英国苏格兰 2011-20 年阿片类激动剂治疗患者的死亡率：一项全国回顾性队列研究。

Mortality among individuals prescribed opioid-agonist therapy in Scotland, UK, 2011-20: a national retrospective cohort study.

机构信息

School of Health and Life Sciences, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK; Public Health Scotland, Edinburgh, UK.

出版信息

Lancet Public Health. 2023 Jul;8(7):e484-e493. doi: 10.1016/S2468-2667(23)00082-8. Epub 2023 Jun 7.

DOI:10.1016/S2468-2667(23)00082-8

PMID:37295452

Abstract

BACKGROUND

Drug-related death (DRD) rate in Scotland, UK, has increased rapidly to one of the highest in the world. Our aim was to examine the extent to which opioid-agonist therapy (OAT) in Scotland is protective against drug-related mortality and how this effect has varied over time.

METHODS

We included individuals in Scotland with opioid use disorder who received at least one OAT prescription between Jan 1, 2011, and Dec 31, 2020. We calculated drug-related mortality rates and used Quasi-Poisson regression models to estimate trends over time and by OAT exposure, adjusting for potential confounding.

FINDINGS

In a cohort of 46 453 individuals prescribed OAT with a total of 304 000 person-years of follow-up, DRD rates more than trebled from 6·36 per 1000 person-years (95% CI 5·73-7·01) in 2011-12 to 21·45 (20·31-22·63) in 2019-20. DRD rates were almost three and a half times higher (hazard ratio 3·37; 95% CI 1·74-6·53) for those off OAT compared with those on OAT after adjustment for confounders. However, confounder adjusted DRD risk increased over time for both people off and on OAT.

INTERPRETATION

Drug-related mortality rates among people with opioid use disorders in Scotland increased between 2011 and 2020. OAT remains protective but is insufficient on its own to slow the increase in DRD risk for people who are opioid dependent in Scotland.

FUNDING

Scottish Government Drug Deaths Taskforce, Public Health Scotland, and National Institute for Health and Care Research.

摘要

背景

英国苏格兰的与药物相关的死亡率（DRD）迅速上升，达到世界最高水平之一。我们的目的是研究苏格兰的阿片类激动剂治疗（OAT）在多大程度上能预防与药物相关的死亡，以及这种效果随时间的变化。

方法

我们纳入了 2011 年 1 月 1 日至 2020 年 12 月 31 日期间在苏格兰接受过至少一次 OAT 处方的患有阿片类药物使用障碍的个体。我们计算了与药物相关的死亡率，并使用拟泊松回归模型估计随时间的趋势和 OAT 暴露的趋势，同时调整了潜在的混杂因素。

结果

在一个接受 OAT 治疗的 46453 名个体的队列中，总共有 304000 人年的随访，DRD 发生率从 2011-12 年的 6.36/1000 人年（95%CI 5.73-7.01）增加到 2019-20 年的 21.45/1000 人年（20.31-22.63），增加了两倍多。在调整混杂因素后，与接受 OAT 治疗的个体相比，停止 OAT 治疗的个体的 DRD 发生率（危险比 3.37；95%CI 1.74-6.53）高出近三倍。然而，对于停止和继续接受 OAT 治疗的个体，调整混杂因素后的 DRD 风险随时间增加。