南非私营部门医疗保险计划中阿片类药物相关障碍的诊断和治疗：一项队列研究。
Diagnosis and treatment of opioid-related disorders in a South African private sector medical insurance scheme: A cohort study.
机构信息
Centre for Infectious Disease Epidemiology & Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Urban Futures Centre, Steve Biko Campus, Durban University of Technology, Durban, South Africa; TB HIV Care, 7th Floor, 11 Adderley Street, Cape Town, South Africa; Community Oriented Primary Care Research Unit, Department of Family Medicine, University of Pretoria, Pretoria, South Africa.
出版信息
Int J Drug Policy. 2022 Nov;109:103853. doi: 10.1016/j.drugpo.2022.103853. Epub 2022 Oct 3.
BACKGROUND
The use of opioids is increasing globally, but data from low- and middle-income countries on opioid-related mental and behavioural disorders (hereafter referred to as opioid-related disorders) are scarce. This study examines the incidence of opioid-related disorders, opioid agonist use, and excess mortality among persons with opioid-related disorders in South Africa's private healthcare sector.
METHODS
We analysed longitudinal data of beneficiaries (≥ 11 years) of a South African medical insurance scheme using reimbursement claims from Jan 1, 2011, to Jul 1, 2020. Beneficiaries were classified as having an opioid-related disorder if they received an opioid agonist (buprenorphine or methadone) or an ICD-10 diagnosis for harmful opioid use (F11.1), opioid dependence or withdrawal (F11.2-4), or an unspecified or other opioid-related disorder (F11.0, F11.5-9). We calculated adjusted hazard ratios (aHR) for factors associated with opioid-related disorders, estimated the cumulative incidence of opioid agonist use after receiving an ICD-10 diagnosis for opioid dependence or withdrawal, and examined excess mortality among beneficiaries with opioid-related disorders.
RESULTS
Of 1,251,458 beneficiaries, 1286 (0.1%) had opioid-related disorders. Between 2011 and 2020, the incidence of opioid-related disorders increased by 12% (95% CI 9%-15%) per year. Men, young adults in their twenties, and beneficiaries with co-morbid mental health or other substance use disorders were at increased risk of opioid-related disorders. The cumulative incidence of opioid agonist use among beneficiaries who received an ICD-10 diagnosis for opioid dependence or withdrawal was 18.0% (95% CI 14.0-22.4) 3 years after diagnosis. After adjusting for age, sex, year, medical insurance coverage, and population group, opioid-related disorders were associated with an increased risk of mortality (aHR 2.28, 95% CI 1.84-2.82). Opioid-related disorders were associated with a 7.8-year shorter life expectancy.
CONCLUSIONS
The incidence of people diagnosed with or treated for an opioid-related disorder in the private sector is increasing rapidly. People with opioid-related disorders are a vulnerable population with substantial psychiatric comorbidity who often die prematurely. Evidence-based management of opioid-related disorders is urgently needed to improve the health outcomes of people with opioid-related disorders.
背景
阿片类药物的使用在全球范围内呈上升趋势，但来自中低收入国家的阿片类药物相关精神和行为障碍（以下简称阿片类相关障碍）数据却很少。本研究调查了南非私营医疗保健部门中阿片类相关障碍患者的阿片类相关障碍、阿片类激动剂使用和超额死亡率的发病率。
方法
我们使用南非医疗保险计划的纵向受益人的报销索赔数据（年龄≥11 岁）进行分析，时间范围为 2011 年 1 月 1 日至 2020 年 7 月 1 日。如果受益人为阿片类激动剂（丁丙诺啡或美沙酮）或 ICD-10 有害阿片类物质使用（F11.1）、阿片类物质依赖或戒断（F11.2-4）、未特指或其他阿片类相关障碍（F11.0、F11.5-9）的诊断，则将其归类为患有阿片类相关障碍。我们计算了与阿片类相关障碍相关因素的调整后风险比（aHR），估计了接受 ICD-10 阿片类依赖或戒断诊断后阿片类激动剂使用的累积发生率，并检查了阿片类相关障碍患者的超额死亡率。
结果
在 1251458 名受益人中，有 1286 人（0.1%）患有阿片类相关障碍。2011 年至 2020 年间，阿片类相关障碍的发病率每年增加 12%（95%CI9%-15%）。男性、二十多岁的年轻人以及患有合并精神健康或其他物质使用障碍的受益人群患阿片类相关障碍的风险增加。在接受 ICD-10 阿片类依赖或戒断诊断的受益人群中，阿片类激动剂使用的累积发生率为 3 年后为 18.0%（95%CI14.0-22.4）。在调整年龄、性别、年份、医疗保险覆盖范围和人群组后，阿片类相关障碍与死亡率增加相关（aHR2.28，95%CI1.84-2.82）。阿片类相关障碍与预期寿命缩短 7.8 年相关。
结论
私营部门中诊断或治疗阿片类相关障碍的人数发病率正在迅速上升。阿片类相关障碍患者是一个脆弱的群体，他们合并严重的精神疾病，经常过早死亡。迫切需要对阿片类相关障碍进行循证管理，以改善阿片类相关障碍患者的健康结局。
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