Association of Obesity With Prescription Opioids for Painful Conditions in Patients Seeking Primary Care in the US
Association of Obesity With Prescription Opioids for Painful Conditions in Patients Seeking Primary Care in the US
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DOI：
10.1001/jamanetworkopen.2020.2012
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发表时间：
2020-04-02
影响因子：
13.8
通讯作者：
Neogi, Tuhina
中科院分区：
文献类型：
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作者：
Stokes, Andrew;Lundberg, Dielle J.;Neogi, Tuhina
先前的研究已经确定了肥胖与美国处方阿片类药物使用之间的关联。然而，作为这种关联因素的疼痛状况仍未确立。目的探讨肥胖与基层临床医生记录的阿片类药物处方原因疼痛诊断之间的关系。设计、设置和参与者进行了一项横断面研究，包括565 & x202 f;930名年龄在35至64岁的患者，2016年记录了体重指数（BMI）测量结果。审查了2015年1月1日至2017年12月31日期间美国初级保健临床医生在多付款人athenahealth网络中看到的患者的电子健康记录，并分析了2019年3月1日至9月15日的数据。确定了2016年首次BMI测量之前或之后365天内的任何阿片类药物处方。所有国际疾病分类，第九次修订版和国际疾病和相关健康问题统计分类，第十次修订版，在每次阿片类药物处方前7天内的索赔被捕获并使用疼痛诊断类型学系统进行分类。体重分类为体重不足（BMI，18.5-19.9）、正常体重（BMI，20.0-24.9）、超重（BMI，25.0-29.9）、肥胖I（BMI，30-34.9）、肥胖II（BMI，35.0-39.9）、肥胖III（BMI，40.0-49.9）和肥胖IV（BMI，50.0-80.0）。结果565930例患者中，女性329083例（58.1%）。共有125 093例患者（22.1%）的年龄为35 - 44岁，199 384例患者（35.2%）的年龄为45 - 54岁，241 453例患者（42.7%）的年龄为55 - 64岁。基线时，共有177 631例患者（31.4%）超重，273 135例患者（48.2%）肥胖。超过2年，93 & x202 f;954例患者（16.6%）处方阿片类药物。接受处方阿片类药物的风险随着BMI的增加而逐渐增加（超重校正相对危险度：1.08; 95% CI，1.06-1.10;肥胖I：1.24; 95% CI，1.22-1.26;肥胖II：1.33; 95% CI，1.30-1.36;肥胖III：1.48; 95% CI，1.45-1.51;和肥胖IV，1.71; 95% CI，1.65-1.77）。因超重或肥胖BMI而接受阿片类药物处方的患者百分比为16.2%（95% CI，15.0%-17.4%）。用于治疗骨关节炎（肥胖与正常体重的相对风险，1.90; 95%CI，1.77-2.05）和其他关节疾病（相对风险，1.63; 95%CI，1.55-1.72）的处方阿片类药物与肥胖的相关性均高于任何疼痛诊断的平均值（相对风险，1.33; 95%CI，1.31-1.36）。骨关节炎、其他关节疾病和其他背部疾病占肥胖阿片类药物处方绝对差异的53.4%。结论和相关性关节和背部疾病似乎是解释肥胖患者阿片类药物处方增加的最重要诊断。解决阿片类药物危机将需要注意的潜在来源的需求处方阿片类药物，包括肥胖，通过其与pain.This cross-sectional study investigates the association of obesity with prescription opioid for pain diagnosis among US adults seeking primary care.Question肥胖与处方阿片类药物疼痛诊断在美国寻求初级保健的患者之间的关联？结果在这项横断面研究的电子健康记录的565 &x202f;930例患者，骨关节炎，其他关节疾病，和其他背部疾病是最重要的疼痛诊断与阿片类药物处方增加肥胖患者。研究结果表明，预防和治疗肥胖的人群水平的努力可能会减少关节和背部疾病的患病率和严重程度以及处方阿片类药物的相关使用。
Importance Prior studies have identified an association between obesity and prescription opioid use in the US. However, the pain conditions that are factors in this association remain unestablished. Objective To investigate the association between obesity and pain diagnoses recorded by primary care clinicians as reasons for prescription of opioids. Design, Setting, and Participants A cross-sectional study including 565 & x202f;930 patients aged 35 to 64 years with a body mass index (BMI) measurement recorded in 2016 was conducted. Electronic health records of patients seen by primary care clinicians in the US in the multipayer athenahealth network from January 1, 2015, to December 31, 2017, were reviewed, and data were analyzed from March 1 to September 15, 2019. Main Outcomes and Measures Any prescription of opioids in the 365 days before or after the first BMI measurement in 2016 were identified. All International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, claims within 7 days before each opioid prescription were captured and classified using a pain diagnosis typologic system. Weight was categorized as underweight (BMI, 18.5-19.9), normal weight (BMI, 20.0-24.9), overweight (BMI, 25.0-29.9), obese I (BMI, 30-34.9), obese II (BMI, 35.0-39.9), obese III (BMI, 40.0-49.9), and obese IV (BMI, 50.0-80.0). Results Among 565 & x202f;930 patients, 329 & x202f;083 (58.1%) were women. A total of 125 093 patients (22.1%) were aged 35 to 44 years, 199 384 patients (35.2%) were 45 to 54 years, and 241 453 patients (42.7%) were 55 to 64 years. A total of 177 & x202f;631 patients (31.4%) were overweight and 273 135 patients (48.2%) were obese at baseline. Over 2 years, 93 & x202f;954 patients (16.6%) were prescribed opioids. The risk of receiving prescription opioids increased progressively with BMI (adjusted relative risk for overweight: 1.08; 95% CI, 1.06-1.10; obese I: 1.24; 95% CI, 1.22-1.26; obese II: 1.33; 95% CI, 1.30-1.36; obese III: 1.48; 95% CI, 1.45-1.51; and obese IV, 1.71; 95% CI, 1.65-1.77). The percentage of patients with opioid prescriptions attributable to an overweight or obese BMI was 16.2% (95% CI, 15.0%-17.4%). Prescription opioids for management of osteoarthritis (relative risk for obese vs normal weight, 1.90; 95% CI, 1.77-2.05) and other joint disorders (relative risk, 1.63; 95% CI, 1.55-1.72) both had stronger associations with obesity than the mean for any pain diagnosis (relative risk, 1.33; 95% CI, 1.31-1.36). Osteoarthritis, other joint disorders, and other back disorders comprised a combined 53.4% of the absolute difference in prescription of opioids by obesity. Conclusions and Relevance Joint and back disorders appear to be the most important diagnoses in explaining the increased receipt of opioid prescriptions among patients with obesity. Addressing the opioid crisis will require attention to underlying sources of demand for prescription opioids, including obesity, through its associations with pain.This cross-sectional study investigates the association of obesity with prescription opioids for pain diagnoses among US adults seeking primary care.Question Is obesity associated with prescription opioids for pain diagnoses among patients seeking primary care in the United States? Findings In this cross-sectional study of electronic health records of 565 & x202f;930 patients, osteoarthritis, other joint disorders, and other back disorders were the most important pain diagnoses associated with the increased prescribing of opioids to patients with obesity. Meaning The findings suggest that population-level efforts to prevent and treat obesity may reduce the prevalence and severity of joint and back disorders and the associated use of prescription opioids.