Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower Pkwy, Ann Arbor, MI, 48108, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA.
Int J Clin Pharm. 2023 Jun;45(3):669-680. doi: 10.1007/s11096-023-01553-5. Epub 2023 Mar 10.
There is little epidemiologic evidence on opioid prescription among adults with cerebral palsy (CP).
To describe the population- and individual-level opioid prescription patterns for adults with versus without CP.
This retrospective cohort study used commercial claims (Optum's de-identified Clinformatics® Data Mart Database) from the USA from 01/01/2011-12/31/2017 from adults ≥ 18 years old with CP and matched adults without CP. For the population-level analysis, monthly estimates of opioid exposure were described for adults ≥ 18 years old with CP and matched adults without CP. For the individual-level analysis, group based trajectory modelling (GBTM) was used to identify groups of similar individual-level monthly opioid exposure patterns for adults with CP and matched adults without CP for 1-year starting from their first opioid exposure month.
For the population-level, adults with (n = 13,929) versus without (n = 278,538) CP had a higher prevalence of opioid exposure (~ 12%, ~ 8%) and days supplied (median, ~ 23, ~17) monthly over 7 years. For the individual-level, there were 6 trajectory groups for CP (n = 2099) and 5 for non-CP (n = 10,361). Notably, 14% of CP (comprising 4 distinct trajectory groups) and 8% (comprising 3 distinct groups) of non-CP had variably high monthly opioid volume for extended periods; exposure was higher for CP. The remaining had low/absent opioid exposure trajectories; for CP (non-CP), 55.7% (63.3%) had nearly absent exposure and 30.4% (28.9%) had consistently low exposure to opioids.
Adults with versus without CP were more likely to be exposed to opioids and for a longer duration, which may alter the risk-benefit balance of opioids.
关于脑瘫成年人的阿片类药物处方，目前仅有少量流行病学证据。
描述脑瘫成年人与非脑瘫成年人的人群和个体水平阿片类药物处方模式。
本回顾性队列研究使用了来自美国的商业索赔数据（Optum 的匿名 Clinformatics® Data Mart 数据库），时间范围为 2011 年 1 月 1 日至 2017 年 12 月 31 日，纳入年龄≥18 岁的脑瘫成年人和匹配的非脑瘫成年人。对于人群水平分析，描述了年龄≥18 岁的脑瘫成年人和匹配的非脑瘫成年人每月的阿片类药物暴露情况。对于个体水平分析，使用基于群组的轨迹建模（GBTM）来识别年龄≥18 岁的脑瘫成年人和匹配的非脑瘫成年人的个体水平每月阿片类药物暴露模式相似的群组，时间范围为从首次阿片类药物暴露的 1 年。
在人群水平上，与非脑瘫成年人（n=278538）相比，脑瘫成年人（n=13929）的阿片类药物暴露（12%对8%）和每月供应的天数（中位数，23 对17）更高，持续 7 年。在个体水平上，CP 有 6 个轨迹组（n=2099），非 CP 有 5 个轨迹组（n=10361）。值得注意的是，CP（由 4 个不同的轨迹组组成）中有 14%和非 CP（由 3 个不同的轨迹组组成）中有 8%的患者有不同程度的长时间高每月阿片类药物用量；CP 的暴露水平更高。其余的患者的阿片类药物暴露轨迹较低或不存在；CP（非 CP）中，55.7%（63.3%）的患者几乎没有暴露，30.4%（28.9%）的患者长期低剂量使用阿片类药物。
与非脑瘫成年人相比，脑瘫成年人更有可能接触阿片类药物且接触时间更长，这可能改变阿片类药物的风险效益平衡。
