Kaur Jaskaranpreet, Sandhu Ramneek K, Kubra Khadija T, Canenguez Benitez Johanna S, Onyeaka Henry K, Akter Sabiha, Amuk Williams Ozge C
Internal Medicine, Dayanand Medical College and Hospital, Punjab, IND.
Internal Medicine, Shri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, IND.
Cureus. 2021 Jun 29;13(6):e16033. doi: 10.7759/cureus.16033. eCollection 2021 Jun.
Objectives To understand the demographic pattern of substance use disorders (SUD) in Parkinson's disease (PD) inpatients and to evaluate the impact of SUD on hospitalization outcomes including the severity of illness, length of stay (LOS), total charges, and disposition to nursing facilities. Methods We used the nationwide inpatient sample and identified adult patients (age, ≥40 years) with PD as a primary diagnosis and comorbid SUD (N = 959) and grouped by co-diagnosis of alcohol (N = 789), cannabis (N = 46), opioid (N = 30), stimulants (N = 54) and barbiturate (N = 40) use disorders. We used a binomial logistic regression model to evaluate the odds ratio (OR) for major loss of functioning and disposition to nursing facilities in PD inpatients. All regression models were adjusted for demographics, including age, sex, race, and median household income. Results Alcohol, opioid, and stimulant use disorders were prevalent in old-age adults (60-79 years), males, and whites, but cannabis use was prevalent in middle-aged adults (40-59 years), and barbiturate use among older-age (>80 years). The severity of illness is statistically higher in PD inpatients with comorbid opioid and barbiturate use disorders with major loss of body functioning, closely seconded by alcohol and stimulant use disorder cohorts (27.6% and 25.9%, respectively). Disease severity and loss of body functioning increase with advancing age (>80 years adults, OR 5.8, 95%CI 5.32-6.37), and in blacks (OR 1.7, 95%CI 1.56-1.81), and those with opioid use disorder (OR 3.8, 95%CI 1.96-7.35). PD inpatients with barbiturate use disorder had a higher LOS and charges by 17.4 days and $68,922, and six-fold increased likelihood (95%CI 2.33-15.67) for disposition to nursing facilities. Conclusions SUD is prevalent among PD patients and is associated with more severe illnesses with body loss functioning and prolonged care. A multidisciplinary care model including collaborative neuropsychiatric and addiction management is required to manage SUD among PD patients to lessen disease severity, slow down the disease progression and potentially save medical costs.
目的 了解帕金森病（PD）住院患者物质使用障碍（SUD）的人口统计学模式，并评估SUD对住院结局的影响，包括疾病严重程度、住院时间（LOS）、总费用以及转至护理机构的情况。方法 我们使用全国住院患者样本，确定以PD为主要诊断且合并SUD的成年患者（年龄≥40岁）（N = 959），并按酒精（N = 789）、大麻（N = 46）、阿片类药物（N = 30）、兴奋剂（N = 54）和巴比妥类药物（N = 40）使用障碍的合并诊断进行分组。我们使用二项逻辑回归模型评估PD住院患者功能严重丧失和转至护理机构的比值比（OR）。所有回归模型均针对人口统计学因素进行了调整，包括年龄、性别、种族和家庭收入中位数。结果 酒精、阿片类药物和兴奋剂使用障碍在老年成年人（60 - 79岁）、男性和白人中普遍存在，但大麻使用在中年成年人（40 - 59岁）中普遍存在，而巴比妥类药物使用在高龄（>80岁）人群中普遍存在。合并阿片类药物和巴比妥类药物使用障碍且身体功能严重丧失的PD住院患者疾病严重程度在统计学上更高，其次是酒精和兴奋剂使用障碍队列（分别为27.6%和25.9%）。疾病严重程度和身体功能丧失随年龄增长（>80岁成年人，OR 5.8，95%CI 5.32 - 6.37）、黑人（OR 1.7，95%CI 1.56 - 1.81）以及患有阿片类药物使用障碍的患者（OR 3.8，95%CI 1.96 - 7.35）而增加。患有巴比妥类药物使用障碍的PD住院患者住院时间和费用分别高出17.4天和68,922美元，转至护理机构的可能性增加了六倍（95%CI 2.33 - 15.67）。结论 SUD在PD患者中普遍存在，并且与更严重的疾病、身体功能丧失和长期护理相关。需要一种多学科护理模式，包括协作性神经精神和成瘾管理，来管理PD患者中的SUD，以减轻疾病严重程度、减缓疾病进展并可能节省医疗成本。
