The Public Health and Economic Impact of Drug Overdose Out-of-Hospital Cardiac Arrest in the United States

Abstract

Objective

To calculate disability-adjusted life years (DALY) and labor productivity loss due to drug overdose out-of-hospital cardiac arrest (DO-OHCA) and compare its contribution to the burden of disease and economic impact of all-cause nontraumatic out-of-hospital cardiac arrest (OHCA) in the US.

Methods

We performed a retrospective observational cohort analysis of all adult (age ≥18 years) nontraumatic emergency medical services-treated OHCA events, including those due to DO-OHCA, from the national Cardiac Arrest Registry to Enhance Survival (CARES) database from January 1, 2017 and December 31, 2020. The main outcome measures of interest were disability-adjusted life years, annual, and lifetime labor productivity loss over the 4-year study period. The findings for the study population were extrapolated to a national level using the CARES population catchment and U.S. population estimates by year.

Results

A total of 378,088 adult OHCA events, including 23,252 DO-OHCA (6.2%) met study inclusion criteria. The DO-OHCA DALY increased from 156,707 in 2017 to 265,692 in 2020. Per year, DO-OHCA contributed to 11.4%, 12.0%, 10.5%, and 11.4% of all OHCA DALY lost from 2017-2020, respectively. The mean annual and lifetime productivity losses for all OHCA were stable over time (annual: $47K in 2017 to $50K in 2020; lifetime: $647K in 2017 to $692K in 2020). The CARES population catchment increased by 39.8% over the study period (102.6 M in 2017 to 143.4 M in 2020). For DO-OHCA, the mean annual productivity loss was approximately 30% higher than non-DO-OHCA ($64K vs. $49K in 2020, respectively). The mean lifetime productivity loss for DO-OHCA was 2.5 times higher than non-DO-OHCA ($1.6 M vs. $630K in 2020, respectively).

Conclusions

The DALY due to DO-OHCA has increased over time with expansion of the CARES dataset, but its relative contribution to total OHCA DALY (all non-traumatic etiologies) remained fairly stable. The DO-OHCAs represent approximately 6% of all adult non-traumatic EMS-treated OHCA events but has a disproportionately greater economic impact. Continued efforts to reduce DO-OHCA through public health initiatives are warranted to lessen the societal impact of OHCA in the U.S.

Acknowledgments

CARES participating sites can be located at: https://mycares.net/sitepages/map.jsp

Authors’ contributions

RAC and TJM designed the study, analyzed the data, and wrote the manuscript. BHN performed the statistical analysis and participated in manuscript writing. MCK participated in data analysis, manuscript writing and editing. ACS, CNW, and EJA participated in manuscript writing and editing. All authors have read and approved of the manuscript.

Disclosure statement

RAC: NHLBI K23H166692, NHLBI R21HL156198; BHN: BHN’s company, OptiStatim, LLC was paid a consulting fee for statistical services related to the manuscript; ACS: none. CNW: none. MCK: none. EAJ: none. TJM: NHLBI R21HL156198. CARES receives funding from the American Red Cross and the American Heart Association.

Additional information

Funding

This study was funded by a grant from the National Heart, Lung, and Blood Institute (R21HL156198).