Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States.
Department of Population Health, NYU Grossman School of Medicine, New York, NY 10016, United States.
Pain Med. 2023 Dec 1;24(12):1296-1305. doi: 10.1093/pm/pnad121.
To assess whether chronic pain increases the risk of COVID-19 complications and whether opioid use disorder (OUD) differentiates this risk among New York State Medicaid beneficiaries.
DESIGN, SETTING, AND SUBJECTS: This was a retrospective cohort study of New York State Medicaid claims data. We evaluated Medicaid claims from March 2019 through December 2020 to determine whether chronic pain increased the risk of COVID-19 emergency department (ED) visits, hospitalizations, and complications and whether this relationship differed by OUD status. We included beneficiaries 18-64 years of age with 10 months of prior enrollment. Patients with chronic pain were propensity score-matched to those without chronic pain on demographics, utilization, and comorbidities to control for confounders and were stratified by OUD. Complementary log-log regressions estimated hazard ratios (HRs) of COVID-19 ED visits and hospitalizations; logistic regressions estimated odds ratios (ORs) of hospital complications and readmissions within 0-30, 31-60, and 61-90 days.
Among 773 880 adults, chronic pain was associated with greater hazards of COVID-related ED visits (HR = 1.22 [95% CI: 1.16-1.29]) and hospitalizations (HR = 1.19 [95% CI: 1.12-1.27]). Patients with chronic pain and OUD had even greater hazards of hospitalization (HR = 1.25 [95% CI: 1.07-1.47]) and increased odds of hepatic- and cardiac-related events (OR = 1.74 [95% CI: 1.10-2.74]).
Chronic pain increased the risk of COVID-19 ED visits and hospitalizations. Presence of OUD further increased the risk of COVID-19 hospitalizations and the odds of hepatic- and cardiac-related events. Results highlight intersecting risks among a vulnerable population and can inform tailored COVID-19 management.
评估慢性疼痛是否会增加 COVID-19 并发症的风险，以及阿片类药物使用障碍 (OUD) 是否会在纽约州医疗补助受益人群中区分这种风险。
设计、设置和研究对象：这是一项回顾性队列研究，使用了纽约州医疗补助索赔数据。我们评估了 2019 年 3 月至 2020 年 12 月期间的医疗补助索赔数据，以确定慢性疼痛是否会增加 COVID-19 急诊就诊、住院和并发症的风险，以及这种关系是否因 OUD 状况而异。我们纳入了年龄在 18-64 岁之间、有 10 个月入组前病史的受益人群。对有慢性疼痛的患者进行倾向评分匹配，以匹配无慢性疼痛的患者在人口统计学、利用情况和合并症方面的情况，以控制混杂因素，并按 OUD 进行分层。互补对数-对数回归估计 COVID-19 急诊就诊和住院的风险比 (HR)；逻辑回归估计住院并发症和 0-30、31-60 和 61-90 天内再入院的比值比 (OR)。
在 773880 名成年人中，慢性疼痛与 COVID 相关的急诊就诊 (HR=1.22 [95%CI：1.16-1.29]) 和住院 (HR=1.19 [95%CI：1.12-1.27]) 的风险增加有关。患有慢性疼痛和 OUD 的患者住院的风险更高 (HR=1.25 [95%CI：1.07-1.47])，且与肝脏和心脏相关事件的几率增加 (OR=1.74 [95%CI：1.10-2.74])。
慢性疼痛增加了 COVID-19 急诊就诊和住院的风险。存在 OUD 会进一步增加 COVID-19 住院的风险，并增加与肝脏和心脏相关事件的几率。结果突出了弱势群体之间的交叉风险，并为有针对性的 COVID-19 管理提供了信息。
