Table 4.
Characteristics and adjusted odds ratio of discharge against medical advice (DAMA), routine, and transfer discharges among inpatient drug-detoxification hospitalizations for patients aged≥12 years: 2003–2011 Nationwide Inpatient Samples
| Detoxification discharge status | DAMA | Routine | Transfer to further treatment | DAMA (1) vs. routine (0) | DAMA (1) vs. transfer to further treatment (0) | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Sample size, unweighted N (weighted row %) | 36,885 (13.67%) | 208,291 (76.65%) | 25,566 (9.44%) | 219,536b | 54,832b | |||||||
| Weighted column %/Adjusted odds ratio (AOR) | % | (95% CI) | % | (95% CI) | % | (95% CI) | AOR | (95% CI) | p value‡ | AOR | (95% CI) | p value‡ |
| Age group, years | ||||||||||||
| 12–17 | 0.25 | (0.16–0.40) | 0.79 | (0.47–1.34) | 0.91 | (0.59–1.42) | 0.39 | (0.26–0.57) | < 0.001 | 0.34 | (0.19–0.61) | < 0.001 |
| 18–25 | 16.16 | (14.42–18.07) | 13.56 | (12.41–14.79) | 13.82 | (12.51–15.24) | 1.00 | 1.00 | ||||
| 26–34 | 27.20 | (25.96–28.48) | 21.94 | (20.86–23.05) | 20.51 | (19.45–21.62) | 0.98 | (0.93–1.03) | 0.469 | 1.06 | (0.98–1.16) | 0.157 |
| 35–49 | 44.65 | (42.43–46.88) | 45.30 | (43.68–46.94) | 43.39 | (41.34–45.46) | 0.72 | (0.67–0.78) | < 0.001 | 0.85 | (0.76–0.94) | 0.003 |
| 50–64 | 11.17 | (10.10–12.34) | 16.89 | (15.77–18.08) | 18.17 | (16.99–19.42) | 0.53 | (0.48–0.58) | < 0.001 | 0.56 | (0.49–0.63) | < 0.001 |
| 65+ | 0.57 | (0.45–0.71) | 1.51 | (1.32–1.73) | 3.19 | (2.64–3.84) | 0.33 | (0.27–0.40) | < 0.001 | 0.18 | (0.14–0.24) | < 0.001 |
| Sex | ||||||||||||
| Male | 70.99 | (69.35–72.57) | 64.30 | (62.99–65.58) | 64.91 | (63.01–66.76) | ||||||
| Female | 28.87 | (27.29–30.49) | 35.58 | (34.31–36.87) | 35.00 | (33.16–36.89) | 0.88 | (0.85–0.91) | < 0.001 | 0.85 | (0.80–0.91) | < 0.001 |
| Race/Ethnicity | ||||||||||||
| White, non-Hispanic | 43.23 | (38.42–48.18) | 44.48 | (40.77–48.24) | 48.73 | (44.72–52.77) | 1.00 | 1.00 | ||||
| Black, non-Hispanic | 19.98 | (16.75–23.66) | 20.94 | (17.70–24.61) | 20.54 | (17.31–24.20) | 0.84 | (0.74–0.96) | 0.011 | 1.03 | (0.85–1.25) | 0.762 |
| Hispanic | 13.15 | (9.70–17.60) | 8.97 | (7.18–11.17) | 9.95 | (7.86–12.53) | 0.98 | (0.86–1.12) | 0.758 | 1.11 | (0.83–1.47) | 0.481 |
| Asian/Pacific-Islander/Native-American | 0.63 | (0.46–0.86) | 0.68 | (0.52–0.90) | 0.65 | (0.50–0.85) | 1.02 | (0.79–1.32) | 0.851 | 1.37 | (1.01–1.85) | 0.044 |
| Other races, non-Hispanic | 5.52 | (3.68–8.20) | 3.54 | (2.56–4.87) | 3.95 | (2.87–5.40) | 1.07 | (0.88–1.31) | 0.490 | 1.25 | (0.95–1.66) | 0.112 |
| Unknowna | 14.21 | (10.74-18.57) | 17.81 | (14.20–22.10) | 12.39 | (9.66–15.76) | 1.07 | (0.88–1.31) | 0.485 | 1.24 | (0.90–1.69) | 0.183 |
| Household income | ||||||||||||
| Lowest quartile | 37.70 | (33.71–41.87) | 36.93 | (34.05–39.92) | 30.66 | (27.26–34.28) | 1.00 | 1.00 | ||||
| 2nd quartile | 19.81 | (17.95–21.82) | 20.90 | (19.65–22.21) | 21.03 | (18.68–23.59) | 1.00 | (0.93–1.07) | 0.938 | 0.79 | (0.65–0.95) | 0.012 |
| 3rd quartile | 17.03 | (15.28–18.93) | 18.65 | (17.32–20.06) | 21.62 | (18.24–25.43) | 0.93 | (0.86–1.00) | 0.055 | 0.66 | (0.51–0.86) | 0.002 |
| Highest quartile | 16.94 | (14.34–19.91) | 17.68 | (15.99–19.50) | 18.14 | (15.99–20.50) | 0.90 | (0.81–1.00) | 0.060 | 0.78 | (0.66–0.93) | 0.006 |
