September 2018

Hospitalizations for Opioid Overdose – Population Differences

This research brief is part of a series produced by the PA Health Care Cost Containment Council (PHC4)
that examines opioid-related hospitalizations. This edition examines population differences in
hospitalization rates for opioid overdose among Pennsylvania residents (2017 data) and examines rate
increases (2016 to 2017). It includes Pennsylvania residents, age 15 and older, who were admitted to a
Pennsylvania general acute care hospital. This analysis does not include overdoses that did not result in
a hospital admission (e.g., those treated with naloxone and/or treated in the emergency department
and not admitted to the hospital or overdose deaths that occurred outside the hospital setting).

Key Findings
In 2017, there were 3,500 hospitalizations for opioid
overdose—divided almost evenly between heroin Heroin
overdoses at 1,753 hospitalizations and pain medication
overdoses at 1,747 hospitalizations.  Highest rates by demographic:
Rate per 100,000
This brief looks at these hospitalizations with a focus on Statewide 16.5
demographic differences among Pennsylvania residents Residents age 15-34 28.8
(by age, race/ethnicity, income, rural/urban residency and Hispanic residents 19.3
Lower income residents 40.5
female/male). It highlights…
Urban residents 19.0
Male residents 24.1
Residents with the highest rates of
hospitalization for overdose of heroin or pain  Highest increases by demographic:
medication. Statewide ↑ 12.5%
Residents age 55 and older ↑ 35.8%
Residents with the highest increases in Hispanic residents ↑ 48.8%
hospitalization rates for overdose of heroin or Lower income residents ↑ 40.8%
Urban residents ↑ 14.0%
pain medication between 2016 and 2017.
Male residents ↑ 13.5%
In 2017, Pennsylvanians were hospitalized at the rate of
16.5 per 100,000 residents for both heroin overdose and Pain Medication
pain medication overdose. Between 2016 and 2017, the
rate of admission increased 12.5% for heroin overdose  Highest rates by demographic:
and decreased 2.4% for overdose of pain medication. Rate per 100,000
Statewide 16.5
Residents age 55 and older 19.8
Overdose Hospitalization Rate per 100,000 Residents Black (non-Hispanic) residents 18.5
16.9 Lower income residents 27.5
16.5 16.5 Urban residents 16.8
Male residents 16.8
14.7
 Highest increases by demographic:
2016 2017 2016 2017
Statewide ↓ 2.4%
Residents age 15-34 ↑ 8.0%
Heroin Pain Medication Hispanic residents ↑ 31.1%
Lower income residents ↑ 8.7%
↑ 12.5% ↓ 2.4% Male residents ↑ 7.8%
Rates decreased for both rural and urban residents.

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 By Age…

Heroin Overdose
Rate per 100,000 Residents
2016 Rate
2017 Rate

26.6 28.8
14.7 16.5 15.9 18.1
3.9 5.3
Statewide Age 15-34 Age 35-54 Age 55+

↑ 12.5% ↑ 8.5% ↑ 13.9% ↑ 35.8%

In 2017, residents age 15-34 had the highest hospitalization rate for heroin overdose at 28.8 per 100,000
residents. While residents age 55 and older had the lowest rate at 5.3 per 100,000, they had the highest rate
increase—35.8% between 2016 (when the rate was 3.9) and 2017. The rate more than tripled for this age
group since 2013 (when the rate was 1.5 per 100,000). Rate increases between 2016 and 2017 for other age
groups: age 15-34 (↑8.5%; from 26.6 to 28.8) and age 35-54 (↑13.9%; from 15.9 to 18.1).

Pain Medication Overdose

Rate per 100,000 Residents
2016 Rate
2017 Rate

21.1 19.8
16.9 16.5 18.5 17.9
10.2 11.0

Statewide Age 15-34 Age 35-54 Age 55+

↓ 2.4% ↑ 8.0% ↓ 3.4% ↓ 6.2%

In 2017, residents age 55 and older had the highest rate of hospitalization for overdose of pain medication at
19.8 per 100,000 residents. Residents age 15-34 had the only rate increase between 2016 and 2017 (↑8.0%;
from 10.2 to 11.0). Other age groups had rate decreases: age 35-54 (↓3.4%; from 18.5 to 17.9) and age 55+
(↓6.2%; from 21.1 to 19.8).

Rate Calculations: Rates include residents age 15 and older and were calculated using PHC4 hospital discharge data and US Census
Bureau data (2016 and 2017 population figures). Rates by income were based on Census 2016 estimates of median household income
and population at the zip code level. Rate increases/decreases were calculated using unrounded rates.

