DOSE-DIS Dashboard: Nonfatal Overdose Emergency Department and Inpatient Hospitalization Discharge Data

On this dashboard you can:

• View monthly and annual counts and rates of nonfatal overdose emergency department (ED) visits and inpatient hospitalizations, based on discharge data, for participating jurisdictions—both overall and by jurisdiction—beginning in 2018. Data come from the CDC's Drug Overdose Surveillance and Epidemiology Discharge Surveillance (DOSE-DIS) System.

• Data are provided for nonfatal overdoses involving "all drugs" (i.e., drug overdoses involving any drug) as well as specific drugs: all opioids, fentanyl, heroin, all stimulants, cocaine, methamphetamine, and benzodiazepine. Results by age and sex category are available for all participating jurisdictions combined. One-year and 5-year rates of nonfatal drug overdose ED visits are presented by county among participating jurisdictions. Please see "Important Data Considerations" and "Footnotes" sections for more important information about DOSE-DIS.

• View the accessible version of the DOSE-DIS dashboard.
• Read more about the DOSE system.

This dashboard represents the most up-to-date data that CDC's DOSE-DIS system has available and is updated annually with an expected eight-to-ten month lag between end-of-year closeout and dashboard updates to account for data submission and review timelines.

States participating in CDC's DOSE-DIS System that report ED and/or inpatient hospitalization discharge data†

Data from the CDC's Drug Overdose Surveillance and Epidemiology Discharge Surveillance (DOSE-DIS) system come from discharge (billing) information from ED visits and inpatient hospitalizations. CDC processes and reports DOSE-DIS data for the following 8 nonfatal overdose discharge data definitions on the public-facing dashboard:

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These definitions are not mutually exclusive but rather reflect nesting of drug categories depicted in this figure. Some nonfatal overdose visits may involve multiple substances (e.g., a given overdose-related ED visit could have involved both opioids and stimulants). The dashboard includes monthly and annual counts and rates (per 100,000 population) of ED and inpatient hospitalization visits involving nonfatal drug overdoses. This dashboard represents the most up-to-date data from the CDC's DOSE-DIS system, and routine dashboard updates occur annually. Key data considerations for interpretation are provided below the dashboard.

Read more about the DOSE System.

DOSE leverages finalized discharge data from ED visits and inpatient hospitalizations to estimate trends in nonfatal overdoses and calculate burden. Discharge data offer a more complete and accurate understanding of overdose burden compared to syndromic surveillance data (for more information on DOSE syndromic surveillance data, see DOSE-SYS Dashboard). Currently, 34 states and DC share discharge data with DOSE: 31 states and DC share both ED and inpatient hospitalization discharge data, no states share only ED discharge data, and 3 states share only inpatient hospitalization discharge data.

Participating jurisdictions share aggregate data on total ED visits and inpatient hospitalizations and line-level data on nonfatal overdoses with CDC annually, with approximately a 6-month lag between end-of-year closeout and data submission. Whereas syndromic surveillance data are preliminary and may not contain a confirmed diagnosis, discharge data may offer a more complete and accurate estimation of overdose burden in EDs and among hospitalizations. Collected data include patient-level information on age, sex, race, ethnicity, and county of patient residence.

ED and inpatient hospitalization discharge data are collected for administrative/billing purposes. The standardized coding scheme is considered more reliable than self-reports, and less expensive to obtain than survey data or medical chart abstractions. However, billing coders assign diagnosis codes in discharge data and the assigned codes may not provide a fully accurate, comprehensive account of the conditions treated. Diagnosis codes may be reported strategically to optimize reimbursement, and surveillance for drug overdoses using these data may not accurately reflect the true overdose burden.

Additionally, the overdoses identified may not be confirmed by toxicological testing, which is often limited in ED or hospital settings. Data not available by the reporting deadline may not ever be submitted, as data are typically considered final at submission. Comparisons between ED and inpatient hospitalization discharge data should be made with caution, as some states submit ED data only or inpatient hospitalization data only. Although coverage is high within participating states (on average >90% of ED and hospital facilities in participating states), these data are not nationally representative.

Standardized discharge data definitions for categorizing nonfatal all drug, all opioid-, heroin-, fentanyl- benzodiazepine-, all stimulant-, methamphetamine-, and cocaine-involved overdoses are established by CDC. While syndromic surveillance definitions on the DOSE-SYS Dashboard are applied to the chief complaint and diagnosis codes available immediately following a patient encounter, discharge data definitions are applied to International Classification of Diseases, 10^th Revision, Clinical Modification (ICD-10-CM) codes reported in finalized medical billing data discharge diagnosis fields. Jurisdictions submit line-level data on visits involving any T36-T50 ICD-10-CM codes to CDC, which then applies DOSE discharge data definitions to identify initial encounters for nonfatal drug overdoses of unintentional/undetermined intent.

Similar to the syndromic surveillance definitions used on the DOSE-SYS Dashboard, the discharge data definitions are nested.

The tables linked below (Excel file) detail the ICD-10-CM codes used for identifying initial encounters for nonfatal overdoses of unintentional and undetermined intent using DOSE discharge data. Codes that indicated adverse effect of or underdosing are not included in DOSE discharge data definitions used on the DOSE-DIS dashboard. It is important to note that new ICD-10-CM codes, such as those for emerging drugs, may be added to the case definitions as diagnosis codes evolve. This comprehensive approach ensures that all relevant substances contributing to the progression of the drug overdose epidemic are adequately captured in the data submission process.

Access DOSE-DIS data case definitions.

• All visualizations will responsively adjust to your selections, including the summary data points; line graph, bar graph, sex by age pyramid, and county-level heat map. There are radio buttons for drug type above each figure except for the county heat map (the county heat map is only shown for all-drug overdose ED visits). Other selections (e.g., data source, date, jurisdiction) are made at the top of the dashboard.
• Select Data Source: Click on the box to select the desired data source (emergency department visit or inpatient hospitalization discharge data); the selected data source shows up in blue.
• Select Time Frame: Click on the box to select the desired time frame (monthly or annual); if monthly data are selected, an option to Select a Month will be displayed.
• Select a Year: Click on the box to select the desired year.
• View Data for (Select a Jurisdiction or View Overall): Click on the box to select and highlight overdose data by a specific jurisdiction (state or Washington, DC) or overall. Note: Only jurisdictions that submitted the selected data during the selected time frame will be displayed in the drop-down list, so the number of reporting jurisdictions varies.
• Select a Drug: Click on a radio button above each figure/banner to select a drug type. Multiple drugs can be selected for the trend graph when "Overall" (all participating jurisdictions) is selected in the top drop-down.
  
• Reset the Visualizations: Use the reset button below the selection boxes to clear all selections and return to the default settings.
• Simplify the Trend Graph: If the trend graph appears too busy, use the "labels off" toggle button to view a simplified version without labels.
• Analyze Percent Change in the Trend Graph: When viewing annual data, toggle the percent change feature. Hover over any data point in the trend graph to see the percent change from the selected year compared to the previous year.