| Primary expected payer | ||||||||||||
| Medicare | 9.08 | (8.21–10.04) | 11.98 | (11.20–12.80) | 15.13 | (13.36–17.09) | 1.62 | (1.50–1.75) | < 0.001 | 1.38 | (1.20–1.59) | < 0.001 |
| Medicaid | 47.27 | (42.00–52.60) | 38.61 | (34.70–42.67) | 39.92 | (35.29–44.74) | 1.64 | (1.49–1.81) | < 0.001 | 1.60 | (1.33–1.91) | < 0.001 |
| Private | 14.85 | (12.75–17.24) | 23.89 | (21.46–26.50) | 24.35 | (21.30–27.68) | 1.00 | 1.00 | ||||
| Self-pay | 22.08 | (18.33–26.35) | 18.67 | (15.78–21.96) | 12.34 | (10.76–14.13) | 1.68 | (1.49–1.89) | < 0.001 | 2.43 | (1.94–3.06) | < 0.001 |
| Other payers | 6.57 | (4.74–9.04) | 6.62 | (5.41–8.07) | 8.07 | (5.81–11.12) | 1.70 | (1.35–2.13) | < 0.001 | 0.99 | (0.74–1.33) | 0.954 |
| Hospital region | ||||||||||||
| Northeast | 58.49 | (51.60–65.06) | 40.51 | (35.16–46.09) | 51.11 | (44.61–57.58) | 1.00 | 1.00 | ||||
| Midwest | 16.41 | (12.45–21.31) | 22.04 | (17.65–27.17) | 13.67 | (10.98–16.88) | 0.60 | (0.50–0.72) | < 0.001 | 1.30 | (0.89–1.90) | 0.180 |
| South | 17.01 | (12.68–22.43) | 27.08 | (22.91–31.69) | 20.37 | (16.55–24.79) | 0.53 | (0.44–0.63) | < 0.001 | 1.01 | (0.72–1.41) | 0.967 |
| West | 8.10 | (6.25–10.44) | 10.37 | (8.47–12.64) | 14.86 | (11.11–19.59) | 0.77 | (0.65–0.92) | 0.004 | 0.78 | (0.57–1.06) | 0.115 |
| Hospital location | ||||||||||||
| Rural | 5.87 | (3.93–8.67) | 7.01 | (5.36–9.14) | 8.57 | (6.20–11.72) | 1.00 | 1.00 | ||||
| Urban | 94.10 | (91.30–96.04) | 92.84 | (90.71–94.50) | 91.34 | (88.19–93.71) | 1.04 | (0.81–1.33) | 0.768 | 1.75 | (1.28–2.40) | < 0.001 |
| Any-listed alcohol use disorder | ||||||||||||
| No | 55.93 | (51.94–59.85) | 59.05 | (55.91–62.12) | 48.59 | (45.67–51.51) | 1.00 | 1.00 | ||||
| Yes | 44.07 | (40.15–48.06) | 40.95 | (37.88–44.09) | 51.41 | (48.49–54.33) | 1.13 | (1.06–1.21) | < 0.001 | 0.83 | (0.75–0.92) | < 0.001 |
| Any-listed opioid use disorder | ||||||||||||
| No | 18.92 | (16.60–21.47) | 25.36 | (23.21–27.63) | 32.61 | (29.82–35.53) | 1.00 | 1.00 | ||||
| Yes | 81.08 | (78.53–83.40) | 74.64 | (72.37–76.79) | 67.39 | (64.47–70.18) | 1.33 | (1.23–1.45) | < 0.001 | 1.73 | (1.49–2.02) | < 0.001 |
| Any-listed any non-addiction mental health disorderc | ||||||||||||
| No | 67.58 | (65.03–70.03) | 50.19 | (47.39–52.99) | 45.03 | (41.95–48.14) | 1.00 | 1.00 | ||||
| Yes | 32.42 | (29.97–34.97) | 49.81 | (47.01–52.61) | 54.97 | (51.86–58.05) | 0.58 | (0.54–0.62) | < 0.001 | 0.46 | (0.42–0.51) | < 0.001 |
DAMA discharges against medical advice, AOR adjusted odds ratio, CI confidence interval
‡We reduced the significant level to 0.01 due to a relatively large sample. Boldface: p < 0.01
aRace/ethnicity information were not available in some states in some years, which were coded into unknown category
bHospitalizations with missing values or zero trend weight were excluded. The regression model included all variables listed in the first column and controlled for survey year
cAny mental health disorder included adjustment disorders, anxiety disorders, attention-deficit, conduct, and disruptive behavior disorders, impulse control disorders, mood disorders, personality disorders, schizophrenia, psychotic, delusional disorders