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Identifying Co-Occurring Disorders among Opioid Users Using Linked Hospital Care and Mortality Data: Capstone to an Existing FY18 OS-PCORTF Project

Improve Public Health Surveillance and Expand Researchers’ Access to Data on Health Outcomes of Opioid Users with Co-occurring Substance and Mental Health Issues
  • Centers for Disease Control and Prevention (CDC)
Start Date
  • 5/1/2019
  • Use of Enhanced Publically-Funded Data Systems for Research
  • Use of Clinical Data for Research
  • Linking of Clinical and Other Data for Research


STATUS: Active Project


According to the 2017 National Survey on Drug Use and Health (NSDUH), the number of adults with substance use disorders (SUD) who had any mental illness was about 8.5 million and the number with severe mental illness was about 3.1 million people. Based on 2015 NSDUH data, approximately 1.5 million adults with severe mental illness had misused opioids in the past year, which is equivalent to a co-occurrence of opioid misuse and severe mental illness in an estimated 1 in 8 adults (13%) . It is important for the National Hospital Care Survey (NCHS) to monitor the role that co-occurring disorders plays in opioid-related morbidity and mortality outcomes.

A previously funded OS-PCORTF FY18 project at NCHS titled, Enhancing Identification of Opioid-Involved Health Outcomes Using Linked Hospital Care and Mortality Data, has provided enhanced methodology to accurately identify a hospital patient’s use of opioids in any form (i.e., used as directed, misused in a manner contrary to provider instructions, used intentionally to become intoxicated or for the purpose of self-harm, taken accidentally, etc.). Additionally, the FY18 OS-PCORTF project identified the specific legal or illicit opioid agent taken. This OS-PCORTF FY19 Capstone project will build upon the FY18 project methodology to flag evidence of co-occurring mental health disorders. Both projects use algorithms that determine the occurrence of an event (the use of opioids, type of opioid agent taken, and presence of a substance use or mental health issue) by selecting combinations of coded items (diagnoses, procedures, lab results, etc.) and terms contained in free-text (clinical notes, cause of death literal text). Both projects will result in the creation of linked files that combine three data sources to enable access to data that follows patients with an opioid event for one year following hospital discharge. This will allow for retrospective analysis of the extent to which specific opioid agents and the co-occurrence of mental health disorders were involved in hospital encounters preceding post-discharge deaths.


The goal of this project is to improve public health surveillance and expand researchers’ access to data on health outcomes of opioid users with co-occurring substance use and mental health issues by completion of the following objectives:

  • Develop a new set of algorithms that uses the linked NHCS/ National Death Index (NDI)/ National Vital Statistics System restricted mortality data, drug specific information (NVSS-M-DO) files to identify hospital encounters and death records involving patients with co-occurring disorders using medical code-based algorithm and natural language processing.

  • Conduct a study to validate algorithms from this project and the FY18 Enhancing Identification project to identify the use of opioids and the existence of co-occurring disorders.

  • Apply the validated algorithm to identify prevalence of opioid-involved emergency department visits and co-occurring disorders among opioid users in the 2016 linked NHCS, NDI and NVSS-M-DO files.

  • Provide data on opioid use and co-occurring disorders and make that data available through: 1) the NCHS Research Data Center, and 2) a previously developed interactive web portal for NHCS participating hospitals.

  • Disseminate research findings from the validation study and the application of the validated algorithm to calculate prevalence of co-occurring disorders among opioid users in the linked data between NHCS, NDI, and the NVSS-M-DO files.