6
Pacific					5,146	5.0	6.2	5.6
South Atlantic					9,030	4.0	5.3	5.8
West North Central					528	3.0	4.6	4.5
West South Central					5,916	4.0	5.2	4.3
Overall					32,413	4.0	5.5	5.2

Abbreviation: LOS, length of stay.