老年人出院时阿片类药物处方的种族和民族差异：一项全国回顾性队列研究。

Racial and Ethnic Disparities in Opioid Prescribing on Hospital Discharge Among Older Adults: A National Retrospective Cohort Study.

机构信息

Division of General Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon Street, Brookline, MA, 02246, USA.

Department of Medicine, Harvard Medical School, Boston, MA, USA.

出版信息

J Gen Intern Med. 2024 Jun;39(8):1444-1451. doi: 10.1007/s11606-024-08687-w. Epub 2024 Feb 29.

DOI:10.1007/s11606-024-08687-w

PMID:38424348

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11169105/

Abstract

BACKGROUND

Disparities in opioid prescribing among racial and ethnic groups have been observed in outpatient and emergency department settings, but it is unknown whether similar disparities exist at discharge among hospitalized older adults.

OBJECTIVE

To determine filled opioid prescription rates on hospital discharge by race/ethnicity among Medicare beneficiaries.

DESIGN

Retrospective cohort study.

PARTICIPANTS

Medicare beneficiaries 65 years or older discharged from hospital in 2016, without opioid fills in the 90 days prior to hospitalization (opioid-naïve).

MAIN MEASURES

Race/ethnicity was categorized by the Research Triangle Institute (RTI), grouped as Asian/Pacific Islander, Black, Hispanic, other (American Indian/Alaska Native/unknown/other), and White. The primary outcome was an opioid prescription claim within 2 days of hospital discharge. The secondary outcome was total morphine milligram equivalents (MMEs) among adults with a filled opioid prescription.

KEY RESULTS

Among 316,039 previously opioid-naïve beneficiaries (mean age, 76.8 years; 56.2% female), 49,131 (15.5%) filled an opioid prescription within 2 days of hospital discharge. After adjustment, Black beneficiaries were 6% less likely (relative risk [RR] 0.94, 95% CI 0.91-0.97) and Asian/Pacific Islander beneficiaries were 9% more likely (RR 1.09, 95% CI 1.03-1.14) to have filled an opioid prescription when compared to White beneficiaries. Among beneficiaries with a filled opioid prescription, mean total MMEs were lower among Black (356.9; adjusted difference - 4%, 95% CI - 7 to - 1%), Hispanic (327.0; adjusted difference - 7%, 95% CI - 10 to - 4%), and Asian/Pacific Islander (328.2; adjusted difference - 8%, 95% CI - 12 to - 4%) beneficiaries when compared to White beneficiaries (409.7).

CONCLUSIONS AND RELEVANCE

Black older adults were less likely to fill a new opioid prescription after hospital discharge when compared to White older adults and received lower total MMEs. The factors contributing to these differential prescribing patterns should be investigated further.

摘要

背景

在门诊和急诊环境中，不同种族和族裔群体的阿片类药物处方存在差异，但尚不清楚在出院时住院的老年患者中是否存在类似的差异。

目的

确定医疗保险受益人群中，根据种族/族裔，出院时开具阿片类药物处方的情况。

设计

回顾性队列研究。

参与者

2016 年出院的年龄在 65 岁及以上、住院前 90 天内无阿片类药物（阿片类药物初治）的医疗保险受益人。

主要措施

种族/族裔由 Research Triangle Institute（RTI）分类，分为亚裔/太平洋岛民、黑人、西班牙裔、其他（美洲印第安人/阿拉斯加原住民/未知/其他）和白人。主要结局是出院后 2 天内开具阿片类药物处方。次要结局是开具阿片类药物处方的成年人中总吗啡毫克当量（MME）。

主要结果

在 316039 名以前未使用过阿片类药物的受益人群中（平均年龄 76.8 岁，56.2%为女性），49131 名（15.5%）在出院后 2 天内开具了阿片类药物处方。调整后，黑人受益人的处方可能性比白人低 6%（相对风险 [RR]0.94，95%CI0.91-0.97），亚裔/太平洋岛民受益人的处方可能性比白人高 9%（RR1.09，95%CI1.03-1.14）。在开具阿片类药物处方的受益人群中，黑人（356.9；调整差异-4%，95%CI-7 至-1%）、西班牙裔（327.0；调整差异-7%，95%CI-10 至-4%）和亚裔/太平洋岛民（328.2；调整差异-8%，95%CI-12 至-4%）的总 MME 均低于白人（409.7）。