2000 - 2011年退伍军人健康管理局中患有阿片类药物使用障碍的老年人的死亡率。
Mortality among older adults with opioid use disorders in the Veteran's Health Administration, 2000-2011.
作者信息
Larney Sarah, Bohnert Amy S B, Ganoczy Dara, Ilgen Mark A, Hickman Matthew, Blow Fred C, Degenhardt Louisa
机构信息
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia; Alpert Medical School, Brown University, Providence, RI, USA.
Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA.
出版信息
Drug Alcohol Depend. 2015 Feb 1;147:32-7. doi: 10.1016/j.drugalcdep.2014.12.019. Epub 2014 Dec 30.
BACKGROUND
The population of people with opioid use disorders (OUD) is aging. There has been little research on the effects of aging on mortality rates and causes of death in this group. We aimed to compare mortality in older (≥ 50 years of age) adults with OUD to that in younger (<50 years) adults with OUD and older adults with no history of OUD. We also examined risk factors for specific causes of death in older adults with OUD.
METHODS
Using data from the Veteran's Health Administration National Patient Care Database (2000-2011), we compared all-cause and cause-specific mortality rates in older adults with OUD to those in younger adults with OUD and older adults without OUD. We then generated a Cox regression model with specific causes of death treated as competing risks.
RESULTS
Older adults with OUD were more likely to die from any cause than younger adults with OUD. The drug-related mortality rate did not decline with age. HIV-related and liver-related deaths were higher among older OUD compared to same-age peers without OUD. There were very few clinically important predictors of specific causes of death.
CONCLUSION
Considerable drug-related mortality in people with OUD suggests a need for greater access to overdose prevention and opioid substitution therapy across the lifespan. Elevated risk of liver-related death in older adults may be addressed through antiviral therapy for hepatitis C virus infection. There is an urgent need to explore models of care that address the complex health needs of older adults with OUD.
背景
患有阿片类物质使用障碍（OUD）的人群正在老龄化。关于老龄化对该群体死亡率和死因的影响，此前研究甚少。我们旨在比较老年（≥50岁）OUD患者与年轻（<50岁）OUD患者以及无OUD病史的老年人的死亡率。我们还研究了老年OUD患者特定死因的危险因素。
方法
利用退伍军人健康管理局国家患者护理数据库（2000 - 2011年）的数据，我们比较了老年OUD患者与年轻OUD患者以及无OUD的老年人的全因死亡率和特定原因死亡率。然后，我们生成了一个Cox回归模型，将特定死因视为竞争风险。
结果
老年OUD患者比年轻OUD患者更易死于任何原因。与药物相关的死亡率并未随年龄下降。与无OUD的同龄人相比，老年OUD患者中与HIV相关和与肝脏相关的死亡人数更高。特定死因的临床重要预测因素很少。
结论
OUD患者中相当数量的药物相关死亡表明，在整个生命周期中需要更多地获得过量预防和阿片类物质替代疗法。老年成年人中与肝脏相关死亡风险的升高可通过丙型肝炎病毒感染的抗病毒治疗来解决。迫切需要探索能够满足老年OUD患者复杂健康需求的护理模式。
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