The association of injury with substance use disorder among women of reproductive age: an opportunity to address a major contributor to recurrent preventable emergency department visits?
The association of injury with substance use disorder among women of reproductive age: an opportunity to address a major contributor to recurrent preventable emergency department visits?
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DOI：
10.1111/acem.12548
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发表时间：
2014-12
期刊：
影响因子：
--
通讯作者：
Kotelchuck M
中科院分区：
文献类型：
--
作者：
Bernstein J;Bernstein E;Belanoff C;Cabral HJ;Babakhanlou-Chase H;Derrington TM;Diop H;Douriez C;Evans SR;Jacobs H;Kotelchuck M
育龄妇女的药物使用障碍（SUD）是一个复杂的公共卫生问题，影响着不同类型的妇女及其家庭，并可能对几代人产生影响。本研究的目标是 1) 描述和比较 SUD 阳性和 SUD 阴性女性中需要急诊室 (ED) 就诊的损伤模式的患病率，2) 在 SUD 阳性女性中，调查特定类别的损伤与所用物质类型的关联。本研究是对大型多源医疗保健利用数据集的二次分析，该数据集旨在分析 2002 年至 2008 年马萨诸塞州育龄妇女的 SUD 患病率以及健康和药物滥用治疗结果。该关联数据集的来源包括 ED、住院和门诊出院的诊断代码； SUD 设施处理记录；以及妇女及其新生儿的重要记录。 127,227 名 SUD 阳性女性的损伤数据（ICD-9-CM E 代码）可用。几乎三分之二的 SUD 阳性女性曾受过任何类型的伤害，而 SUD 阴性女性的这一比例为 44.8%。事件的平均数 (±SD) 也不同（SUD 阳性女性为 2.27 ± 4.1，SUD 阴性女性为 0.73 ± 1.3，p < 0.0001）。对于四种特定的损伤类型，SUD 阳性女性的受伤比例几乎是其两倍（49.3% vs 23.4%），平均事件数 (±SD) 是两倍多（0.72 ± 0.9 vs. 0.26 ± 0.5，p < 0.0001）。 SUD 阳性女性的机动车辆事故和跌倒的数量和比例显着较高（分别为 22.5% vs. 12.5% 和 26.6% vs. 11.0%），但最大差异是自伤（11.5% vs. 0.8%；平均值 ± SD 事件 = 0.19 ± 0.9 vs. 0.009 ± 0.2，p < 0.0001）和故意造成的伤害（11.5% vs 1.9%，平均值 ± SD 事件 = 0.18 ± 0.1 vs. 0.02 ± 0.2，p < 0.0001）。在我们检查的每个伤害类别中，SUD 阳性女性的伤害率在仅酒精障碍时最低，而在酒精和药物障碍联合时最高。在 33,600 名被确定使用阿片类药物的女性中，有 2,132 名 (6.3%) 因服用过量而向急诊科就诊。多次服药过量就诊很常见（平均值±SD=3.67±6.70次就诊）。在调整社会人口特征、精神病史和复杂/慢性疾病后，SUD仍然是所有类型伤害的重要危险因素，但对于自杀/自伤类别，精神病史是迄今为止更强的预测因素。 SUD 的存在增加了 15 至 49 岁年龄组女性因受伤到急诊室就诊的可能性。相反，受伤的女性可能更有可能酗酒或使用其他药物。我们在患有 SUD 的女性中发现的高受伤率表明，将简短、经过验证的物质使用筛查作为 ED 伤害治疗方案的一部分，并在分数表明 SUD 的可能性时转介受伤女性进行评估和/或治疗。
Substance use disorder (SUD) among women of reproductive age is a complex public health problem affecting a diverse spectrum of women and their families, with potential consequences across generations. The goals of this study were 1) to describe and compare the prevalence of patterns of injury requiring emergency department (ED) visits among SUD-positive and SUD-negative women and 2) among SUD-positive women, to investigate the association of specific categories of injury with type of substance used. This study was a secondary analysis of a large, multisource health care utilization data set developed to analyze SUD prevalence, and health and substance abuse treatment outcomes, for women of reproductive age in Massachusetts, 2002 through 2008. Sources for this linked data set included diagnostic codes for ED, inpatient, and outpatient stay discharges; SUD facility treatment records; and vital records for women and for their neonates. Injury data (ICD-9-CM E-codes) were available for 127,227 SUD-positive women. Almost two-thirds of SUD-positive women had any type of injury, compared to 44.8% of SUD-negative women. The mean (±SD) number of events also differed (2.27 ± 4.1 for SUD-positive women vs. 0.73 ± 1.3 for SUD-negative women, p < 0.0001). For four specific injury types, the proportion injured was almost double for SUD-positive women (49.3% vs 23.4%), and the mean (±SD) number of events was more than double (0.72 ± 0.9 vs. 0.26 ± 0.5, p < 0.0001). The numbers and proportions of motor vehicle incidents and falls were significantly higher in SUD-positive women (22.5% vs. 12.5% and 26.6% vs. 11.0%, respectively), but the greatest differences were in self-inflicted injury (11.5% vs. 0.8%; mean ± SD events = 0.19 ± 0.9 vs. 0.009 ± 0.2, p < 0.0001) and purposefully inflicted injury (11.5% vs 1.9%, mean ± SD events = 0.18 ± 0.1 vs. 0.02 ± 0.2, p < 0.0001). In each of the injury categories that we examined, injury rates among SUD-positive women were lowest for alcohol disorders only and highest for alcohol and drug disorders combined. Among 33,600 women identified as using opioids, 2,132 (6.3%) presented to the ED with overdose. Multiple overdose visits were common (mean ± SD = 3.67 ± 6.70 visits). After adjustment for sociodemographic characteristics, psychiatric history, and complex/chronic illness, SUD remained a significant risk factor for all types of injury, but for the suicide/self-inflicted injury category, psychiatric history was by far the stronger predictor. The presence of SUD increases the likelihood that women in the 15- to 49-year age group will present to the ED with injury. Conversely, women with injury may be more likely to be involved in alcohol abuse or other substance use. The high rates of injury that we identified among women with SUD suggest the utility of including a brief, validated screen for substance use as part of an ED injury treatment protocol and referring injured women for assessment and/or treatment when scores indicate the likelihood of SUD.
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影响因子：
3.9
作者：
McAuliffe, WE;Woodworth, R;Dunn, RP
通讯作者：
Dunn, RP
影响因子：
--
作者：
Mertens, JR;Lu, YW;Weisner, CM
通讯作者：
Weisner, CM
影响因子：
1.7
作者：
Greenfield, Shelly F.;Back, Sudie E.;Lawson, Katie;Brady, Kathleen T.
通讯作者：
Brady, Kathleen T.
影响因子：
3.5
作者：
Colantonio, Angela;Mar, Wanna;Cullen, Nora
通讯作者：
Cullen, Nora
DOI：
10.1111/j.1521-0391.2013.00316.x
发表时间：
2013-03
期刊：
The American journal on addictions
影响因子：
--
作者：
Cherpitel CJ;Martin G;Macdonald S;Brubacher JR;Stenstrom R
通讯作者：
Stenstrom R