A comprehensive multivariate model of biopsychosocial factors associated with opioid misuse and use disorder in a 2017-2018 United States national survey.
A comprehensive multivariate model of biopsychosocial factors associated with opioid misuse and use disorder in a 2017-2018 United States national survey.
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DOI：
10.1186/s12889-020-09856-2
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发表时间：
2020-11-18
影响因子：
4.5
通讯作者：
Williams F
中科院分区：
文献类型：
--
作者：
Montiel Ishino FA;McNab PR;Gilreath T;Salmeron B;Williams F
很少有研究全面和背景地检查与阿片类药物使用相关的变量的关系。我们的目的是通过确定最显著的预测因素，填补美国阿片类药物滥用和使用障碍综合风险模型的关键空白。2017年和2018年全国药物使用和健康调查使用了多变量逻辑回归，其中包括美国所有50个州和哥伦比亚特区。样本包括所有18岁及以上非住院的平民成年人（N = 85,580；加权N = 248,008,986）。阿片类药物滥用和/或使用障碍的结果基于所报告的处方止痛药和/或海洛因使用依赖、滥用或误用。在我们的综合模型中，除了社会人口学特征和其他物质依赖或滥用外，还检查了阿片类药物滥用和使用障碍的生物心理社会预测因素。生物心理社会特征包括社会生态和健康指标。犯罪是社会生态指标。健康指标包括自我报告的健康状况、私人健康保险、心理困扰和自杀倾向。社会人口学变量包括年龄、性别/性别、种族/民族、性别认同、教育程度、居住地、收入和就业状况。物质依赖或滥用包括合法和非法物质（即尼古丁、酒精、大麻、可卡因、吸入剂、甲基苯丙胺、镇定剂、兴奋剂、镇静剂）。综合模型发现犯罪行为(调整优势比(AOR) = 2.58, 95%可信区间[CI] = 1.98 - -3.37, p < 0.001),自我报告健康(例如,优秀而公平/贫穷(优势比= 3.71,95% CI -6.29 = 2.19, p < 0.001),好(优势比= 3.43,95% CI -5.34 = 2.20, p < 0.001),很好(优势比= 2.75,95% CI -3.98 = 1.90, p < 0.001]),没有私人健康保险(优势比= 2.12,95% CI -2.89 = 1.55, p < 0.001),严重的心理压力(优势比= 2.12,95% CI -2.89 = 1.55, p < 0.001),自杀（AOR = 1.58, 95% CI = 1.17-2.14, p = 0.004）和其他物质依赖或滥用是阿片类药物滥用和/或使用障碍的重要预测因素。相关物质尼古丁(优势比= 3.01,95% CI -3.93 = 2.30, p < 0.001),酒精(优势比= 1.40,95% CI -1.92 = 1.02, p = 0.038),大麻(优势比= 2.24,95% CI -3.58 = 1.40, p = 0.001),可卡因(优势比= 3.92,95% CI -7.17 = 2.14, p < 0.001),甲基苯丙胺(AOR = 3.32, 95% CI -5.64 = 1.96, p < 0.001),镇静剂(优势比= 16.72,95% CI -28.65 = 9.75, p < 0.001),和兴奋剂(优势比= 2.45,95% CI -5.87 = 1.03, p = 0.044)。生物心理社会特征，如社会生态和健康指标，以及其他物质依赖或滥用，比社会人口特征更能预测阿片类药物滥用和使用障碍。
Few studies have comprehensively and contextually examined the relationship of variables associated with opioid use. Our purpose was to fill a critical gap in comprehensive risk models of opioid misuse and use disorder in the United States by identifying the most salient predictors. A multivariate logistic regression was used on the 2017 and 2018 National Survey on Drug Use and Health, which included all 50 states and the District of Columbia of the United States. The sample included all noninstitutionalized civilian adults aged 18 and older (N = 85,580; weighted N = 248,008,986). The outcome of opioid misuse and/or use disorder was based on reported prescription pain reliever and/or heroin use dependence, abuse, or misuse. Biopsychosocial predictors of opioid misuse and use disorder in addition to sociodemographic characteristics and other substance dependence or abuse were examined in our comprehensive model. Biopsychosocial characteristics included socioecological and health indicators. Criminality was the socioecological indicator. Health indicators included self-reported health, private health insurance, psychological distress, and suicidality. Sociodemographic variables included age, sex/gender, race/ethnicity, sexual identity, education, residence, income, and employment status. Substance dependence or abuse included both licit and illicit substances (i.e., nicotine, alcohol, marijuana, cocaine, inhalants, methamphetamine, tranquilizers, stimulants, sedatives). The comprehensive model found that criminality (adjusted odds ratio [AOR] = 2.58, 95% confidence interval [CI] = 1.98–3.37, p < 0.001), self-reported health (i.e., excellent compared to fair/poor [AOR = 3.71, 95% CI = 2.19–6.29, p < 0.001], good [AOR = 3.43, 95% CI = 2.20–5.34, p < 0.001], and very good [AOR = 2.75, 95% CI = 1.90–3.98, p < 0.001]), no private health insurance (AOR = 2.12, 95% CI = 1.55–2.89, p < 0.001), serious psychological distress (AOR = 2.12, 95% CI = 1.55–2.89, p < 0.001), suicidality (AOR = 1.58, 95% CI = 1.17–2.14, p = 0.004), and other substance dependence or abuse were significant predictors of opioid misuse and/or use disorder. Substances associated were nicotine (AOR = 3.01, 95% CI = 2.30–3.93, p < 0.001), alcohol (AOR = 1.40, 95% CI = 1.02–1.92, p = 0.038), marijuana (AOR = 2.24, 95% CI = 1.40–3.58, p = 0.001), cocaine (AOR = 3.92, 95% CI = 2.14–7.17, p < 0.001), methamphetamine (AOR = 3.32, 95% CI = 1.96–5.64, p < 0.001), tranquilizers (AOR = 16.72, 95% CI = 9.75–28.65, p < 0.001), and stimulants (AOR = 2.45, 95% CI = 1.03–5.87, p = 0.044). Biopsychosocial characteristics such as socioecological and health indicators, as well as other substance dependence or abuse were stronger predictors of opioid misuse and use disorder than sociodemographic characteristics.
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