Yin Ying, Workman Elizabeth, Ma Phillip, Cheng Yan, Shao Yijun, Goulet Joseph L, Sandbrink Friedhelm, Brandt Cynthia, Spevak Christopher, Kean Jacob T, Becker William, Libin Alexander, Shara Nawar, Sheriff Helen M, Butler Jorie, Agrawal Rajeev M, Kupersmith Joel, Zeng-Trietler Qing
Washington DC VA Medical Center, Washington, DC, USA.
Biomedical Informatics Center, George Washington University, Washington, DC, USA.
Sci Rep. 2025 Jan 29;15(1):3648. doi: 10.1038/s41598-024-77602-4.
The opioid crisis has disproportionately affected U.S. veterans, leading the Veterans Health Administration to implement opioid prescribing guidelines. Veterans who receive care from both VA and non-VA providers-known as dual-system users-have an increased risk of Opioid Use Disorder (OUD). The interaction between dual-system use and demographic and clinical factors, however, has not been previously explored. We conducted a retrospective study of 856,299 patient instances from the Washington DC and Baltimore VA Medical Centers (2012-2019), using a deep neural network (DNN) and explainable Artificial Intelligence to examine the impact of dual-system use on OUD and how demographic and clinical factors interact with it. Of the cohort, 146,688(17%) had OUD, determined through Natural Language Processing of clinical notes and ICD-9/10 diagnoses. The DNN model, with a 78% area under the curve, confirmed that dual-system use is a risk factor for OUD, along with prior opioid use or other substance use. Interestingly, a history of other drug use interacted negatively with dual-system use regarding OUD risk. In contrast, older age was associated with a lower risk of OUD but interacted positively with dual-system use. These findings suggest that within the dual-system users, patients with certain risk profiles warrant special attention.
阿片类药物危机对美国退伍军人的影响尤为严重，导致退伍军人健康管理局实施了阿片类药物处方指南。同时接受退伍军人事务部（VA）和非VA医疗机构治疗的退伍军人（即双重系统使用者）患阿片类药物使用障碍（OUD）的风险更高。然而，此前尚未探讨双重系统使用与人口统计学和临床因素之间的相互作用。我们对华盛顿特区和巴尔的摩VA医疗中心856,299例患者病例（2012 - 2019年）进行了一项回顾性研究，使用深度神经网络（DNN）和可解释人工智能来研究双重系统使用对OUD的影响，以及人口统计学和临床因素如何与之相互作用。在该队列中，通过对临床记录和ICD - 9/10诊断进行自然语言处理确定，有146,688例（17%）患有OUD。DNN模型曲线下面积为78%，证实双重系统使用与先前使用阿片类药物或其他物质使用一样，是OUD的一个风险因素。有趣的是，就OUD风险而言，其他药物使用史与双重系统使用之间存在负向相互作用。相比之下，年龄较大与OUD风险较低相关，但与双重系统使用存在正向相互作用。这些发现表明，在双重系统使用者中，具有某些风险特征的患者值得特别关注。
