纽约市老年阿片类药物使用障碍患者的共病与住院利用情况。
Multimorbidity and Inpatient Utilization Among Older Adults with Opioid Use Disorder in New York City.
机构信息
Department of Medicine, Division of Geriatrics, Gerontology, and Palliative Care, San Diego School of Medicine, University of California, 9500 Gilman Dr, San Diego, CA, 92161, USA.
Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, New York City Department of Health and Mental Hygiene, 42-09 28th Street, 19th Floor, Queens, NY, 11101, USA.
出版信息
J Gen Intern Med. 2022 May;37(7):1634-1640. doi: 10.1007/s11606-021-07130-8. Epub 2021 Oct 13.
BACKGROUND
Nationally, there is a sharp increase in older adults with opioid use disorder (OUD). However, we know little of the acute healthcare utilization patterns and medical comorbidities among this population.
OBJECTIVE
This study describes the prevalence of chronic conditions, patterns of inpatient utilization, and correlates of high inpatient utilization among older adults with OUD in New York City (NYC).
DESIGN
Retrospective longitudinal cohort study.
PARTICIPANTS
Patients aged ≥55 with OUD hospitalized in NYC in 2012 identified using data from New York State's Statewide Planning and Research Cooperative System (SPARCS).
MAIN MEASURES
The prevalence of comorbid substance use diagnoses, chronic medical disease, and mental illness was measured using admission diagnoses from the index hospitalization. We calculated the ICD-Coded Multimorbidity-Weighted Index (MWI-ICD) for each patient to measure multimorbidity. We followed the cohort through September 30, 2015 and the outcome was the number of rehospitalizations for inpatient services in NYC. We compared patient-level factors between patients with the highest use of inpatient services (≥7 rehospitalizations) during the study period to low utilizers. We used multiple logistic regression to examine possible correlates of high inpatient utilization.
KEY RESULTS
Of 3669 adults aged ≥55 with OUD with a hospitalization in 2012, 76.4% (n=2803) had a subsequent hospitalization and accounted for a total of 22,801 rehospitalizations during the study period. A total of 24.7% of the cohort (n=906) were considered high utilizers and had a higher prevalence of alcohol and cocaine-related diagnoses, congestive heart failure, diabetes, schizophrenia, and chronic obstructive pulmonary disease. Multivariable predictors of high utilization included being a Medicaid beneficiary (adjusted odds ratio [aOR]=1.70, 95% confidence interval [CI]=1.37-2.11), alcohol-related diagnoses (aOR=1.43, 95% CI: 1.21-1.69), and increasing comorbidity measured by MWI-ICD (highest MWI-ICD quartile: aOR=1.98, 95% CI=1.59-2.48).
CONCLUSIONS
Among older adults with OUD admitted to the hospital, multimorbidity is strongly associated with high inpatient utilization.
背景
全国范围内，患有阿片类药物使用障碍（OUD）的老年人数量急剧增加。然而，我们对这一人群的急性医疗保健利用模式和合并症知之甚少。
目的
本研究描述了纽约市（NYC）老年 OUD 患者的慢性疾病患病率、住院利用模式以及高住院利用率的相关因素。
设计
回顾性纵向队列研究。
参与者
使用来自纽约州全州规划和研究合作系统（SPARCS）的数据，确定了 2012 年在 NYC 住院治疗的年龄≥55 岁且患有 OUD 的患者。
主要措施
使用入院诊断来衡量合并物质使用诊断、慢性疾病和精神疾病的患病率。我们为每位患者计算了 ICD 编码的多疾病加权指数（MWI-ICD）以衡量多病。我们随访队列直至 2015 年 9 月 30 日，结果是 NYC 再次住院治疗的次数。我们比较了研究期间使用住院服务量最高（≥7 次再住院）的患者与低利用率患者的患者水平因素。我们使用多变量逻辑回归来检查高住院利用率的可能相关因素。
主要结果
在 3669 名年龄≥55 岁且患有 OUD 并于 2012 年住院的成年人中，76.4%（n=2803）有后续住院治疗，并且在研究期间共有 22801 次再住院治疗。该队列中有 24.7%（n=906）的患者被认为是高利用率患者，他们更有可能出现酒精和可卡因相关诊断、充血性心力衰竭、糖尿病、精神分裂症和慢性阻塞性肺疾病。高利用率的多变量预测因素包括医疗补助受益（调整后的优势比[OR]=1.70，95%置信区间[CI]=1.37-2.11）、酒精相关诊断（OR=1.43，95% CI：1.21-1.69）和通过 MWI-ICD 衡量的合并症增加（MWI-ICD 最高四分位数：OR=1.98，95% CI=1.59-2.48）。
结论
在因 OUD 住院的老年患者中，合并症与高住院利用率密切相关。
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