Long-term Infective Endocarditis Mortality Associated With Injection Opioid Use in the United States: A Modeling Study.
Long-term Infective Endocarditis Mortality Associated With Injection Opioid Use in the United States: A Modeling Study.
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DOI：
10.1093/cid/ciaa1346
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发表时间：
2021-12-06
期刊：
影响因子：
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通讯作者：
Linas, Benjamin P
中科院分区：
文献类型：
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作者：
Barocas, Joshua A;Eftekhari Yazdi, Golnaz;Linas, Benjamin P
背景：美国阿片类药物流行的扩大导致感染显着增加，例如与注射行为有关的感染性心内膜炎（IE）。我们的目的是估计注射阿片类药物人群的人群水平 IE 死亡率，并将 IE 死亡风险与其他原因导致的死亡风险进行比较。方法：我们开发了注射阿片类药物使用自然史的微观模拟模型。我们通过注射频率和注射技术定义了注射行为曲线。我们考虑了死亡的竞争风险，并用主要数据和已发表的数据填充模型。我们对 100 万名具有不同注射行为特征的个体进行了建模，直至 60 岁。我们将模型生成的估计值与已发布的数据相结合，预测到 2030 年美国 IE 死亡的预期总人数。 结果：对于 20 岁、30 岁和 40 岁男性，与感染风险较低的技术相比，频繁使用较高感染风险技术的 20 岁、30 岁和 40 岁男性在 60 岁时死于 IE 的概率分别为 53.8% 和 3.7%、51.4% 和 3.1%， 44.5% 对比 分别为2.2%。所有风险组中 IE 10 年死亡率的预测人群水平归因分数为 20%。我们估计，到 2030 年，预计将有约 257 800 人死于 IE。结论：在美国注射阿片类药物的人群中，IE 的预期负担很大。采用减少危害的方法，包括通过扩大注射器服务计划来解决注射行为，可能会对降低与阿片类药物流行相关的死亡率产生重大影响。
BACKGROUND: The expansion of the US opioid epidemic has led to significant increases in infections, such as infective endocarditis (IE), which is tied to injection behaviors. We aimed to estimate the population-level IE mortality rate among people who inject opioids and compare the risk of IE death against the risks of death from other causes.METHODS: We developed a microsimulation model of the natural history of injection opioid use. We defined injection behavior profiles by both injection frequency and injection techniques. We accounted for competing risks of death and populated the model with primary and published data. We modeled cohorts of 1 million individuals with different injection behavior profiles until age 60 years. We combined model-generated estimates with published data to project the total expected number of IE deaths in the United States by 2030.RESULTS: The probabilities of death from IE by age 60 years for 20-, 30-, and 40-year-old men with high-frequency use with higher infection risk techniques compared to lower risk techniques for IE were 53.8% versus 3.7%, 51.4% versus 3.1%, and 44.5% versus 2.2%, respectively. The predicted population-level attributable fraction of 10-year mortality from IE among all risk groups was 20%. We estimated that approximately 257 800 people are expected to die from IE by 2030.CONCLUSIONS: The expected burden of IE among people who inject opioids in the United States is large. Adopting a harm reduction approach, including through expansion of syringe service programs, to address injection behaviors could have a major impact on decreasing the mortality rate associated with the opioid epidemic.