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不同处方阿片类药物使用建模方法的比较及其与不良事件的关联。

Comparison of Different Modeling Approaches for Prescription Opioid Use and Its Association With Adverse Events.

出版信息

Am J Epidemiol. 2023 Sep 1;192(9):1592-1603. doi: 10.1093/aje/kwad115.

Abstract

Previous research linking opioid prescribing to adverse drug events has failed to properly account for the time-varying nature of opioid exposure. This study aimed to explore how the risk of opioid-related emergency department visits, readmissions, or deaths (composite outcome) varies with opioid dose and duration, comparing different novel modeling techniques. A prospective cohort of 1,511 hospitalized patients discharged from 2 McGill-affiliated hospitals in Montreal, 2014-2016, was followed from the first postdischarge opioid dispensation until 1 year after discharge. Marginal structural Cox proportional hazards models and their flexible extensions were used to explore the association between time-varying opioid use and the composite outcome. Weighted cumulative exposure models assessed cumulative effects of past use and explored how its impact depends on the recency of exposure. The patient mean age was 69.6 (standard deviation = 14.9) years; 57.7% were male. In marginal structural model analyses, current opioid use was associated with a 71% increase in the hazard of opioid-related adverse events (adjusted hazard ratio = 1.71, 95% confidence interval: 1.21, 2.43). The weighted cumulative exposure results suggested that the risk cumulates over the previous 50 days of opioid consumption. Flexible modeling techniques helped assess how the risk of opioid-related adverse events may be associated with time-varying opioid exposures while accounting for nonlinear relationships and the recency of past use.

摘要

先前将阿片类药物处方与不良药物事件联系起来的研究未能正确考虑阿片类药物暴露的时变性质。本研究旨在探索不同新型建模技术如何比较不同的新型建模技术,随着阿片类药物剂量和持续时间的变化,阿片类药物相关急诊就诊、再入院或死亡(复合结局)的风险如何变化。2014 年至 2016 年,对从蒙特利尔的 2 家麦吉尔附属医院出院的 1511 名住院患者进行了前瞻性队列研究,从首次出院后开阿片类药物开始随访,直到出院后 1 年。使用边缘结构 Cox 比例风险模型及其灵活扩展来探索随时间变化的阿片类药物使用与复合结局之间的关联。加权累积暴露模型评估了过去使用的累积效应,并探讨了其影响如何取决于暴露的新近程度。患者的平均年龄为 69.6 岁(标准差= 14.9);57.7%为男性。在边缘结构模型分析中,当前阿片类药物使用与阿片类药物相关不良事件的风险增加 71%(调整后的危险比= 1.71,95%置信区间:1.21,2.43)。加权累积暴露结果表明,风险在过去 50 天的阿片类药物消耗中累积。灵活的建模技术有助于评估随时间变化的阿片类药物暴露与阿片类药物相关不良事件的风险之间可能存在的关联,同时考虑到非线性关系和过去使用的新近程度。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0efc/10472496/a2c18b5eafe5/kwad115f1.jpg

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