Trends in rates of acetaminophen-related adverse events in the United States

Abstract

Purpose: The goal of this study is to summarize trends in rates of adverse events attributable to acetaminophen use, including hepatotoxicity and mortality.

Methods: A comprehensive analysis of data from three national surveillance systems estimated rates of acetaminophen-related events identified in different settings, including calls to poison centers (2008-2012), emergency department visits (2004-2012), and inpatient hospitalizations (1998-2011). Rates of acetaminophen-related events were calculated per setting, census population, and distributed drug units.

Results: Rates of poison center calls with acetaminophen-related exposures decreased from 49.5/1000 calls in 2009 to 43.5/1000 calls in 2012. Rates of emergency department visits for unintentional acetaminophen-related adverse events decreased from 58.0/1000 emergency department visits for adverse drug events in 2009 to 50.2/1000 emergency department visits in 2012. Rates of hospital inpatient discharges with acetaminophen-related poisoning decreased from 119.8/100 000 hospitalizations in 2009 to 108.6/100 000 hospitalizations in 2011. After 2009, population rates of acetaminophen-related events per 1 million census population decreased for poison center calls and hospitalizations, while emergency department visit rates remained stable. However, when accounting for drug sales, the rate of acetaminophen-related events (per 1 million distributed drug units) increased after 2009. Prior to 2009, the rates of acetaminophen-related hospitalizations had been slowly increasing (p-trend = 0.001).

Conclusions: Acetaminophen-related adverse events continue to be a public health burden. Future studies with additional time points are necessary to confirm trends and determine whether recent risk mitigation efforts had a beneficial impact on acetaminophen-related adverse events. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

Keywords: acetaminophen; emergency department; hospitalizations; overdose; pharmacoepidemiology.

Conflict of interest statement

CONFLICT OF INTEREST

The authors declare no conflict of interest. The opinions in this paper are those of the authors and do not necessarily represent the views of the US FDA.

Published 2015. This article is a U.S. Government work and is in the public domain in the USA.

Figures

Figure 1

Rates of acetaminophen-related events by event setting. AAPCC, American Association of Poison Control Centers; NEISS-CADES, National Electronic Injury Surveillance System – Cooperative Adverse Drug Events Surveillance; NIS, Nationwide Inpatient Sample

Figure 2

Rates of acetaminophen-related events per 1 million census population. ED, emergency department

Figure 3

Rates of acetaminophen-related events per 1 million drug units sold to retail and non-retail channels of distribution. Source for drug units: IMS Health, National Sales Perspectives™. Years 1998–2012. Data extracted April 2014. ED, emergency department