Centre for Pain and Disability Management, Adult Rehabilitation, Geriatrics and Palliative Care Program, Eastern Regional Health Authority, St. John's, NL, Canada.
Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
Pain. 2021 Nov 1;162(11):2737-2749. doi: 10.1097/j.pain.0000000000002264.
Health administrative data provide a potentially robust information source regarding the substantial burden chronic pain exerts on individuals and the health care system. This study aimed to use health administrative data to estimate comorbidity prevalence and annual health care utilization associated with chronic pain in Newfoundland and Labrador, Canada. Applying the validated Chronic Pain Algorithm to provincial Fee-for-Service Physician Claims File data (1999-2009) established the Chronic Pain (n = 184,580) and No Chronic Pain (n = 320,113) comparator groups. Applying the Canadian Chronic Disease Surveillance System coding algorithms to Claims File and Provincial Discharge Abstract Data (1999-2009) determined the prevalence of 16 comorbidities. The 2009/2010 risk and person-year rate of physician and diagnostic imaging visits and hospital admissions were calculated and adjusted using the robust Poisson model with log link function (risks) and negative binomial model (rates). Results indicated a significantly higher prevalence of all comorbidities and up to 4 times the odds of multimorbidity in the Chronic Pain Group (P-value < 0.001). Chronic Pain Group members accounted for 58.8% of all physician visits, 57.6% of all diagnostic imaging visits, and 54.2% of all hospital admissions in 2009/2010, but only 12% to 16% of these were for pain-related conditions as per recorded diagnostic codes. The Chronic Pain Group had significantly higher rates of physician visits and high-cost hospital admission/diagnostic imaging visits (P-value < 0.001) when adjusted for demographics and comorbidities. Observations made using this methodology supported that people identified as having chronic pain have higher prevalence of comorbidities and use significantly more publicly funded health services.
健康行政数据为评估慢性疼痛给个人和医疗保健系统带来的巨大负担提供了一个潜在的强大信息来源。本研究旨在利用健康行政数据来估计加拿大纽芬兰和拉布拉多省慢性疼痛的共病患病率和年度医疗保健利用情况。应用经验证的慢性疼痛算法对省级按服务收费医师索赔档案数据（1999-2009 年）进行分析，确定了慢性疼痛（n=184580）和无慢性疼痛（n=320113）对照组。应用加拿大慢性疾病监测系统编码算法对索赔档案和省级出院摘要数据（1999-2009 年）进行分析，确定了 16 种共病的患病率。计算并调整了 2009/2010 年医生和诊断性影像学就诊和住院的风险和人次率，使用稳健泊松模型（风险）和负二项模型（率），采用对数链接函数。结果表明，慢性疼痛组所有共病的患病率显著更高，且多种共病的患病风险高达 4 倍（P 值<0.001）。2009/2010 年，慢性疼痛组成员占所有医生就诊的 58.8%、所有诊断性影像学就诊的 57.6%和所有住院的 54.2%，但根据记录的诊断代码，这些就诊中只有 12%至 16%是与疼痛相关的疾病。在调整了人口统计学特征和共病情况后，慢性疼痛组的医生就诊和高成本住院/诊断性影像学就诊的人次率显著更高（P 值<0.001）。本研究采用的方法观察到，被认定为患有慢性疼痛的人群共病患病率更高，且使用更多的公共资助医疗服务。
