Hello, I am one of the second year ID fellows at VUMC. I’ve been working on a project this year to try and look at possible trends of serious infections in persons who inject drugs. In the midst of the opioid epidemic, we are seeing significant cases of young people having to spend a lot of time in the hospital with severe, life threatening infections.
Our plan is to look at this in several ways with several hypotheses.
One, we plan to look at the trends here in the state of Tennessee. To do this, we will use hospital discharge data from the dept of health from 2010-2017. We will look at ICD 9/10 codes for severe infections (inpatient admissions for endocarditis, osteomyelitis, septic arthritis, epidural abscess, extremity skin/soft tissue infection). Using this data, we’ve planned to look at the total numbers and also the numbers of infections in persons who also carry a diagnosis of hepatitis C or substance use disorder (primarily opioids). We plan to look at this on a case per 100,000 persons.
Secondly, we want to look at differences in the numbers of these infections among the grand divisions in TN (East, Middle, West TN). The thought is that East TN has been the epicenter of the opioid crisis in TN, so we thought it would be interesting to look at this to see if admissions for infections were correlating with this. We are planning to use the same ICD 9/10 codes but just separating the patients into a Grand Division based on the county they were discharged from.
Thirdly, we want to look at how the numbers of these infections in TN compare to the nation as a whole. To do this, we will look at a national database called HCUP. Unfortunately, this dataset is a little less sophisticated. We can basically enter ICD 9/10 codes and generate numbers that match those codes. We can break those down based on age, race, sex, and payer though, which we plan to do and look at.
I know I am leaving a lot of details out. We know we have some limitations to our study, notably determining a denominator. For that, we’ve planned to try and use a diagnosis of either hepatitis C or substance use disorder as surrogates for intravenous drug use (this has been done in other studies). Also, reliance on administrative data has it’s inherent constraints.
Our hope is to try and produce the most impactful study we can with what we have available to us here. We think that there is something interesting to uncover here. If anyone has any thoughts or tips on how to potentially make this more meaningful we are all ears and certainly appreciate it