Moeller Jamie, Farmer Julie, Quiñonez Carlos
Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
PLoS One. 2017 May 1;12(5):e0176125. doi: 10.1371/journal.pone.0176125. eCollection 2017.
The use of prescription opioids has increased dramatically in Canada in recent decades. This rise in opioid prescriptions has been accompanied by increasing rates of opioid-related abuse and addiction, creating serious public health challenges in British Columbia (BC), one of Canada's most populated provinces. Our study explores the relationship between dental pain and prescription opioid use among residents in BC. We used data from the 2003 Canadian Community Health Survey (CCHS), which asked respondents about their use of specific analgesic medications, including opioids, and their history of tooth pain in the past month. We used logistic regression, controlling for potential confounding variables, to identify the predictive value of socioeconomic factors, oral health-related variables, and dental care utilization indicators. The Relative Index of Inequality (RII) was calculated to assess the magnitude of socioeconomic inequalities in the use of particular analgesics by incorporating income-derived ridit values into a binary logistic regression model. Our results showed that conventional non-opioid based analgesics (such as aspirin or Tylenol) and opioids were more likely to be used by those who had experienced a toothache in the past month than those who did not report experiencing a toothache. The use of non-opioid painkillers to relieve tooth pain was associated with more recent and more frequent dental visits, better self-reported oral health, and a greater income. Conversely, a lower household income was associated with a preference for opioid use to relieve tooth pain. The RII for recent opioid use and conventional painkiller use were 2.06 (95% CI: 1.75-2.37) and 0.62 (95% CI: 0.35-0.91), respectively, among those who experienced recent tooth pain, suggesting that adverse socioeconomic conditions may influence the need for opioid analgesics to relieve dental pain. We conclude that programs and policies targeted at improving the dental health of the poor may help to reduce the use of prescription opioids, thereby narrowing health inequalities within the broader society.
近几十年来，加拿大处方类阿片类药物的使用急剧增加。阿片类药物处方量的这种增长伴随着与阿片类药物相关的滥用和成瘾率的上升，给加拿大人口最多的省份之一不列颠哥伦比亚省（BC省）带来了严峻的公共卫生挑战。我们的研究探讨了BC省居民牙齿疼痛与处方类阿片类药物使用之间的关系。我们使用了2003年加拿大社区健康调查（CCHS）的数据，该调查询问了受访者关于他们对包括阿片类药物在内的特定止痛药物的使用情况，以及他们在过去一个月内的牙痛病史。我们使用逻辑回归，控制潜在的混杂变量，以确定社会经济因素、口腔健康相关变量和牙科护理利用指标的预测价值。通过将收入衍生的ridit值纳入二元逻辑回归模型，计算不平等相对指数（RII），以评估使用特定止痛药物时社会经济不平等的程度。我们的结果表明，与未报告牙痛的人相比，过去一个月内经历过牙痛的人更有可能使用传统的非阿片类止痛药物（如阿司匹林或泰诺）和阿片类药物。使用非阿片类止痛药缓解牙痛与最近更频繁的牙科就诊、更好的自我报告口腔健康状况以及更高的收入相关。相反，较低的家庭收入与更倾向于使用阿片类药物缓解牙痛有关。在近期经历过牙痛的人群中，近期使用阿片类药物和传统止痛药的RII分别为2.06（95%CI：1.75 - 2.37）和0.62（95%CI：0.35 - 0.91），这表明不利的社会经济状况可能会影响使用阿片类止痛药缓解牙痛的需求。我们得出结论，旨在改善贫困人口牙齿健康的项目和政策可能有助于减少处方类阿片类药物的使用，从而缩小更广泛社会中的健康不平等。
