Collett Garen A, Song Kangwon, Jaramillo Carlos A, Potter Jennifer S, Finley Erin P, Pugh Mary Jo
Departments of Epidemiology and Biostatistics, Medicine, Psychiatry, Anesthesiology, and Rehabilitation Medicine, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
Research, and Polytrauma Rehabilitation Center, South Texas Veterans Healthcare System, 7400 Merton Minter BLVD, San Antonio, TX, USA.
Drugs Real World Outcomes. 2016 Mar;3(1):45-52. doi: 10.1007/s40801-015-0055-0.
The increase in the quantities of central nervous system (CNS)-acting medications prescribed has coincided with increases in overdose mortality, suicide-related behaviors, and unintentional deaths in military personnel deployed in support of the wars in Iraq and Afghanistan. Data on the extent and impact of prescribing multiple CNS drugs among Iraq and Afghanistan Veterans (IAVs) are sparse.
We sought to identify the characteristics of IAVs with CNS polypharmacy and examine the association of CNS polypharmacy with drug overdose and suicide-related behaviors controlling for known risk factors.
This cross-sectional cohort study examined national data of Iraq and Afghanistan Veterans (N = 311,400) who used the Veterans Health Administration (VHA) during the fiscal year 2011. CNS polypharmacy was defined as five or more CNS-acting medications; drug/alcohol overdose and suicide-related behaviors were identified using ICD-9-CM codes. Demographic and clinical characteristics associated with CNS polypharmacy were identified using a multivariable logistic regression model.
We found that 25,546 (8.4 %) of Iraq and Afghanistan Veterans had CNS polypharmacy. Those with only post-traumatic stress disorder (PTSD) (adjusted odds ratio (AOR) 6.50, 99 % confidence interval (CI) 5.96-7.10), only depression (AOR 6.42, 99 % CI 5.86-7.04), co-morbid PTSD and depression (AOR 12.98, 99 % CI 11.97-14.07), and co-morbid traumatic brain injury (TBI), PTSD, and depression (AOR 15.30, 99 % CI 14.00-16.73) had the highest odds of CNS polypharmacy. After controlling for these co-morbid conditions, CNS polypharmacy was significantly associated with drug/alcohol overdose and suicide-related behavior.
CNS polypharmacy was most strongly associated with PTSD, depression, and TBI, and independently associated with overdose and suicide-related behavior after controlling for known risk factors. These findings suggest that CNS polypharmacy may be used as an indicator of risk for adverse outcomes. Further research should evaluate whether CNS polypharmacy may be used as a trigger for evaluation of the current care provided to these individuals.
在支持伊拉克和阿富汗战争的军事人员中，中枢神经系统（CNS）作用药物的处方量增加，与此同时，过量用药死亡率、自杀相关行为和意外死亡也有所增加。关于伊拉克和阿富汗退伍军人（IAV）中开具多种中枢神经系统药物的程度和影响的数据很少。
我们试图确定患有中枢神经系统多药联用的IAV的特征，并在控制已知风险因素的情况下，研究中枢神经系统多药联用与药物过量及自杀相关行为之间的关联。
这项横断面队列研究检查了2011财年使用退伍军人健康管理局（VHA）的伊拉克和阿富汗退伍军人的全国数据（N = 311,400）。中枢神经系统多药联用定义为使用五种或更多中枢神经系统作用药物；使用ICD - 9 - CM编码识别药物/酒精过量及自杀相关行为。使用多变量逻辑回归模型确定与中枢神经系统多药联用相关的人口统计学和临床特征。
我们发现25,546名（8.4%）伊拉克和阿富汗退伍军人存在中枢神经系统多药联用情况。仅患有创伤后应激障碍（PTSD）的退伍军人（调整优势比（AOR）为6.50，99%置信区间（CI）为5.96 - 7.10）、仅患有抑郁症的退伍军人（AOR为6.42，99% CI为5.86 - 7.04）、同时患有PTSD和抑郁症的退伍军人（AOR为- 12.98，99% CI为11.97 - 14.07）以及同时患有创伤性脑损伤（TBI）、PTSD和抑郁症的退伍军人（AOR为15.30，99% CI为14.00 - 16.73）出现中枢神经系统多药联用的几率最高。在控制这些共病情况后，中枢神经系统多药联用与药物/酒精过量及自杀相关行为显著相关。
中枢神经系统多药联用与PTSD、抑郁症和TBI关联最为密切，在控制已知风险因素后，与过量用药及自杀相关行为独立相关。这些发现表明中枢神经系统多药联用可能用作不良后果风险的指标。进一步的研究应评估中枢神经系统多药联用是否可作为评估当前为这些个体提供的护理的触发因素。
