Incidence rates of and risk factors for opioid overdose in new users of prescription opioids amongUSMedicaid enrollees: A cohort study
Incidence rates of and risk factors for opioid overdose in new users of prescription opioids amongUSMedicaid enrollees: A cohort study
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DOI：
10.1002/pds.5067
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发表时间：
2020-07-10
影响因子：
2.6
通讯作者：
Hennessy, Sean
中科院分区：
文献类型：
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作者：
Nam, Young Hee;Bilker, Warren B.;Hennessy, Sean
目的了解医疗补助人群中处方类阿片类药物新使用者阿片类药物过量的发生率及其危险因素。方法一项队列研究使用了来自四个州的医疗补助申请(1999-2012)，在连续参加医疗补助的成年人中，在进入队列之前连续3年没有阿片类药物处方和阿片类药物过量。感兴趣的暴露和结果分别是在住院和门诊索赔中确定的处方阿片类药物的使用和明显的阿片类药物过量(敏感性接近97%；阳性预测价值接近87%)。结果在新处方阿片类药物使用者(1336 140人；246466人年)中，每10万人年阿片类药物过量总发生率为247.1(95%可信区间227.5~266.7)，2002年为251.0(CI，188.6~313.5)，2012年为225.5(CI，142.0~309.0)。阿片类药物过量的风险在65-80岁(调整后的危险比[HR]，0.50；CI，0.37-0.66)和80-100岁(0.35；0.23-0.52)与18-35岁；女性(0.79；0.67-0.93)与男性；以及其他/未知种族/族裔(0.71；0.54-0.93)与白人相比较低。阿片类药物的初始剂量在吗啡毫克当量(MME)，50-100毫克/天(1.52；1.24-1.86)和>；100毫克/天(1.98；1.55-2.53)的风险更高，与
Purpose To measure incidence rates of and risk factors for opioid overdose among new users of prescription opioids in the Medicaid population. Methods A cohort study using Medicaid claims from four states (1999-2012) among adults continuously enrolled in Medicaid for >= 3 years free of opioid prescriptions and opioid overdose before cohort entry. Exposure and outcome of interest were prescription opioid use and apparent incident opioid overdose identified in inpatient and outpatient claims (sensitivity approximate to 97%; positive predictive value approximate to 87%), respectively. Results Among new prescription opioid users (1 336 140 persons; 246 466 person-years), the overall opioid overdose incidence rate per 100 000 person-years was 247.1 (95% confidence interval [CI], 227.5-266.7), with 251.0 (CI, 188.6-313.5) in 2002 and 225.5 (CI, 142.0-309.0) in 2012. A lower hazard for opioid overdose was seen for age 65-80 years (adjusted hazard ratio [HR], 0.50; CI, 0.37-0.66) and 80-100 years (0.35; 0.23-0.52) vs 18-35 years; females (0.79; 0.67-0.93) vs males; and other/unknown race/ethnicity (0.71; 0.54-0.93) vs whites. A higher hazard was seen for initial opioid dose in morphine milligram equivalents (MMEs), 50-100 MME/day (1.52; 1.24-1.86) and >100 MME/day (1.98; 1.55-2.53), vs