Toxicology Test Results for Public Health Surveillance of the Opioid Epidemic: Retrospective Analysis.
Toxicology Test Results for Public Health Surveillance of the Opioid Epidemic: Retrospective Analysis.
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DOI：
10.2196/50936
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发表时间：
2023
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应对阿片类药物流行需要及时了解人口层面的因素，如法律的和非法药物的流行趋势、过量和死亡。这项研究旨在研究来自各种来源的活体个体的毒理学测试结果是否有助于监测阿片类药物的流行。一项回顾性分析对2018年9月1日至2019年8月31日期间美国印第安纳州马里恩县24个实验室的毒理学结果进行了标准化、合并和关联。数据集包括33,787名马里恩县居民和他们的746,681个结果。我们将这些数据与马里恩县的一般人口统计数据进行了关联，并将毒理学结果产生的警报与阿片类药物过量相关的急诊室就诊进行了比较。19位领域专家帮助建立了分析可视化的原型。主要结果指标包括县内和邮政编码的检测阳性率;具有毒理学结果的个人的选定人口统计学;以及毒理学结果与阿片类药物过量相关的急诊室就诊的相关性。马里恩县4%的居民至少有一个毒理学结果。测试阳性率范围从3%到19%的邮政编码。男性在数据集中的代表性不足。年龄分布与马里恩县相似。阿片类药物毒理学结果警报与阿片类药物过量相关的急诊室就诊无关。大规模分析毒理学结果受到不同数据格式、完整性和代表性、数据源变化和患者匹配困难的阻碍。在这项研究中，毒理学结果并没有预测阿片类药物过量的峰值。需要更大，更严格和良好对照的研究来评估毒理学测试在预测阿片类药物过量峰值方面的效用。
Addressing the opioid epidemic requires timely insights into population-level factors, such as trends in prevalence of legal and illegal substances, overdoses, and deaths. This study aimed to examine whether toxicology test results of living individuals from a variety of sources could be useful in surveilling the opioid epidemic. A retrospective analysis standardized, merged, and linked toxicology results from 24 laboratories in Marion County, Indiana, United States, from September 1, 2018, to August 31, 2019. The data set consisted of 33,787 Marion County residents and their 746,681 results. We related the data to general Marion County demographics and compared alerts generated by toxicology results to opioid overdose–related emergency department visits. Nineteen domain experts helped prototype analytical visualizations. Main outcome measures included test positivity in the county and by ZIP code; selected demographics of individuals with toxicology results; and correlation of toxicology results with opioid overdose–related emergency department visits. Four percent of Marion County residents had at least 1 toxicology result. Test positivity rates ranged from 3% to 19% across ZIP codes. Males were underrepresented in the data set. Age distribution resembled that of Marion County. Alerts for opioid toxicology results were not correlated with opioid overdose–related emergency department visits. Analyzing toxicology results at scale was impeded by varying data formats, completeness, and representativeness; changes in data feeds; and patient matching difficulties. In this study, toxicology results did not predict spikes in opioid overdoses. Larger, more rigorous and well-controlled studies are needed to assess the utility of toxicology tests in predicting opioid overdose spikes.