DRUG DISORDERS AND CARDIOVASCULAR-DISEASE - THE IMPACT ON ANNUAL HOSPITAL LENGTH OF STAY FOR THE MEDICARE POPULATION

We studied 3,942,868 Medicare patients (comprised of elderly and disab led) discharged with cardiovascular disease (CVD) during 1987, of whic h 41,095 (1%) had a drug disorder. Among this small subgroup, the perc ent of those overlapping with an alcohol and/or mental disorder is 33% for the elderly and 47% for the disabled. The presence of a drug diso rder discharge diagnosis is associated with an excess of 329,650 days of hospital care and $174,498,071 in hospital charges as illustrated b y a 51% increase in average annual days in the hospital for the elderl y, and a similar 61% increase for the disabled. The concomitant increa se in average annual discharges offers an explanation. Clinical progre ssion in drug disorder severity (six categories were defined) is assoc iated with increasing lengths of stay; for example, drug dependence co morbidities present longer lengths of stay than drug abuse comorbiditi es. Among the 12 categories of CVD defined, patients with rheumatic he art disease, hypertensive heart disease, hypertension, and other venou s disorders were those whose length of stay experienced the largest pe rcent increase when a drug disorder was present. When drug disorders c ompete with alcohol and/or mental disorders in a general linear model predicting average annual length of stay, they remain significant at t he p < .001 level.