Tantoco Ann-Marie, Badawy Sherif M, Lee Cheryl K, Merz Jeffrey, Steed Maura, Kluk Mark, Bhasin Ajay
Department of Medicine, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Pediatrics, Division of Hospital-Based Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Pediatr Hematol Oncol. 2025 Mar;42(2):69-78. doi: 10.1080/08880018.2024.2437045. Epub 2024 Dec 11.
Hospitalized patients with sickle cell disease (SCD) may use opioid medications for both acute and chronic pain management. Use of these medications may unintentionally generate diagnostic codes for opioid misuse including "opioid use," "opioid abuse," and "opioid dependence," which connote a behavioral problem or addiction. In this study, we sought to compare diagnostic codes for opioid misuse amongst hospitalized patients with and without SCD. We performed a cross-sectional study of hospitalized non-obstetric, non-surgical, and non-elective patients with SCD using the National Inpatient Sample published by the Agency for Healthcare Research and Quality Hospital Cost Utilization Project during years 2016-2019. We used descriptive statistics to characterize patient demographics and opioid misuse diagnostic codes. We used Chi Square testing to compare rates of diagnostic codes for opioid misuse between patients with and without SCD. There were 165 ± 3 hospitalizations for SCD per 100,000 US population. Patients with SCD had higher rates of opioid misuse diagnostic codes for "opioid use" (0.3% vs 0.1%, < 0.001) and "opioid dependence" (4.5% vs 1.6%, < 0.001), but a lower rate for "opioid abuse" (0.2% vs 0.3%, < 0.001). We found that diagnostic codes for opioid misuse are higher in those with SCD than without SCD, even at young ages, which impart substantial bias toward these patients.
镰状细胞病（SCD）住院患者可能会使用阿片类药物来管理急性和慢性疼痛。使用这些药物可能会无意中生成阿片类药物滥用的诊断代码，包括“阿片类药物使用”、“阿片类药物滥用”和“阿片类药物依赖”，这些都意味着行为问题或成瘾。在本研究中，我们试图比较有和没有SCD的住院患者中阿片类药物滥用的诊断代码。我们使用医疗保健研究与质量局医院成本利用项目发布的2016 - 2019年全国住院患者样本，对非产科、非手术且非择期的SCD住院患者进行了横断面研究。我们使用描述性统计来描述患者人口统计学特征和阿片类药物滥用诊断代码。我们使用卡方检验来比较有和没有SCD的患者之间阿片类药物滥用诊断代码的发生率。每10万美国人口中有165±3例SCD住院病例。SCD患者的“阿片类药物使用”（0.3%对0.1%，<0.001）和“阿片类药物依赖”（4.5%对1.6%，<0.001）的阿片类药物滥用诊断代码发生率较高，但“阿片类药物滥用”的发生率较低（0.2%对0.3%，<0.001）。我们发现，即使在年轻患者中，SCD患者的阿片类药物滥用诊断代码也高于非SCD患者，这对这些患者造成了很大的偏差。
