RAND Corporation, Boston, Massachusetts.
Section of General Internal Medicine, School of Medicine, Boston University, Boston, Massachusetts.
J Am Geriatr Soc. 2019 Jan;67(1):128-132. doi: 10.1111/jgs.15659. Epub 2018 Nov 24.
To examine the effect of age on the likelihood of PIP of opioids and the effect of PIP on adverse outcomes.
Retrospective cohort study.
Data from multiple state agencies in Massachusetts from 2011 to 2015.
Adult Massachusetts residents (N=3,078,163) who received at least one prescription opioid during the study period; approximately half (1,589,365) aged 50 and older.
We measured exposure to 5 types of PIP: high-dose opioids, coprescription with benzodiazepines, multiple opioid prescribers, multiple opioid pharmacies, and continuous opioid therapy without a pain diagnosis. We examined 3 adverse outcomes: nonfatal opioid overdose, fatal opioid overdose, and all-cause mortality.
The rate of any PIP increased with age, from 2% of individuals age 18 to 29 to 14% of those aged 50 and older. Older adults also had higher rates of exposure to 2 or more different types of PIP (40-49, 2.5%; 50-69, 5%; ≥70, 4%). Of covariates assessed, older age was the greatest predictor of PIP. In analyses stratified according to age, any PIP and specific types of PIP were associated with nonfatal overdose, fatal overdose, and all-cause mortality in younger and older adults.
Older adults are more likely to be exposed to PIP, which increases their risk of adverse events. Strategies to reduce exposure to PIP and to improve outcomes in those already exposed will be instrumental to addressing the opioid crisis in older adults. J Am Geriatr Soc 67:128-132, 2019.
考察年龄对阿片类药物 PIP 可能性的影响，以及 PIP 对不良结局的影响。
回顾性队列研究。
2011 年至 2015 年马萨诸塞州多个州立机构的数据。
在研究期间接受至少一种阿片类药物处方的成年马萨诸塞州居民（N=3078163）；约一半（1589365 人）年龄在 50 岁及以上。
我们测量了 5 种 PIP 的暴露情况：高剂量阿片类药物、与苯二氮䓬类药物联合处方、多名阿片类药物开方者、多家阿片类药物药店、以及无疼痛诊断的连续阿片类药物治疗。我们研究了 3 种不良结局：非致命性阿片类药物过量、致命性阿片类药物过量和全因死亡率。
任何 PIP 的发生率随年龄增长而增加，从 18-29 岁人群的 2%增加到 50 岁及以上人群的 14%。老年人也有更高的暴露于 2 种或更多不同类型的 PIP 的风险（40-49 岁，2.5%；50-69 岁，5%；≥70 岁，4%）。在评估的协变量中，年龄是 PIP 的最大预测因素。在根据年龄分层的分析中，任何 PIP 和特定类型的 PIP 与年轻和老年成年人的非致命性过量、致命性过量和全因死亡率相关。
老年人更有可能接触到 PIP，这增加了他们发生不良事件的风险。减少 PIP 暴露并改善已经暴露的人群的结局的策略对于解决老年人阿片类药物危机至关重要。美国老年医学会杂志 67：128-132，2019 年。
