Identifying sociodemographic profiles of veterans at risk for high-dose opioid prescribing using classification and regression trees.
Identifying sociodemographic profiles of veterans at risk for high-dose opioid prescribing using classification and regression trees.
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确定使用分类和回归树的高剂量阿片类药物处方的退伍军人的社会人口统计学概况。
DOI：
10.5055/jom.2020.0599
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发表时间：
2020-11
影响因子：
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通讯作者：
Hausmann LRM
中科院分区：
文献类型：
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作者：
Lipkin JS;Thorpe JM;Gellad WF;Hanlon JT;Zhao X;Thorpe CT;Sileanu FE;Cashy JP;Hale JA;Mor MK;Radomski TR;Good CB;Fine MJ;Hausmann LRM
确定高剂量阿片类药物处方患者的社会人口学特征。横断面队列研究。退伍军人在退伍军人健康管理局和医疗保险D部分双重登记，2012年有≥1个阿片类药物处方。我们确定了5个患者层面的人口统计学特征和12个社区变量，反映了地区，社会经济贫困，安全和互联网连接。我们的结果是连续≥90天接受>120吗啡毫克当量（MME）的退伍军人的比例，这是药房质量联盟对慢性高剂量阿片类药物处方的衡量标准。我们使用分类和回归树（CART）方法来确定社会人口统计学亚组的慢性高剂量阿片类药物处方的风险。总体而言，在525，716名双重登记的退伍军人中，有17，271人（3.3%）接受了慢性高剂量阿片类药物的处方。CART分析使用四种社会人口统计学和五种社区水平的指标确定了35个亚组，高剂量阿片类药物的处方率从0.28%到12.1%不等。结果频率最高的亚组（n = 16，302）包括残疾退伍军人，年龄18-64岁，白色或其他种族，并居住在西部人口普查地区。结果频率最低的亚组（n = 14，835）包括无残疾的退伍军人，未接受Medicare Part D低收入补贴，年龄>85岁，居住在社区公共援助的第二和第六至第十个十位数内的社区。仅使用社会人口统计学和社区水平变量的CART分析，我们确定了退伍军人亚组，其慢性高剂量阿片类药物处方差异为43倍。在大规模人群中识别高风险亚组时，应考虑残疾、年龄、种族/民族和地区之间的相互作用。
To identify sociodemographic profiles of patients prescribed high-dose opioids. Cross-sectional cohort study. Veterans dually-enrolled in Veterans Health Administration and Medicare Part D, with ≥1 opioid prescription in 2012. We identified five patient-level demographic characteristics and 12 community variables reflective of region, socioeconomic deprivation, safety, and internet connectivity. Our outcome was the proportion of veterans receiving >120 morphine milligram equivalents (MME) for ≥90 consecutive days, a Pharmacy Quality Alliance measure of chronic high-dose opioid prescribing. We used classification and regression tree (CART) methods to identify risk of chronic high-dose opioid prescribing for sociodemographic subgroups. Overall, 17,271 (3.3 percent) of 525,716 dually enrolled veterans were prescribed chronic high-dose opioids. CART analyses identified 35 subgroups using four sociodemographic and five community-level measures, with high-dose opioid prescribing ranging from 0.28 percent to 12.1 percent. The subgroup (n = 16,302) with highest frequency of the outcome included veterans who were with disability, age 18–64 years, white or other race, and lived in the Western Census region. The subgroup (n = 14,835) with the lowest frequency of the outcome included veterans who were without disability, did not receive Medicare Part D Low Income Subsidy, were >85 years old, and lived in communities within the second and sixth to tenth deciles of community public assistance. Using CART analyses with sociodemographic and community-level variables only, we identified subgroups of veterans with a 43-fold difference in chronic high-dose opioid prescriptions. Interactions among disability, age, race/ethnicity, and region should be considered when identifying high-risk subgroups in large populations.