Since the U.S. rate of opioid use-associated infective endocarditis (OUA IE) hospitalizations in 2016 was 3.86/100,000 for rural and 3.49/100,000 for urban residents, the current study estimated the Kentucky OUA IE hospitalization rates for 2016-2019, describing differences in rural-urban residency trends, demographics, relevant comorbidities, and discharge disposition; OUA IE hospitalization rates between counties with and without syringe services programs (SSPs) were also compared.
The study used Kentucky statewide inpatient discharge records from 2016 to 2019. An OUA IE hospitalization was identified by an infective endocarditis discharge diagnosis in any diagnosis field and a concurrent diagnosis indicating opioid use. Rurality was determined based on the 2013 Rural-Urban Continuum Codes (RUCC). The study found that Kentucky's rate of OUA IE hospitalizations in 2016 was 8.9/100,000, with no significant variation between rural and urban residents. By 2019, the average rate for urban residents doubled to 17.9/100,000, significantly higher than the rural resident rate, 13.2/100,000. There were no significant rural-urban differences in percentages of those with concurrent diagnoses of HIV (<1 percent) or HCV (>60 percent). Counties that established SSPs in 2017-2018 had a 39.4- percent increase in OUA IE rates from 2016 to 2019, while counties without SSPs had a 79.5-percent increase. The study concluded that the estimated 2016 Kentucky rates of OUA IE hospitalizations were two times higher than reported national rates, highlighting Kentucky as one of the areas most affected by this particular opioid use disorder complication. Despite challenges and barriers to the effectiveness of SSPs as a harm reduction measure, this study suggests a positive effect that should be further investigated. (publisher abstract modified)