科罗拉多州与大麻相关的心理健康急诊就诊情况。
Mental Health-related Emergency Department Visits Associated With Cannabis in Colorado.
机构信息
Department of Environmental Epidemiology, Occupational Health, and Toxicology, Colorado Department of Public Health and Environment, Denver, CO.
Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO.
出版信息
Acad Emerg Med. 2018 May;25(5):526-537. doi: 10.1111/acem.13393. Epub 2018 Apr 10.
BACKGROUND
Cannabis legalization in Colorado resulted in increased cannabis-associated health care utilization. Our objective was to examine cooccurrence of cannabis and mental health diagnostic coding in Colorado emergency department (ED) discharges and replicate the study in a subpopulation of ED visits where cannabis involvement and psychiatric diagnosis were confirmed through medical review.
METHODS
We collected statewide ED International Classification of Diseases, 9th Revision, Clinical Modification diagnoses from the Colorado Hospital Association and a subpopulation of ED visits from a large, academic hospital from 2012 to 2014. Diagnosis codes identified visits associated with mental health and cannabis. Codes for mental health conditions and cannabis were confirmed by manual records review in the academic hospital subpopulation. Prevalence ratios (PRs) of mental health ED discharges were calculated to compare cannabis-associated visits to those without cannabis. Rates of mental health and cannabis-associated ED discharges were examined over time.
RESULTS
Statewide data demonstrated a fivefold higher prevalence of mental health diagnoses in cannabis-associated ED visits (PR = 5.35, 95% confidence interval [CI], 5.27-5.43) compared to visits without cannabis. The hospital subpopulation supported this finding with a fourfold higher prevalence of psychiatric complaints in cannabis attributable ED visits (PR = 4.87, 95% CI = 4.36-5.44) compared to visits not attributable to cannabis. Statewide rates of ED visits associated with both cannabis and mental health significantly increased from 2012 to 2014 from 224.5 to 268.4 per 100,000 (p < 0.0001).
CONCLUSIONS
In Colorado, the prevalence of mental health conditions in ED visits with cannabis-associated diagnostic codes is higher than in those without cannabis. There is a need for further research determining if these findings are truly attributed to cannabis or merely coincident with concurrent increased use and availability.
背景
科罗拉多州大麻合法化导致与大麻相关的医疗保健利用率增加。我们的目的是研究科罗拉多州急诊部（ED）出院患者中与大麻相关的精神健康诊断编码的同时出现情况，并在通过医疗审查确认大麻参与和精神科诊断的 ED 就诊亚群中复制该研究。
方法
我们从科罗拉多州医院协会收集了全州范围的 ED 国际疾病分类，第 9 修订版，临床修正诊断，并从一家大型学术医院收集了 ED 就诊的亚群。精神健康和大麻相关的就诊通过手动记录审查在学术医院亚群中确认诊断编码。计算精神健康 ED 出院的患病率比（PR），以比较与大麻相关的就诊与无大麻的就诊。研究了随时间推移精神健康和大麻相关 ED 出院的发生率。
结果
全州数据显示，与无大麻的就诊相比，与大麻相关的 ED 就诊中精神健康诊断的患病率高五倍（PR = 5.35，95%置信区间 [CI]，5.27-5.43）。医院亚群支持这一发现，与大麻相关的 ED 就诊中出现精神科投诉的患病率高四倍（PR = 4.87，95%CI = 4.36-5.44），与非大麻归因的就诊相比。与大麻和精神健康均相关的 ED 就诊的全州发生率从 2012 年到 2014 年从每 100,000 人 224.5 例增加到 268.4 例（p < 0.0001）。
结论
在科罗拉多州，ED 就诊中与大麻相关诊断编码相关的精神健康状况的患病率高于无大麻的就诊。需要进一步研究确定这些发现是否确实归因于大麻，还是仅仅与同期使用和可用性的增加巧合。
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