在被诊断患有慢性疼痛疾病的老年医疗保险受益人中，阿片类药物的使用情况以及阿尔茨海默病和相关痴呆症的存在情况。
Opioid use and the presence of Alzheimer's disease and related dementias among elderly Medicare beneficiaries diagnosed with chronic pain conditions.
作者信息
Shen Chan, Zhao Xiaohui, Dwibedi Nilanjana, Wiener R Constance, Findley Patricia A, Sambamoorthi Usha
机构信息
Departments of Health Services Research and Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], Morgantown, WV, USA.
出版信息
Alzheimers Dement (N Y). 2018 Dec 7;4:661-668. doi: 10.1016/j.trci.2018.10.012. eCollection 2018.
INTRODUCTION
There is scant literature on the use of opioids among community-dwelling elderly with Alzheimer's disease and related dementias (ADRD).
METHODS
We adopted a retrospective, cross-sectional study design using Medicare Current Beneficiary Survey data from 2006 to 2013. The study sample included elderly community-dwelling Medicare beneficiaries who were diagnosed with chronic pain conditions and had Medicare fee-for-service plans for the entire year. We conducted bivariate χ test and multivariate logistic regression to examine the relationship between opioid use and ADRD status.
RESULTS
The study sample included 19,347 Medicare beneficiaries; 7.7% of them had ADRD. We found no statistically significant difference in opioid use by ADRD status in the unadjusted analysis; however, controlling for various factors, those with ADRD had lower odds of opioid use (adjusted odds ratio = 0.81, 95% confidence interval = 0.71, 0.93) than those without ADRD.
DISCUSSION
This population-based study suggests that elderly Medicare beneficiaries with ADRD and chronic pain conditions may have undertreatment of pain.
引言
关于社区居住的患有阿尔茨海默病及相关痴呆症（ADRD）的老年人使用阿片类药物的文献很少。
方法
我们采用回顾性横断面研究设计，使用2006年至2013年医疗保险当前受益人的调查数据。研究样本包括社区居住的老年医疗保险受益人，他们被诊断患有慢性疼痛疾病，并全年拥有医疗保险按服务收费计划。我们进行了双变量χ检验和多变量逻辑回归，以检验阿片类药物使用与ADRD状态之间的关系。
结果
研究样本包括19347名医疗保险受益人；其中7.7%患有ADRD。在未经调整的分析中，我们发现ADRD状态对阿片类药物使用没有统计学上的显著差异；然而，在控制各种因素后，患有ADRD的人使用阿片类药物的几率（调整后的优势比=0.81，95%置信区间=0.71，0.93）低于没有ADRD的人。
讨论
这项基于人群的研究表明，患有ADRD和慢性疼痛疾病的老年医疗保险受益人可能存在疼痛治疗不足的情况。
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