美国医疗补助计划参保者中处方类阿片类药物新使用者的阿片类药物过量发生率和风险因素：一项队列研究。
Incidence rates of and risk factors for opioid overdose in new users of prescription opioids among US Medicaid enrollees: A cohort study.
机构信息
Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman of School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
出版信息
Pharmacoepidemiol Drug Saf. 2020 Aug;29(8):931-938. doi: 10.1002/pds.5067. Epub 2020 Jul 10.
PURPOSE
To measure incidence rates of and risk factors for opioid overdose among new users of prescription opioids in the Medicaid population.
METHODS
A cohort study using Medicaid claims from four states (1999-2012) among adults continuously enrolled in Medicaid for ≥3 years free of opioid prescriptions and opioid overdose before cohort entry. Exposure and outcome of interest were prescription opioid use and apparent incident opioid overdose identified in inpatient and outpatient claims (sensitivity ≈ 97%; positive predictive value ≈ 87%), respectively.
RESULTS
Among new prescription opioid users (1 336 140 persons; 246 466 person-years), the overall opioid overdose incidence rate per 100 000 person-years was 247.1 (95% confidence interval [CI], 227.5-266.7), with 251.0 (CI, 188.6-313.5) in 2002 and 225.5 (CI, 142.0-309.0) in 2012. A lower hazard for opioid overdose was seen for age 65-80 years (adjusted hazard ratio [HR], 0.50; CI, 0.37-0.66) and 80-100 years (0.35; 0.23-0.52) vs 18-35 years; females (0.79; 0.67-0.93) vs males; and other/unknown race/ethnicity (0.71; 0.54-0.93) vs whites. A higher hazard was seen for initial opioid dose in morphine milligram equivalents (MMEs), 50-100 MME/day (1.52; 1.24-1.86) and >100 MME/day (1.98; 1.55-2.53), vs <50 MME/day; prior diagnosis of substance use disorders (2.30; 1.91-2.79) or mental health conditions (1.75; 1.47-2.08); and prior prescriptions for benzodiazepines (1.43; 1.13-1.81).
CONCLUSION
In Medicaid enrollees in four study states during 2002 to 2012, opioid overdose incidence rate per 100 000 person-years among apparent new users of prescription opioids was 247.1, with 251.0 in 2002 and 225.5 in 2012. Younger ages, white race/ethnicity, higher MME opioid daily doses, prior substance use disorders, mental health conditions, and benzodiazepine prescriptions were associated with a higher risk of opioid overdose incidence.
目的
在医疗补助人群中，衡量处方类阿片新使用者的阿片类药物过量发生率及其危险因素。
方法
这是一项使用来自四个州（1999 年至 2012 年）的医疗补助数据的队列研究，纳入了连续 3 年以上在队列入组前没有接受过阿片类药物处方和阿片类药物过量的医疗补助成年人。感兴趣的暴露和结局分别为处方类阿片药物使用和住院及门诊索赔中明显的阿片类药物过量（敏感性≈97%；阳性预测值≈87%）。
结果
在新使用处方类阿片药物的患者中（1336140 人；2464660 人年），每 100000 人年的阿片类药物过量发生率为 247.1（95%置信区间[CI]，227.5-266.7），2002 年为 251.0（CI，188.6-313.5），2012 年为 225.5（CI，142.0-309.0）。与 18-35 岁年龄组相比，65-80 岁（调整后的危害比[HR]，0.50；CI，0.37-0.66）和 80-100 岁（0.35；0.23-0.52）年龄组发生阿片类药物过量的风险较低；女性（0.79；0.67-0.93）比男性；其他/未知种族/民族（0.71；0.54-0.93）比白人。起始阿片类药物剂量（以吗啡毫克当量[MME]计）为 50-100 MME/天（1.52；1.24-1.86）和>100 MME/天（1.98；1.55-2.53）的患者，与<50 MME/天的患者相比，发生阿片类药物过量的风险更高；有物质使用障碍（2.30；1.91-2.79）或精神健康状况（1.75；1.47-2.08）既往诊断史；以及有苯二氮䓬类药物（1.43；1.13-1.81）处方史。
结论
在 2002 年至 2012 年期间参与四项研究的医疗补助州的参保者中，新使用处方类阿片药物的患者每 100000 人年的阿片类药物过量发生率为 247.1，2002 年为 251.0，2012 年为 225.5。年龄较小、白人、较高的 MME 每日阿片类药物剂量、既往物质使用障碍、精神健康状况和苯二氮䓬类药物处方与阿片类药物过量发生率的增加相关。
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