Chaudhary Muhammad Ali, Scully Rebecca, Jiang Wei, Chowdhury Ritam, Zogg Cheryl K, Sharma Meesha, Ranjit Anju, Koehlmoos Tracey, Haider Adil H, Schoenfeld Andrew J
Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T. H. Chan School of Public Health, Boston, MA, USA.
Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Am J Surg. 2017 Nov;214(5):792-797. doi: 10.1016/j.amjsurg.2017.05.013. Epub 2017 Jun 7.
Inappropriate use of prescription opioids is a growing public-health issue. We sought to estimate the proportion of traumatic injury patients using legal prescription opioids up to 1-year after hospitalization.
We used 2006-2014 claims data from TRICARE insurance to identify adults hospitalized secondary to trauma between 2007 and 2013. Prescription opioid use was evaluated for one-year post-discharge. Risk-adjusted Cox Proportional-hazards models were used to evaluate predictors of opioid discontinuation.
Only 1% of patients sustained legal prescription opioid use at 1-year following trauma. Lower socioeconomic status (HR 0.92, 95% CI 0.87-0.98) and higher injury severity (HR 0.88, 95% CI 0.84-0.91) were associated with sustained use. Younger patients (HR 1.12, 95% CI 1.04-1.21) and Black patients (HR 1.09, 95% CI 1.04-1.15) were found to have a higher likelihood of opioid discontinuation.
In this population, adult patients who sustained trauma were not at high risk of sustained legal prescription opioid use.
处方阿片类药物的不当使用是一个日益严重的公共卫生问题。我们试图估算创伤患者在住院后长达1年使用合法处方阿片类药物的比例。
我们使用了2006 - 2014年TRICARE保险的理赔数据，以识别2007年至2013年间因创伤住院的成年人。对出院后1年的处方阿片类药物使用情况进行了评估。使用风险调整后的Cox比例风险模型来评估阿片类药物停用的预测因素。
创伤后1年只有1%的患者持续使用合法处方阿片类药物。社会经济地位较低（风险比0.92，95%置信区间0.87 - 0.98）和损伤严重程度较高（风险比0.88，95%置信区间0.84 - 0.91）与持续使用有关。发现年轻患者（风险比1.12，95%置信区间1.04 - 1.21）和黑人患者（风险比1.09，95%置信区间1.04 - 1.15）停用阿片类药物的可能性更高。
在这一人群中，遭受创伤的成年患者持续合法使用处方阿片类药物的风险不高。
