Sex Differences in Dose Escalation and Overdose Death during Chronic Opioid Therapy: A Population-Based Cohort Study.
Sex Differences in Dose Escalation and Overdose Death during Chronic Opioid Therapy: A Population-Based Cohort Study.
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DOI：
10.1371/journal.pone.0134550
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Juurlink DN
中科院分区：
文献类型：
--
作者：
Kaplovitch E;Gomes T;Camacho X;Dhalla IA;Mamdani MM;Juurlink DN
阿片类药物用于非癌症疼痛的使用很普遍，在美国每年有超过16，000人死于阿片类药物相关的原因。死亡风险最大的患者是那些接受高剂量阿片类药物的患者。性别是否影响剂量递增或阿片类药物相关死亡的风险尚不清楚。我们使用加拿大安大略32，499名15至64岁的患者的医疗记录进行了一项队列研究，这些患者于1997年4月1日至2010年12月31日期间开始接受慢性阿片类药物治疗非癌症疼痛。患者从第一次阿片类药物处方开始接受随访，直至停止治疗、任何原因导致的死亡或研究期结束。在接受长期阿片类药物治疗的患者中，589例（1.8%）递增至高剂量治疗，n = 59例（0.2%）在治疗期间死于阿片类药物相关原因。多变量调整后，男性比女性更有可能升级为高剂量阿片类药物治疗（调整后的风险比1.44; 95%置信区间1.21至1.70），死于阿片类药物相关原因的可能性是女性的两倍（调整后的风险比2.04; 95%置信区间1.18至3.53）。在对285，520名接受任何阿片类药物的个体进行的二次分析中，无论治疗持续时间如何，这些相关性都得到了维持。男性比女性更容易升级到高剂量阿片类药物治疗和因阿片类药物相关原因死亡。这两种结果都比预期的更常见。
The use of opioids for noncancer pain is widespread, and more than 16,000 die of opioid-related causes in the United States annually. The patients at greatest risk of death are those receiving high doses of opioids. Whether sex influences the risk of dose escalation or opioid-related mortality is unknown. We conducted a cohort study using healthcare records of 32,499 individuals aged 15 to 64 who commenced chronic opioid therapy for noncancer pain between April 1, 1997 and December 31, 2010 in Ontario, Canada. Patients were followed from their first opioid prescription until discontinuation of therapy, death from any cause or the end of the study period. Among patients receiving chronic opioid therapy, 589 (1.8%) escalated to high dose therapy and n = 59 (0.2%) died of opioid-related causes while on treatment. After multivariable adjustment, men were more likely than women to escalate to high-dose opioid therapy (adjusted hazard ratio 1.44; 95% confidence interval 1.21 to 1.70) and twice as likely to die of opioid-related causes (adjusted hazard ratio 2.04; 95% confidence interval 1.18 to 3.53). These associations were maintained in a secondary analysis of 285,520 individuals receiving any opioid regardless of the duration of therapy. Men are at higher risk than women for escalation to high-dose opioid therapy and death from opioid-related causes. Both outcomes were more common than anticipated.