Chen Po-Hung, Patel Reeha, Miller Steven D, Jasper Ryan, Chander Geetanjali, Hutfless Susan
Division of Gastroenterology & Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland.
Gastro Hep Adv. 2023;2(6):747-754. doi: 10.1016/j.gastha.2023.03.019. Epub 2023 Mar 17.
Substance use among persons with Crohn's disease (CD) is associated with symptomatic exacerbation and poorer quality of life. However, data on the prevalence of substance use among individuals with CD are limited. Therefore, our study aimed to estimate the burden of alcohol and drug use among individuals with incident CD in the United States. We also assessed the associations between CD-related interventions and substance use after CD diagnosis.
Our retrospective cohort study of the national Medicaid databases from 2010 to 2019 identified participants with newly diagnosed CD and defined substance use (ie, alcohol, opioids, cocaine, amphetamine, and cannabis) using diagnosis codes. Multivariable logistic regression models assessed the associations between CD-related interventions and substance use after CD diagnosis.
Overall, 16.3% of Medicaid enrollees with incident CD had substance ever-use, most commonly alcohol or opioids (each 8.0%). Any substance use saw an absolute decrease of 3.8% after CD diagnosis, but changes were less than 1% in either direction for each substance. CD-related hospitalization was associated with increased alcohol or opioid use post-CD diagnosis. Surgery was associated with lower use post-CD of opioids but not alcohol. CD medications (except steroids) were generally associated with decreased post-CD alcohol or opioid use.
Among Medicaid enrollees with incident CD, alcohol and opioid use were more frequent than previously published estimates for the general US population (6% and 4%, respectively, in 2019). Consequently, medical communities must be more aware of substance use by patients with CD to provide quality patient-centered care.
克罗恩病（CD）患者的物质使用与症状加重及生活质量较差有关。然而，关于CD患者物质使用患病率的数据有限。因此，我们的研究旨在估计美国新发CD患者中酒精和药物使用的负担。我们还评估了CD相关干预措施与CD诊断后物质使用之间的关联。
我们对2010年至2019年国家医疗补助数据库进行的回顾性队列研究，确定了新诊断为CD的参与者，并使用诊断代码定义物质使用情况（即酒精、阿片类药物、可卡因、苯丙胺和大麻）。多变量逻辑回归模型评估了CD相关干预措施与CD诊断后物质使用之间的关联。
总体而言，16.3%的新发CD医疗补助参保者曾使用过物质，最常见的是酒精或阿片类药物（各占8.0%）。CD诊断后，任何物质的使用绝对减少了3.8%，但每种物质在两个方向上的变化都小于1%。CD相关住院与CD诊断后酒精或阿片类药物使用增加有关。手术与CD诊断后阿片类药物使用减少有关，但与酒精使用无关。CD药物（类固醇除外）通常与CD诊断后酒精或阿片类药物使用减少有关。
在新发CD的医疗补助参保者中，酒精和阿片类药物的使用比之前公布的美国普通人群估计值更频繁（2019年分别为6%和4%）。因此，医疗界必须更加关注CD患者的物质使用情况，以提供以患者为中心的优质护理。
