Objective:

To quantify trends in U.S. stroke hospitalizations involving stimulant drug abuse from 2016-2022 and to compare patient characteristics, in-hospital mortality, resource utilization, and discharge disposition to non-users.

Background:

Stimulant drug use(SDU) disorder associated stroke  is a growing public health concern, linked to a substantially increased risk of hemorrhagic events. However, comprehensive national trends and outcomes in the contemporary era of rising stimulant drug abuse is not reported at national level. 

Design/Methods:

A retrospective cohort study using the National Inpatient Sample (2016-2022) identified adult acute ischemic and hemorrhagic stroke hospitalizations. Stimulant drug use was flagged by ICD-10 codes. Multivariable logistic, generalized linear, and multinomial logistic regression models analyzed trends and outcomes, adjusting for patient demographics, comorbidities, and hospital-level factors.

Results:

Among 4,366,799 stroke hospitalizations (2016-2022), 97,630 (2.24%) involved stimulant use, increasing from 1.77% to 2.76% (aOR 1.08/year, 95%CI 1.07-1.10, p<0.001). Stimulant-associated strokes occurred in younger patients (53.8 vs 69.7 years), predominantly males (68.5% vs 50.4%), with higher proportions of Black patients (39.0% vs 17.1%), Medicaid coverage (45.7% vs 9.6%), and lowest income quartile (48.5% vs 30.1%). Hemorrhagic strokes were disproportionately higher with stimulant use (30.6% vs 20.9%, p<0.001), particularly with methamphetamine (33.5%). After full adjustment, stimulant use independently increased mortality (aOR 1.25, 95%CI 1.12-1.40, p<0.001) with adjusted probabilities of 8.1% vs 6.6%. Length of stay was 17% longer (aRR 1.17, 95%CI 1.11-1.22, p<0.001; adjusted means 7.19 vs 5.93 days). Hospital charges averaged $124,300 vs $86,900 (unadjusted), with significant temporal growth (aRR 1.063/year, p<0.001). Disposition patterns showed  65% higher likelihood of leaving against medical advice (RRR 1.65, 95%CI 1.38-1.98, p<0.001), increase tendency of this behavior (interaction RRR 1.07/year, p=0.003) as compared to discharge to home (RRR 0.74, 95%CI 0.68-0.80, p<0.001).

Conclusions:

Stroke associated with SDU affecting young, socioeconomically disadvantaged populations, with increased hemorrhagic risk, mortality and healthcare utilization, indicate need for early behavioral interventions.