Diagnosis and treatment of opioid-related disorders in a South African private sector medical insurance scheme: A cohort study.
Diagnosis and treatment of opioid-related disorders in a South African private sector medical insurance scheme: A cohort study.
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DOI：
10.1016/j.drugpo.2022.103853
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发表时间：
2022-11
影响因子：
4.4
通讯作者：
Haas, Andreas
中科院分区：
文献类型：
--
作者：
Tlali, Mpho;Scheibe, Andrew;Ruffieux, Yann;Cornell, Morna;Wettstein, Anja E.;Egger, Matthias;Davies, Mary -Ann;Maartens, Gary;Johnson, Leigh F.;Haas, Andreas
关键词：
类阿片的使用在全球范围内不断增加，但中低收入国家关于类阿片相关精神和行为障碍（下称“类阿片相关障碍”）的数据很少。本研究探讨了阿片类药物相关疾病的发病率，阿片类药物激动剂的使用，并与阿片类药物相关疾病的人在南非的私人医疗保健部门的超额死亡率。我们分析了2011年1月1日至2020年7月1日期间南非医疗保险计划受益人（≥ 11岁）的纵向数据。如果受益人接受阿片类激动剂（丁丙诺啡或美沙酮）或ICD-10诊断为有害阿片类药物使用（F11.1）、阿片类药物依赖或戒断（F11.2-4）或未指明或其他阿片类药物相关疾病（F11.0、F11.5-9），则将其归类为患有阿片类药物相关疾病。我们计算了与阿片类药物相关疾病相关因素的调整后风险比（aHR），估计了接受ICD-10阿片类药物依赖或戒断诊断后阿片类药物激动剂使用的累积发生率，并检查了阿片类药物相关疾病受益人的超额死亡率。在1，251，458名受益人中，1，286人（0.1%）患有类阿片相关疾病。在2011年至2020年期间，阿片类药物相关疾病的发病率每年增加12%（95%CI 9%-15%）。男性、20多岁的年轻人和患有共病精神健康或其他物质使用障碍的受益人患阿片类药物相关疾病的风险增加。诊断后3年，接受ICD-10阿片类药物依赖或戒断诊断的受益人中阿片类药物激动剂使用的累积发生率为18.0%（95%CI 14.0-22.4）。调整年龄、性别、年份、医疗保险覆盖范围和人群组后，阿片类药物相关疾病与死亡风险增加相关（aHR 2.28，95% CI 1.84-2.82）。阿片类药物相关疾病与预期寿命缩短7.8年相关。私营部门中被诊断患有类阿片相关疾病或接受类阿片相关疾病治疗的患者人数正在迅速增加。阿片类药物相关疾病患者是一个易受伤害的人群，患有大量的精神病合并症，经常过早死亡。迫切需要对类阿片相关疾病进行循证管理，以改善类阿片相关疾病患者的健康结果。
The use of opioids is increasing globally, but data from low- and middle-income countries on opioid-related mental and behavioural disorders (hereafter referred to as opioid-related disorders) are scarce. This study examines the incidence of opioid-related disorders, opioid agonist use, and excess mortality among persons with opioid-related disorders in South Africa’s private healthcare sector. We analysed longitudinal data of beneficiaries (≥ 11 years) of a South African medical insurance scheme using reimbursement claims from Jan 1, 2011, to Jul 1, 2020. Beneficiaries were classified as having an opioid-related disorder if they received an opioid agonist (buprenorphine or methadone) or an ICD-10 diagnosis for harmful opioid use (F11.1), opioid dependence or withdrawal (F11.2–4), or an unspecified or other opioid-related disorder (F11.0, F11.5–9). We calculated adjusted hazard ratios (aHR) for factors associated with opioid-related disorders, estimated the cumulative incidence of opioid agonist use after receiving an ICD-10 diagnosis for opioid dependence or withdrawal, and examined excess mortality among beneficiaries with opioid-related disorders. Of 1,251,458 beneficiaries, 1,286 (0.1%) had opioid-related disorders. Between 2011 and 2020, the incidence of opioid-related disorders increased by 12% (95% CI 9%−15%) per year. Men, young adults in their twenties, and beneficiaries with co-morbid mental health or other substance use disorders were at increased risk of opioid-related disorders. The cumulative incidence of opioid agonist use among beneficiaries who received an ICD-10 diagnosis for opioid dependence or withdrawal was 18.0% (95% CI 14.0–22.4) 3 years after diagnosis. After adjusting for age, sex, year, medical insurance coverage, and population group, opioid-related disorders were associated with an increased risk of mortality (aHR 2.28, 95% CI 1.84–2.82). Opioid-related disorders were associated with a 7.8-year shorter life expectancy. The incidence of patients diagnosed with or treated for an opioid-related disorder in the private sector is increasing rapidly. People with opioid-related disorders are a vulnerable population with substantial psychiatric comorbidity who often die prematurely. Evidence-based management of opioid-related disorders is urgently needed to improve the health outcomes of people with opioid-related disorders.
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DOI：
10.1016/j.hsag.2015.09.001
发表时间：
2016-01-01
期刊：
Health SA Gesondheid (Online)
影响因子：
--
作者：
Mokwena, Kebogile
通讯作者：
Mokwena, Kebogile
DOI：
10.7196/samj.2021.v111i2.14686
发表时间：
2021-02-01
期刊：
SAMJ: South African Medical Journal
影响因子：
--
作者：
Daniels, A;Muloiwa, R;Buys, H
通讯作者：
Buys, H
影响因子：
6
作者：
Degenhardt, Louisa;Charlson, Fiona;Vos, Theo
通讯作者：
Vos, Theo
影响因子：
168.9
作者：
Degenhardt, Louisa;Grebely, Jason;Larney, Sarah
通讯作者：
Larney, Sarah
影响因子：
2.9
作者：
Corrigan, Patrick W.
通讯作者：
Corrigan, Patrick W.