严重处方阿片类药物引起的呼吸抑制或过量的风险因素：商业保险和退伍军人健康事务人群的比较。
Risk Factors for Serious Prescription Opioid-Induced Respiratory Depression or Overdose: Comparison of Commercially Insured and Veterans Health Affairs Populations.
机构信息
Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia.
Venebio Group, LLC, Richmond, Virginia.
出版信息
Pain Med. 2018 Jan 1;19(1):79-96. doi: 10.1093/pm/pnx038.
OBJECTIVE
To characterize the risk factors associated with overdose or serious opioid-induced respiratory depression (OIRD) among medical users of prescription opioids in a commercially insured population (CIP) and to compare risk factor profiles between the CIP and Veterans Health Administration (VHA) population.
SUBJECTS AND METHODS
Analysis of data from 18,365,497 patients in the IMS PharMetrics Plus health plan claims database (CIP) who were dispensed a prescription opioid in 2009 to 2013. Baseline factors associated with an event of serious OIRD among 7,234 cases and 28,932 controls were identified using multivariable logistic regression. The CIP risk factor profile was compared with that from a corresponding logistic regression among 817 VHA cases and 8,170 controls in 2010 to 2012.
RESULTS
The strongest associations with serious OIRD in CIP were diagnosed substance use disorder (odds ratio [OR] = 10.20, 95% confidence interval [CI] = 9.06-11.40) and depression (OR = 3.12, 95% CI = 2.84-3.42). Other strongly associated factors included other mental health disorders; impaired liver, renal, vascular, and pulmonary function; prescribed fentanyl, methadone, and morphine; higher daily opioid doses; and concurrent psychoactive medications. These risk factors, except depression, vascular disease, and specific opioids, largely aligned with VHA despite CIP being substantially younger, including more females and less chronic disease, and having greater prescribing prevalence of higher daily opioid doses, specific opioids, and most selected nonopioids.
CONCLUSIONS
Risk factor profiles for serious OIRD among US medical users of prescription opioids with private or public health insurance were largely concordant despite substantial differences between the populations in demographics, clinical conditions, health care delivery systems, and clinical practices.
目的
在商业保险人群（CIP）中描述处方阿片类药物医学使用者中与过量或严重阿片类药物引起的呼吸抑制（OIRD）相关的风险因素，并比较 CIP 和退伍军人健康管理局（VHA）人群之间的风险因素特征。
方法
对 IMS PharMetrics Plus 健康计划理赔数据库（CIP）中 2009 年至 2013 年期间接受处方阿片类药物治疗的 18365497 名患者的数据进行分析。使用多变量逻辑回归确定了 7234 例严重 OIRD 事件和 28932 例对照者的基线因素。将 CIP 风险因素特征与 2010 年至 2012 年期间在 817 例 VHA 病例和 8170 例对照者中相应的逻辑回归进行比较。
结果
在 CIP 中，与严重 OIRD 最强相关的因素是诊断为物质使用障碍（OR=10.20，95%置信区间[CI]=9.06-11.40）和抑郁（OR=3.12，95% CI=2.84-3.42）。其他强相关因素包括其他心理健康障碍、肝功能、肾功能、血管功能和肺功能受损；开处方的芬太尼、美沙酮和吗啡；更高的每日阿片类药物剂量；以及同时使用的精神活性药物。这些风险因素，除了抑郁、血管疾病和特定的阿片类药物外，与 VHA 基本一致，尽管 CIP 人群明显更年轻，包括更多的女性和更少的慢性疾病，并且更普遍地开出更高的每日阿片类药物剂量、特定阿片类药物和大多数选定的非阿片类药物。
结论
尽管人群在人口统计学、临床状况、医疗服务提供系统和临床实践方面存在显著差异，但使用私人或公共健康保险的美国处方阿片类药物医学使用者发生严重 OIRD 的风险因素特征基本一致。
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