跨性别和 cisgender 退伍军人的门诊阿片类药物、高风险处方和阿片类药物中毒比较：一项横断面分析。
Comparing Outpatient Opioids, High-Risk Prescribing, and Opioid Poisoning Between Transgender and Cisgender Veterans: A Cross-sectional Analysis.
机构信息
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California.
出版信息
Am J Prev Med. 2022 Aug;63(2):168-177. doi: 10.1016/j.amepre.2022.02.011. Epub 2022 Apr 5.
INTRODUCTION
Transgender veterans have a high prevalence of substance use disorder and physical and mental-health comorbidities, which are associated with prescription opioid use and overdose risk. This study compares receipt of outpatient opioids, high-risk opioid prescribing, and opioid poisoning between transgender and cisgender (i.e., nontransgender) veterans.
METHODS
A secondary analysis of Veterans Health Administration health record data from January 1, 2018 to December 31, 2018 was conducted in 2021. Transgender veterans (n=9,686) were randomly matched to 3 cisgender veterans (n=29,058) on the basis of age and county. Using the same matching criteria, a second cohort was created of all transgender veterans and a matched sample of cisgender veterans who were prescribed an outpatient opioid (n=7,576). Stratified Cox proportional hazard regression measured the RR of each prescription outcome and opioid poisoning.
RESULTS
Transgender veterans had a 20% higher risk of being prescribed any outpatient opioid than cisgender veterans (adjusted RR=1.20, 95% CI=1.13, 1.27). Transgender and cisgender veterans who were prescribed an opioid did not have different risks of high-risk prescribing: overlapping opioid prescriptions (adjusted RR=0.93, 95% CI=0.85, 1.02), daily dose >120 morphine milligram equivalents (adjusted RR=0.86, 95% CI=0.66, 1.10), or overlapping opioid and benzodiazepine prescriptions (adjusted RR=1.05, 95% CI=0.96, 1.14). Overall, transgender veterans had more than twice the risk of opioid poisoning than cisgender veterans (RR=2.76, 95% CI=1.57, 4.86). The risk of opioid poisoning did not differ between transgender and cisgender veterans who were prescribed an opioid (RR=1.09, 95% CI=0.56, 2.11).
CONCLUSIONS
Transgender veterans had a greater risk of being prescribed an outpatient opioid than cisgender veterans but did not have different risks of high-risk opioid prescribing.
引言
跨性别退伍军人滥用药物和精神健康问题的发生率较高，这与处方类阿片类药物的使用和过量风险有关。本研究比较了跨性别和非跨性别（即非跨性别）退伍军人接受门诊类阿片药物、高危类阿片药物处方和类阿片药物中毒的情况。
方法
2021 年，对退伍军人健康管理局健康记录数据进行了二次分析，数据时间为 2018 年 1 月 1 日至 2018 年 12 月 31 日。根据年龄和县，将 9686 名跨性别退伍军人随机与 29058 名顺性别退伍军人匹配。使用相同的匹配标准，创建了另一个所有跨性别退伍军人和一个匹配的门诊类阿片药物处方样本的队列（n=7576）。分层 Cox 比例风险回归衡量了每种处方结果和类阿片药物中毒的 RR。
结果
与顺性别退伍军人相比，跨性别退伍军人开任何门诊类阿片药物的风险高 20%（调整后的 RR=1.20，95%CI=1.13，1.27）。开处方类阿片药物的跨性别和顺性别退伍军人没有不同的高危处方风险：重叠类阿片药物处方（调整后的 RR=0.93，95%CI=0.85，1.02），每日剂量>120 吗啡毫克当量（调整后的 RR=0.86，95%CI=0.66，1.10）或重叠类阿片药物和苯二氮䓬类药物处方（调整后的 RR=1.05，95%CI=0.96，1.14）。总体而言，跨性别退伍军人类阿片药物中毒的风险是顺性别退伍军人的两倍多（RR=2.76，95%CI=1.57，4.86）。与开处方类阿片药物的跨性别和顺性别退伍军人相比，类阿片药物中毒的风险没有差异（RR=1.09，95%CI=0.56，2.11）。
结论
与顺性别退伍军人相比，跨性别退伍军人开门诊类阿片药物的风险更高，但高危类阿片药物处方的风险没有差异。
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