Department of Anesthesiology, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China.
Department of Anesthesiology, Beidahuang Industry Group General Hospital, Harbin, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2024 Sep 30;19:2181-2192. doi: 10.2147/COPD.S467131. eCollection 2024.
Opioids and benzodiazepines are frequently prescribed for managing pain and anxiety in chronic obstructive pulmonary disease (COPD) patients. This study aimed to determine whether opioid use, with or without benzodiazepine use, is associated with increased all-cause mortality in COPD patients.
This prospective cohort study included adults aged ≥20 years with COPD from the US National Health and Nutrition Examination Survey 2007-2012. The primary outcome was all-cause mortality, which were obtained through linkage to registries. Weighted Cox proportional hazards regression models were used to evaluate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality. Additionally, subgroup and sensitivity analyses were used to evaluate the robustness of our findings.
This study enrolled 811 participants, representing 10.84 million COPD individuals in the United States (mean [standard error] age, 58.7 [0.6] years). During a median follow-up of 9.6 years, mortality rates were 57.8 per 1000 person-years in patients using only opioids, 41.3 per 1000 person-years in patients using only benzodiazepines, 45.7 per 1000 person-years in patients using both opioids and benzodiazepines, and 27.0 per 1000 person-years in patients using neither. In the fully adjusted model, COPD patients prescribed both opioids and benzodiazepines (HR: 1.76; 95% CI: 1.11-2.78) and those prescribed opioids only (HR: 1.68; 95% CI: 1.13-2.49) had significantly higher all-cause mortality compared to non-users. After adjusting for propensity scores, the mortality risk for opioid-only users slightly increased (HR: 1.87; 95% CI: 1.25-2.81). Further, subgroup analysis revealed an elevated mortality risk in patients over 60 years receiving coprescriptions or opioids only, but not in younger participants. In contrast, benzodiazepine-only users aged 60 or younger showed increased mortality risk.
Opioid use, with or without benzodiazepine use, was associated with higher mortality in COPD patients over 60, while benzodiazepine-only use was associated with higher mortality aged 60 or younger.
在慢性阻塞性肺疾病（COPD）患者中，经常开具阿片类药物和苯二氮䓬类药物来治疗疼痛和焦虑。本研究旨在确定阿片类药物的使用（无论是否同时使用苯二氮䓬类药物）是否与 COPD 患者的全因死亡率增加有关。
本前瞻性队列研究纳入了来自美国国家健康和营养检查调查 2007-2012 年的年龄≥20 岁的 COPD 成年患者。主要结局是全因死亡率，通过与登记处的链接获得。使用加权 Cox 比例风险回归模型评估全因死亡率的风险比（HR）和 95%置信区间（CI）。此外，还进行了亚组和敏感性分析，以评估我们研究结果的稳健性。
这项研究纳入了 811 名参与者，代表了美国的 1084 万 COPD 患者（平均[标准误差]年龄，58.7[0.6]岁）。在中位随访 9.6 年期间，仅使用阿片类药物的患者的死亡率为每 1000 人年 57.8 例，仅使用苯二氮䓬类药物的患者为每 1000 人年 41.3 例，同时使用阿片类药物和苯二氮䓬类药物的患者为每 1000 人年 45.7 例，而未使用任何药物的患者为每 1000 人年 27.0 例。在完全调整后的模型中，同时使用阿片类药物和苯二氮䓬类药物（HR：1.76；95%CI：1.11-2.78）和仅使用阿片类药物（HR：1.68；95%CI：1.13-2.49）的 COPD 患者的全因死亡率明显更高。在调整倾向评分后，仅使用阿片类药物的患者的死亡风险略有增加（HR：1.87；95%CI：1.25-2.81）。此外，亚组分析显示，60 岁以上接受联合处方或仅使用阿片类药物的患者的死亡风险升高，但在年轻患者中则没有。相比之下，60 岁或以上的仅使用苯二氮䓬类药物的患者则显示出更高的死亡风险。
在 60 岁以上的 COPD 患者中，阿片类药物的使用（无论是否同时使用苯二氮䓬类药物）与死亡率升高有关，而 60 岁或以下的患者仅使用苯二氮䓬类药物与死亡率升高有关。