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 By Race/Ethnicity…

Heroin Overdose
Rate per 100,000 Residents
2016 Rate
2017 Rate

16.7 19.3
14.7 16.5 12.4 13.0 15.0 16.3

Statewide Black (non- Hispanic White (non-

Hispanic) Hispanic)

↑ 12.5% ↑ 34.7% ↑ 48.8% ↑ 8.8%

In 2016, white (non-Hispanic) residents had the highest rate of hospitalization for heroin overdose at 15.0 per
100,000 residents. By 2017, Hispanic residents had the highest rate at 19.3 per 100,000. That figure represents
an increase of 48.8% between 2016 (when the rate was 13.0) and 2017. In 2017, black (non-Hispanic) and
white (non-Hispanic) residents had similar rates at 16.7 and 16.3, respectively. The rate increase for black
(non-Hispanic) residents was 34.7% (from 12.4 to 16.7). The rate increase for white (non-Hispanic) residents
was 8.8% (from 15.0 to 16.3).

Pain Medication Overdose

Rate per 100,000 Residents
2016 Rate
2017 Rate

16.9 16.5 19.6 18.5 17.7 17.0

7.2 9.4

Statewide Black (non- Hispanic White (non-

Hispanic) Hispanic)

↓ 2.4% ↓ 5.7% ↑ 31.1% ↓ 3.6%

In 2017, black (non-Hispanic) residents had the highest hospitalization rate for pain medication overdose at
18.5 per 100,000 residents, followed by white (non-Hispanic) residents at 17.0 per 100,000. Hispanic residents
had the lowest hospitalization rate for pain medication overdose at 9.4 per 100,000 residents; yet, that figure
is a 31.1% increase from the 2016 rate of 7.2. Rates decreased for black (non-Hispanic) residents (↓5.7%; from
19.6 to 18.5) and white (non-Hispanic) residents (↓3.6%; from 17.7 to 17.0).

Note: Other race/ethnicity groups not displayed due to low volume.

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 By Household Income…

Heroin Overdose
Rate per 100,000 Residents
2016 Rate
2017 Rate

40.5
28.8
14.7 16.5 15.5 17.1 12.0 13.2 10.0 9.9

Statewide <$30,000 $30,000 to $60,000 to $90,000+

<$60,000 <$90,000

↑ 12.5% ↑ 40.8% ↑ 10.7% ↑ 9.6% ↓ 1.1%

In 2017, residents living in areas where the average household income is less than $30,000 a year had the
highest rate of hospitalization for heroin overdose at 40.5 per 100,000 residents. This group also had the
highest rate increase (↑40.8%) between 2016 and 2017. Residents living in areas where the average annual
household income was $90,000 or more had the lowest rate (9.9 per 100,000) and was the only income group
with a rate decrease between 2016 and 2017.

Pain Medication Overdose

Rate per 100,000 Residents
2016 Rate
2017 Rate

25.3 27.5
16.9 16.5 19.2 18.9
13.1 11.8
9.8 10.4

Statewide <$30,000 $30,000 to $60,000 to $90,000+

<$60,000 <$90,000

↓ 2.4% ↑ 8.7% ↓ 1.8% ↓ 9.5% ↑ 6.7%

In 2017, residents living in areas where the average household income is less than $30,000 a year had the
highest rate of hospitalization for pain medication overdose at 27.5 per 100,000 residents. This income group
also had the highest rate increase (↑8.7%) between 2016 and 2017. Residents living in areas where the
average annual household income was $90,000 or more had the lowest rate (10.4 per 100,000), a 6.7% rate
increase since 2016.

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 By Rural/Urban Residency…

Heroin Overdose
Rate per 100,000 Residents
2016 Rate
2017 Rate

19.0
14.7 16.5 16.7
9.3 9.7

Statewide Rural Urban

↑ 12.5% ↑ 5.0% ↑ 14.0%

In 2017, residents living in urban counties had a higher rate of hospitalization for heroin overdose at 19.0 per
100,000 residents. That figure represents a 14.0% increase between 2016 (when the rate was 16.7) and 2017.
For residents living in rural counties, the 2017 rate of 9.7 per 100,000 is a 5.0% increase over the 2016 rate of
9.3. Over the longer-term (between 2000 and 2017), the rate of hospitalization for heroin overdose increased
588% for rural residents and 334% for urban residents.

Pain Medication Overdose

Rate per 100,000 Residents
2016 Rate
2017 Rate

17.3
16.9 16.8
16.5
15.7 15.6

Statewide Rural Urban

↓ 2.4% ↓ 1.0% ↓ 2.9%

In 2017, the hospitalization rate for overdose of pain medication was 16.8 per 100,000 for residents living in
urban counties and 15.6 per 100,000 for residents living in rural counties. Between 2016 and 2017, the rate
for urban residents decreased 2.9% (from 17.3 to 16.8). The rate for rural residents decreased 1.0% (from 15.7
to 15.6).

