Faculty of Science, School of Pharmacy, University of Waterloo, Kitchener, ON, Canada.
Faculty of Applied Health Sciences, School of Public Health, University of Waterloo, Waterloo, ON, Canada.
Addiction. 2021 Dec;116(12):3482-3493. doi: 10.1111/add.15571. Epub 2021 Jun 25.
BACKGROUND AND AIMS: Existing assessments of the time-trends of opioid-related mortality, hospitalization and emergency department visits in Canada have relied mainly on provincial databases, while national assessments generally do not provide information before 2016. We aimed to estimate Canadian national time trends in opioid-related mortality from 2000 to 2017 and opioid-related hospitalization and emergency department visits between 2000 and 2012. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Residents of all Canadian provinces and territories for which comparable data were available from 2000 to 2017. MEASUREMENTS: We identified opioid-related mortality, hospitalization and emergency department visits using validated algorithms using ICD codes from administrative databases. We calculated crude rates and sex- and age-adjusted rates per million. For hospitalizations, we calculated case-fatality, 90-day and 365-day all-cause mortality and opioid-related re-hospitalization rates. We used Poisson regression to examine the significance of the time trend. FINDINGS: From 2000 to 2017, the adjusted opioid mortality rate in Canada (outside Quebec) increased significantly by 592.9% (from 20.0 opioid deaths per million in 2000 to 118.3 in 2017). The highest year-to-year increases were from 2015 to 2016 (31.8%) and from 2016 to 2017 (52.2%). The adjusted hospitalizations doubled significantly during the study period (an increase of 103.7%, from 159.7 opioid hospitalizations per million Canadians in 2000 to 325.3 in 2012). The adjusted rate of emergency department visits increased significantly by 188.7% (from 280.6 per million in 2000 to 810.1 in 2012). Case-fatality was 2.3% overall and was mainly constant during the study period. Both 90- and 365-day all-cause mortality increased significantly between 2000 and 2011 (from 1.7 to 3.1% and 3.9 to 7.4%, respectively), while re-hospitalization for opioid-related diagnoses was reduced (from 7.8 to 6.4% and 14.2 to 12.9%, respectively). CONCLUSIONS: Opioid-related mortality, hospitalization and emergency department visits in Canada have been increasing gradually since 2000.
背景和目的：现有的加拿大阿片类药物相关死亡率、住院和急诊就诊时间趋势评估主要依赖于省级数据库，而国家评估通常在 2016 年之前没有提供信息。我们旨在估计加拿大从 2000 年到 2017 年阿片类药物相关死亡率的全国时间趋势，以及从 2000 年到 2012 年阿片类药物相关住院和急诊就诊情况。
设计：回顾性队列研究。
地点和参与者：所有加拿大省和地区的居民，2000 年至 2017 年期间可获得可比数据。
测量方法：我们使用 ICD 代码从行政数据库中使用经过验证的算法确定阿片类药物相关死亡率、住院和急诊就诊情况。我们计算了每百万人口的粗率和性别及年龄调整率。对于住院患者，我们计算了病例死亡率、90 天和 365 天全因死亡率以及阿片类药物相关再住院率。我们使用泊松回归来检查时间趋势的显著性。
结果：2000 年至 2017 年期间，加拿大（魁北克除外）的调整后阿片类药物死亡率显著增加了 592.9%（从 2000 年的每百万人口 20.0 例阿片类药物死亡增加到 2017 年的 118.3 例）。每年的最高增长率来自 2015 年至 2016 年（31.8%）和 2016 年至 2017 年（52.2%）。研究期间，调整后的住院人数显著增加了一倍（从 2000 年每百万加拿大人 159.7 例阿片类药物住院增加到 2012 年的 325.3 例）。调整后的急诊就诊人数显著增加了 188.7%（从 2000 年的每百万 280.6 例增加到 2012 年的 810.1 例）。总体病例死亡率为 2.3%，在研究期间基本保持稳定。2000 年至 2011 年，90 天和 365 天全因死亡率均显著增加（分别从 1.7%增加到 3.1%和从 3.9%增加到 7.4%），而阿片类药物相关诊断的再住院率降低（分别从 7.8%降至 6.4%和从 14.2%降至 12.9%）。
结论：自 2000 年以来，加拿大的阿片类药物相关死亡率、住院和急诊就诊人数一直在逐渐增加。
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