Opioid Analgesic Use and Risk for Invasive Pneumococcal Diseases: A Nested Case-Control Study.
Opioid Analgesic Use and Risk for Invasive Pneumococcal Diseases: A Nested Case-Control Study.
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DOI：
10.7326/m17-1907
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发表时间：
2018-03-20
影响因子：
39.2
通讯作者：
Grijalva CG
中科院分区：
文献类型：
--
作者：
Wiese AD;Griffin MR;Schaffner W;Stein CM;Greevy RA;Mitchel EF Jr;Grijalva CG
Although certain opioid analgesics have immunosuppressive properties and increase the risk of infections in animals, the clinical implications of prescription opioid use on infection risk among humans are unknown. Test the hypothesis that prescription opioid use is an independent risk factor for invasive pneumococcal disease (IPD). Nested-case control study Tennessee Medicaid database linked to Medicare and Active Bacterial Core surveillance system databases (1995–2014) 1,233 IPD cases ≥5 years matched to 24,399 controls on the diagnosis date, age, and county of residence. Opioid use was measured using pharmacy prescription fills. IPD was defined by the isolation of S. pneumoniae from a normally sterile site. We compared the odds of current opioid use between cases and controls accounting for known IPD risk factors. Secondary analyses categorized opioid use by opioid characteristics, applied an IPD risk score to assure comparability between exposure groups and analyzed pneumonia and non-pneumonia IPD cases, separately. IPD cases had a higher odds of being current opioid users compared with controls [adjusted odds ratio (aOR),1.62 (95% CI, 1.36 to 1.92)]. Associations were strongest for opioids that were long-acting [aOR,1.87 (CI, 1.24 to 2.82)], high-potency [aOR,1.72 (CI, 1.32 to 2.25)], and used in high doses [50–90mg/day aOR,1.71 (CI, 1.22 to 2.39) and ≥90mg/day aOR,1.75 (CI, 1.33 to 2.29)]. Results were consistent when accounting for the IPD risk score and when analyzing pneumonia and non-pneumonia IPD, separately. Unmeasured confounding and measurement error, although sensitivity analyses suggested that neither was likely to affect results. Actual opioid use and other non-prescribing use (e.g., illicit opioid use) was not measured. Opioid use was associated with an increased risk of IPD and represents a novel risk factor for these diseases. National Institutes of Health
