腰痛与物质使用：美国老年腰痛患者中阿片类物质使用和依赖的诊断和管理编码增加。
Low Back Pain and Substance Use: Diagnostic and Administrative Coding for Opioid Use and Dependence Increased in U.S. Older Adults with Low Back Pain.
机构信息
Geriatric Research Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland.
Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland.
出版信息
Pain Med. 2021 Apr 20;22(4):836-847. doi: 10.1093/pm/pnaa428.
OBJECTIVE
Low back pain (LBP) is a leading cause of pain and disability. Substance use complicates the management of LBP, and potential risks increase with aging. Despite implications for an aging, diverse U.S. population, substance use and LBP comorbidity remain poorly defined. The objective of this study was to characterize LBP and substance use diagnoses in older U.S. adults by age, gender, and race.
DESIGN
Cross-sectional study of a random national sample.
SUBJECTS
Older adults including 1,477,594 U.S. Medicare Part B beneficiaries.
METHODS
Bayesian analysis of 37,634,210 claims, with 10,775,869 administrative and 92,903,649 diagnostic code assignments.
RESULTS
LBP was diagnosed in 14.8±0.06% of those more than 65 years of age, more in females than in males (15.8±0.08% vs. 13.4±0.09%), and slightly less in those more than 85 years of age (13.3±0.2%). Substance use diagnosis varied by substance: nicotine, 9.6±0.02%; opioid, 2.8±0.01%; and alcohol, 1.3±0.01%. Substance use diagnosis declined with advancing age cohort. Opioid use diagnosis was markedly higher for those in whom LBP was diagnosed (10.5%) than for those not diagnosed with LBP (1.5%). Most older adults (54.9%) with an opioid diagnosis were diagnosed with LBP. Gender differences were modest. Relative rates of substance use diagnoses in LBP were modest for nicotine and alcohol.
CONCLUSIONS
Older adults with LBP have high relative rates of opioid diagnoses, irrespective of gender or age. Most older adults with opioid-related diagnoses have LBP, compared with a minority of those not opioid diagnosed. In caring for older adults with LBP or opioid-related diagnoses, health systems must anticipate complexity and support clinicians, patients, and caregivers in managing pain comorbidities. Older adults may benefit from proactive incorporation of non-opioid pain treatments. Further study is needed.
目的
下背痛（LBP）是疼痛和残疾的主要原因。物质使用使 LBP 的管理变得复杂，并且随着年龄的增长，潜在风险会增加。尽管美国人口老龄化和多样化，但物质使用和 LBP 合并症仍未得到明确界定。本研究的目的是根据年龄、性别和种族描述美国老年成年人的 LBP 和物质使用诊断。
设计
一项针对随机全国样本的横断面研究。
受试者
包括 1477594 名美国医疗保险 B 部分受益人的老年人。
方法
对 37634210 份索赔进行贝叶斯分析，其中 10775869 份为行政索赔，92903649 份为诊断代码分配。
结果
65 岁以上人群中 LBP 的诊断率为 14.8±0.06%，女性多于男性（15.8±0.08% vs. 13.4±0.09%），85 岁以上人群略低（13.3±0.2%）。物质使用诊断因物质而异：尼古丁，9.6±0.02%；阿片类药物，2.8±0.01%；和酒精，1.3±0.01%。随着年龄组的推进，物质使用诊断下降。与未诊断为 LBP 的患者相比，诊断为 LBP 的患者的阿片类药物使用诊断率明显更高（10.5%）。大多数患有阿片类药物诊断的老年患者（54.9%）被诊断为 LBP。性别差异不大。尼古丁和酒精的物质使用诊断的相对比率在 LBP 中适中。
结论
患有 LBP 的老年成年人阿片类药物诊断率相对较高，无论性别或年龄如何。与未被诊断为阿片类药物的患者相比，大多数患有阿片类药物相关诊断的老年患者都患有 LBP。在治疗患有 LBP 或阿片类药物相关诊断的老年成年人时，医疗系统必须预期复杂性，并为临床医生、患者和护理人员管理疼痛合并症提供支持。老年成年人可能受益于非阿片类疼痛治疗的积极纳入。需要进一步研究。
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