Sex differences in factors predicting post-treatment opioid use.
Sex differences in factors predicting post-treatment opioid use.
复制标题
DOI：
10.1111/add.15396
复制
发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Kelly JF
中科院分区：
文献类型：
--
作者：
Davis JP;Eddie D;Prindle J;Dworkin ER;Christie NC;Saba S;DiGuiseppi GT;Clapp JD;Kelly JF
一些报告记录了治疗出院后使用阿片类药物的风险因素，但很少有报告评估性别差异，也没有研究使用当代机器学习方法评估风险。本文的目的是通过探索与治疗后阿片类药物使用最密切相关的每个性别的个体因素，为阿片类药物使用障碍 (OUD) 的治疗提供信息。对全球个人需求评估 (GAIN) 数据库进行二次分析，并在 OUD 治疗出院后 3、6 和 12 个月进行随访，探索预测治疗后阿片类药物使用的人口、心理和行为变量。美国各地有一百三十七个治疗点。接受 OUD 治疗的青少年 (26.9%)、年轻人 (40.8%) 和成人 (32.3%)。样本 (n = 1,126) 中 54.9% 为男性，66.1% 为白人，20% 为西班牙裔，9.8% 为多种族/民族，2.8% 为非裔美国人，1.3% 为其他种族。主要结局是入院后一年多的阿片类药物使用潜伏期。对于女性来说，正则化 Cox 回归表明，较大的戒断症状 [风险比 (HR) = 1.31]、年龄较小 (HR = 0.88)、既往药物使用障碍 (SUD) 治疗 (HR = 1.11) 和治疗抵抗 (HR = 1.11) 是治疗后阿片类药物使用的最大危害，而随机生存森林确定并排列了药物使用问题 [可变重要性 (VI) = 0.007]、刑事司法参与 (VI = 0.006）、年龄较小（VI = 0.005）和较大的戒断症状（VI = 0.004）是最大的危险因素。对于男性，Cox 回归表明，较大的品行障碍症状 (HR = 1.34)、较轻的年龄 (HR = 0.76) 和多种 SUD (HR = 1.27) 与治疗后阿片类药物的使用最为密切相关，而随机生存森林对较轻的年龄 (VI = 0.023)、较严重的品行障碍症状 (VI = 0.010)、患有多种物质使用障碍 (VI = 0.010) 和刑事司法参与 (VI = 0.006）作为最大的风险因素。对于女性来说，阿片类药物使用障碍治疗后复发阿片类药物的危险因素似乎是更大的药物使用问题和戒断症状，对于男性来说，年龄较小以及有行为障碍和多种药物使用障碍史。
Several reports have documented risk factors for opioid use following treatment discharge, yet few have assessed sex differences, and no study has assessed risk using contemporary machine learning approaches. The goal of the present paper was to inform treatments for opioid use disorder (OUD) by exploring individual factors for each sex that are most strongly associated with opioid use following treatment. Secondary analysis of Global Appraisal of Individual Needs (GAIN) database with follow-ups at 3, 6 and 12 months post-OUD treatment discharge, exploring demographic, psychological and behavioral variables that predict post-treatment opioid use. One hundred and thity-seven treatment sites across the United States. Adolescents (26.9%), young adults (40.8%) and adults (32.3%) in treatment for OUD. The sample (n = 1,126) was 54.9% male, 66.1% white, 20% Hispanic, 9.8% multi-race/ethnicity, 2.8% African American and 1.3% other. Primary outcome was latency to opioid use over 1 year following treatment admission. For women, regularized Cox regression indicated that greater withdrawal symptoms [hazard ratio (HR) = 1.31], younger age (HR = 0.88), prior substance use disorder (SUD) treatment (HR = 1.11) and treatment resistance (HR = 1.11) presented the largest hazard for post-treatment opioid use, while a random survival forest identified and ranked substance use problems [variable importance (VI) = 0.007], criminal justice involvement (VI = 0.006), younger age (VI = 0.005) and greater withdrawal symptoms (VI = 0.004) as the greatest risk factors. For men, Cox regression indicated greater conduct disorder symptoms (HR = 1.34), younger age (HR = 0.76) and multiple SUDs (HR = 1.27) were most strongly associated with post-treatment opioid use, while a random survival forests ranked younger age (VI = 0.023), greater conduct disorder symptoms (VI = 0.010), having multiple substance use disorders (VI = 0.010) and criminal justice involvement (VI = 0.006) as the greatest risk factors. Risk factors for relapse to opioid use following opioid use disorder treatment appear to be, for women, greater substance use problems and withdrawal symptoms and, for men, younger age and histories of conduct disorder and multiple substance use disorder.
登录
查看更多内容
影响因子：
4.2
作者：
Gossop, M;Marsden, J;Treacy, S
通讯作者：
Treacy, S
影响因子：
6
作者：
Degenhardt, Louisa;Charlson, Fiona;Vos, Theo
通讯作者：
Vos, Theo
影响因子：
4.2
作者：
Hernandez-Avila, CA;Rounsaville, BJ;Kranzler, HR
通讯作者：
Kranzler, HR
影响因子：
2.3
作者：
Baxley, Catherine;Weinstock, Jeremiah;Garner, Annie A.
通讯作者：
Garner, Annie A.
影响因子：
3.9
作者：
Coviello DM;Zanis DA;Wesnoski SA;Lynch KG;Drapkin M
通讯作者：
Drapkin M