Urban counties include: Allegheny, Beaver, Berks, Bucks, Chester, Cumberland, Dauphin, Delaware, Erie, Lackawanna, Lancaster,
Lebanon, Lehigh, Luzerne, Montgomery, Northampton, Philadelphia, Westmoreland, and York. All other counties are considered rural.
(Source: Center for Rural PA)

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 By Female/Male…

Heroin Overdose

Rate per 100,000 Residents 2016 Rate

2017 Rate

21.2 24.1
14.7 16.5
8.5 9.4

Statewide Female Male

↑ 12.5% ↑ 10.4% ↑ 13.5%

In 2017, male residents had a higher rate of hospitalization for heroin overdose at 24.1 per 100,000 residents.
Males also had a higher rate increase (↑13.5%) between 2016 and 2017.

Pain Medication Overdose

Rate per 100,000 Residents
2016 Rate
2017 Rate

18.1
16.9 16.5 16.8
16.1 15.6

Statewide Female Male

↓ 2.4% ↓ 10.7% ↑ 7.8%

In 2016, female residents had a higher rate of hospitalization for pain medication overdose at 18.1 per
100,000 residents. By 2017, male residents had the higher rate at 16.8 per 100,000. The rate increased for
males (↑7.8%) between 2016 and 2017 and decreased for females (↓10.7%).

About PHC4
Created by the PA General Assembly in 1986, the PA Health Care Cost Containment Council (PHC4) is an independent state agency charged
with collecting, analyzing and reporting information that can be used to improve the quality and restrain the cost of health care in the
state. Today, PHC4 is a recognized national leader in public health care reporting. PHC4 is governed by a 25-member board of directors,
representing business, labor, consumers, health care providers, insurers and state government.

Joe Martin, Executive Director

225 Market Street, Suite 400, Harrisburg, PA 17101
717-232-6787
www.phc4.org

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 Heroin Overdose - Rate of Hospitalization per 100,000 County Residents
Two-Year Period 2016 and 2017
Statewide 31.2
Philadelphia 54.7
Beaver 44.5
Delaware 44.3
Cambria 41.0
Bucks 40.9
Washington 37.9
Allegheny 37.8
York 35.6
Berks 34.3
Carbon 33.5
Erie 33.2
Dauphin 32.1
Westmoreland 31.7
Lebanon 30.9
Mercer 30.8
Lawrence 30.2
Butler 30.1 Counties not reported
due to low volume
Northampton 28.7
Adams
Fayette 27.1 Bedford
Indiana 26.3 Cameron
Clarion
Montgomery 26.3 Clearfield
Clinton
Lehigh 26.2 Elk
Lancaster 25.3 Forest
Fulton
Schuylkill 25.0 Greene
Huntingdon
Chester 24.9
Jefferson
Columbia 24.9 Juniata
McKean
Lycoming 22.2 Mifflin
Bradford 22.1 Montour
Northumberland
Luzerne 21.8 Perry
Pike
Armstrong 21.7 Potter
Crawford 18.2 Snyder
Somerset
Cumberland 17.3 Sullivan
Franklin Susquehanna
16.7
Tioga
Lackawanna 14.8 Union
Venango
Blair 14.7 Warren
Centre 12.7 Wayne
Wyoming
Monroe 12.7

0.0 10.0 20.0 30.0 40.0 50.0 60.0

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 Pain Medication Overdose - Rate of Hospitalization per 100,000 County Residents
Two-Year Period 2016 and 2017
Statewide 33.3
Cambria 62.4
Columbia 56.8
Lackawanna 54.7
Blair 53.7
Philadelphia 44.9
Mercer 44.6
Fayette 44.2
Westmoreland 43.4
Delaware 40.2
Lawrence 39.9
Erie 39.8
Lycoming 39.1
Allegheny 38.4
Northampton 32.7
Luzerne 32.6
York 32.6
Bucks 31.3 Counties not reported
due to low volume
Armstrong 30.8
Adams
Monroe 30.3 Bedford
Cameron
Bradford 30.1
Clarion
Dauphin 29.4 Clearfield
Clinton
Beaver 28.0 Elk
Lancaster 27.5 Forest
Fulton
Schuylkill 27.5 Greene
Huntingdon
Lebanon 27.3 Jefferson
Franklin 27.0 Juniata
McKean
Lehigh 25.8 Mifflin
Montour
Washington 24.7
Northumberland
Chester 24.4 Perry
Pike
Montgomery 22.7 Potter
Berks 22.6 Snyder
Somerset
Carbon 22.3 Sullivan
Susquehanna
Crawford 21.0
Tioga
Indiana 20.7 Union
Venango
Cumberland 19.7 Warren
Butler 16.0 Wayne
Wyoming
Centre 10.5

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0

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