Association of Treatment With Medications for Opioid Use Disorder With Mortality After Hospitalization for Injection Drug Use-Associated Infective Endocarditis.
Association of Treatment With Medications for Opioid Use Disorder With Mortality After Hospitalization for Injection Drug Use-Associated Infective Endocarditis.
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DOI：
10.1001/jamanetworkopen.2020.16228
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发表时间：
2020-10-01
影响因子：
13.8
通讯作者：
Larochelle MR
中科院分区：
文献类型：
--
作者：
Kimmel SD;Walley AY;Li Y;Linas BP;Lodi S;Bernson D;Weiss RD;Samet JH;Larochelle MR
这项队列研究评估了马萨诸塞州注射用药相关性感染性心内膜炎住院后阿片类药物使用障碍的用药与死亡率之间的关系。接受阿片类药物使用障碍(MOUD)治疗与注射用药相关性感染性心内膜炎住院后死亡率之间是否存在关联？在这项队列研究中，679名因注射用药相关性心内膜炎住院的患者中，24%的人在出院后3个月内接受了Moud治疗。出院后3个月内接受MUD治疗与死亡率降低无关，但与接受治疗当月死亡率降低有关。在这项研究中，使用Moud的治疗并不常见，在时变分析中与死亡率降低有关，但在主要分析中，可能是由于治疗保留不良所致。尽管在阿片类药物危机期间，因注射药物使用相关性感染性心内膜炎(IDU-IE)住院的人数有所增加，但IDU-IE患者出院后接受阿片使用障碍(MOUD)药物治疗的使用率和死亡率尚不清楚。评估IDU-IE患者住院后接受MOUD治疗的比例以及接受MOUD治疗与死亡率的关系。这项回溯性队列研究使用了马萨诸塞州2011年1月1日至2015年12月31日期间的人口登记、个人水平的医疗索赔、处方监测计划、死亡率和药物使用治疗数据；分析了2011年7月1日至2015年6月30日期间与IDU-IE相关的出院数据。纳入所有年龄在18岁至之间的马萨诸塞州居民，首次住院治疗为心内膜炎，且在过去6个月内至少有1人因吸毒者、吸毒或丙型肝炎住院，出院后存活2个月。对2018年11月11日至2020年6月23日的数据进行了分析。在出院后3个月内接受Moud治疗，定义为美沙酮、丁丙诺啡或纳曲酮，IDU-IE的出院月份除外。主要结果是全因死亡。计算患者在出院后3个月内接受Moud治疗的比例。采用多变量COX比例风险回归模型，对性别、年龄、内科和精神科合并症、无家可归者进行了调整，研究了MOD值与死亡率之间的关系。在二次分析中，Moud的接收被认为是每月随时间变化的暴露。679例IDU-IE患者中，男性413例(60.8%)，平均年龄39.2岁(12.1岁)，18~34岁298例(43.9%)，精神疾病419例(72.3%)，无家可归209例(30.8%)。共有134人(19.7%)在入院前3个月和165人(24.3%)在出院前3个月内接受了MOUD治疗。在出院后接受Moud治疗的患者中，112人(67.9%)接受丁丙诺啡治疗。粗死亡率为每100人年9.2例死亡。出院后3个月内接受Moud治疗与死亡率的降低无关(调整后的危险比为1.29；95%可信区间为0.61-2.72)；然而，接受Moud治疗的当月死亡率降低(调整后的危险比为0.30；95%CI为0.10-0.89)。在这项队列研究中，仅在接受注射药物相关心内膜炎的月份内，接受Moud治疗与因注射药物相关心内膜炎住院后死亡率降低有关。努力改善IDU-IE住院后Moud的启动和保留可能是有益的。
This cohort study assess the association of receipt of medication for opioid use disorder and mortality after hospitalization for injection drug use–associated infective endocarditis in Massachusetts. Is there an association between receipt of medication for opioid use disorder (MOUD) and mortality after hospitalization for injection drug use–associated infective endocarditis? In this cohort study 679 individuals hospitalized with injection drug use–associated endocarditis, 24% received MOUD within 3 months of discharge. MOUD receipt within 3 months of discharge was not associated with reduced mortality but was associated with a reduction in mortality in the month received. In this study, treatment with MOUD was uncommon and was associated with reduced mortality in the time-varying analysis but not the main analysis, possibly owing to poor treatment retention. Although hospitalizations for injection drug use–associated infective endocarditis (IDU-IE) have increased during the opioid crisis, utilization of and mortality associated with receipt of medication for opioid use disorder (MOUD) after discharge from the hospital among patients with IDU-IE are unknown. To assess the proportion of patients receiving MOUD after hospitalization for IDU-IE and the association of MOUD receipt with mortality. This retrospective cohort study used a population registry with person-level medical claims, prescription monitoring program, mortality, and substance use treatment data from Massachusetts between January 1, 2011, and December 31, 2015; IDU-IE–related discharges between July 1, 2011, and June, 30, 2015, were analyzed. All Massachusetts residents aged 18 to 64 years with a first hospitalization for IDU-IE were included; IDU-IE was defined as any hospitalization with a diagnosis of endocarditis and at least 1 claim in the prior 6 months for OUD, drug use, or hepatitis C and with 2-month survival after hospital discharge. Data were analyzed from November 11, 2018, to June 23, 2020. Receipt of MOUD, defined as any treatment with methadone, buprenorphine, or naltrexone, within 3 months after hospital discharge excluding discharge month for IDU-IE. The main outcome was all-cause mortality. The proportion of patients who received MOUD in the 3 months after hospital discharge was calculated. Multivariable Cox proportional hazard regression models were used to examine the association of MOUD receipt with mortality, adjusting for sex, age, medical and psychiatric comorbidities, and homelessness. In the secondary analysis, receipt of MOUD was considered as a monthly time-varying exposure. Of 679 individuals with IDU-IE, 413 (60.8%) were male, the mean (SD) age was 39.2 (12.1) years, 298 (43.9%) were aged 18 to 34 years, 419 (72.3) had mental illness, and 209 (30.8) experienced homelessness. A total of 134 individuals (19.7%) received MOUD in the 3 months before hospitalization and 165 (24.3%) in the 3 months after hospital discharge. Of those who received MOUD after discharge, 112 (67.9%) received buprenorphine. The crude mortality rate was 9.2 deaths per 100 person-years. MOUD receipt within 3 months after discharge was not associated with reduced mortality (adjusted hazard ratio, 1.29; 95% CI, 0.61-2.72); however, MOUD receipt was associated with reduced mortality in the month that MOUD was received (adjusted hazard ratio, 0.30; 95% CI, 0.10-0.89). In this cohort study, receipt of MOUD was associated with reduced mortality after hospitalization for injection drug use–associated endocarditis only in the month it was received. Efforts to improve MOUD initiation and retention after IDU-IE hospitalization may be beneficial.
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影响因子：
5.7
作者：
Wakeman, Sarah E.;Metlay, Joshua P.;Rigotti, Nancy A.
通讯作者：
Rigotti, Nancy A.
在马萨诸塞州发生抗歧视定居之前和之后，拒绝接受阿片类药物使用障碍患者。
影响因子：
5.5
作者：
Kimmel SD;Rosenmoss S;Bearnot B;Larochelle M;Walley AY
通讯作者：
Walley AY
影响因子：
3.7
作者：
Suzuki, Joji
通讯作者：
Suzuki, Joji
影响因子：
5.5
作者：
Suzuki, Joji;Johnson, Jennifer A.;Weiss, Roger D.
通讯作者：
Weiss, Roger D.
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN