Prevalence, Trends, and Outcomes of Cannabis Use Disorder in Adolescent Hospitalizations with Cyclic Vomiting Syndrome in the United States, 2007-2017

Background: Cyclic vomiting syndrome (CVS) is a chronic functional gastrointestinal disorder characterized by discrete episodes of recurrent vomiting frequently leading to multiple emergency department visits and hospitalizations. Some patients with CVS use cannabis due to its antiemetic and anxiolytic effects. However, chronic cannabis use is associated with a similar pattern of severe nausea and vomiting called cannabinoid hyperemesis syndrome. There exists a relationship between cannabis use and CVS but the burden and epidemiology of cannabis use disorder (CUD) among adolescents with CVS is poorly defined. Our objective was to examine the trends, outcomes, and predictors of CUD among adolescent hospitalizations with CVS in the United States (US) from 2007-2017.

Methods: This was a serial cross-sectional analysis of CVS-related hospitalizations among adolescents aged 14-21 years within the Healthcare Cost and Utilization Project’s National Inpatient Sample from 2008-2017. International Classification of Diseases (ICD-9 and ICD-10) diagnostic codes were used to identify hospitalizations due to CVS and those with concurrent CUD. Elixhauser comorbidity software was used to identify comorbidities. The outcomes of interest were the prevalence and trends in the proportion of CVS-related hospitalizations with CUD. Other outcomes included disposition status and predictors of discharge to other facilities such as other acute facilities, skilled nursing facilities, and intermediate care facilities (adverse discharge). Cochran-Armitage trend test was used to assess trends. Multivariable survey logistic regression was used to analyze predictors of adverse discharge. P-value <0.05 was considered significant.

Results: From 2007 through 2017, there were 40,406 hospitalizations due to CVS, among which 6,258 (15.5%) had concurrent CUD. CUD among CVS hospitalizations increased significantly from 7.0% in 2007 to 12.1% in 2017 (P <0.001). The characteristics of CVS hospitalizations with concurrent CUD were: 77.8% 18-21 years of age, 51.5% male, 59.0% Caucasian/White. The mean Length of Stay (LOS) of CVS hospitalizations with CUD was 3.3 ± 0.1 days. In terms of disposition, 0.08% died prior to discharge, 95.9 were discharged home, and 4.0% were transferred or discharged to other acute facilities, skilled nursing facilities, and intermediate care facilities. In multivariable logistic regression analysis, age 14-17 years (odds ratio (OR) 1.11, 95% confidence interval (CI): 2.09-7.79; P< 0.0001), psychiatric disorders (OR 3.69; 95% CI 1.59-8.53 ; P<0.002) and depression (OR 4.04; 95% CI 2.11-7.74; P<0.001) were associated with higher odds of discharge to other facilities.

Conclusion: In this nationally representative study, there was a significant increase in the proportion of CVS hospitalization with concurrent CUD among adolescents aged 14-21 years in the US from 2007-2017. Focused attention to mental health disorders can potentially decrease adverse discharges and improve outcomes. The role of CUD in CVS requires further study to improve our understanding and management of CVS.