Opioid Dose and Risk of Road Trauma in Canada A Population-Based Study
Opioid Dose and Risk of Road Trauma in Canada A Population-Based Study
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DOI：
10.1001/2013.jamainternmed.733
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发表时间：
2013-02-11
影响因子：
39
通讯作者：
Mamdani, Muhammad M.
中科院分区：
文献类型：
--
作者：
Gomes, Tara;Redelmeier, Donald A.;Mamdani, Muhammad M.
背景资料：使用阿片类药物可能会使司机易患道路创伤，但阿片类药物剂量对这种关联的影响是unknown.Methods：我们进行了一项基于人群的巢式病例对照研究，患者年龄在18至64岁之间，从2003年4月1日至2011年3月31日接受了至少1个阿片类药物的公共资助处方。病例定义为与道路创伤相关的急诊室就诊。无道路创伤的患者作为对照组，与年龄、性别、指数年、既往道路创伤和疾病风险指数相匹配。我们比较了接受阿片类药物剂量从非常低到非常高（每天= 200吗啡当量）治疗的患者的道路创伤风险< 20 to >。在一个亚组分析，我们分层我们的分析司机status.Results：在549 878符合条件的成年人，我们确定了5300例道路创伤和匹配的同等数量的控制。多变量调整显示阿片类药物剂量增加与道路创伤几率之间无显著相关性（调整后的比值比范围为1.00至1.09）。然而，在驾驶员中观察到阿片类药物剂量与道路创伤之间存在显着相关性。与极低剂量的阿片类药物相比，低剂量的驾驶员道路创伤的几率增加了21%（调整后的比值比，1.21 [95% CI，1.02-1.42]）;处方中等剂量的患者，比值比增加29%（1.29 [1.06-1.57]）;处方高剂量者，42%的几率增加（1.42 [1.15-1.76]）;而那些开了很高剂量的处方的人，（1.23 [1.02-1.49]）.结论：在驾驶员处方阿片类药物中，药物剂量与道路创伤风险之间存在显著相关性。这种关联是明显的，并没有出现与乘客，行人和其他受伤的道路创伤。JAMA Intern Med.2013;173（3）：196-201. 2013年1月14日在线发布。doi：10.1001/2013.jamainternmed.733
Background: Use of opioids may predispose drivers to road trauma, yet the effect of opioid dose on this association is unknown.Methods: We conducted a population-based nested case-control study of patients aged 18 to 64 years who received at least 1 publicly funded prescription for an opioid from April 1, 2003, through March 31, 2011. Cases were defined as having an emergency department visit related to road trauma. Patients without road trauma served as a control group matched to cases by age, sex, index year, prior road trauma, and a disease risk index. We compared the risk of road trauma among patients treated with doses of opioids ranging from very low to very high (< 20 to >= 200 morphine equivalents daily). In a subgroup analysis, we stratified our analysis by driver status.Results: Among 549 878 eligible adults, we identified 5300 cases with road trauma and matched an equal number of controls. Multivariate adjustment yielded no significant association between escalating opioid dose and odds of road trauma (adjusted odds ratio ranged between 1.00 and 1.09). However, a significant association between opioid dose and road trauma was observed among drivers. Compared with very low opioid doses, drivers prescribed low doses had a 21% increased odds of road trauma (adjusted odds ratio, 1.21 [95% CI, 1.02-1.42]); those prescribed moderate doses, 29% increased odds (1.29 [1.06-1.57]); those prescribed high doses, 42% increased odds (1.42 [1.15-1.76]); and those prescribed very high doses, 23% increased odds (1.23 [1.02-1.49]).Conclusions: Among drivers prescribed opioids, a significant relationship exists between drug dose and risk of road trauma. This association is distinct and does not appear with passengers, pedestrians, and others injured in road trauma. JAMA Intern Med. 2013;173(3):196-201. Published online January 14, 2013. doi:10.1001/2013.jamainternmed.733