Substance Use and Performance of Toxicology Screens in the Greater Cincinnati Northern Kentucky Stroke Study.
Substance Use and Performance of Toxicology Screens in the Greater Cincinnati Northern Kentucky Stroke Study.
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虽然中风的危险因素如药物使用可能随年龄而变化，但人们对药物使用随时间变化的趋势以及年轻中风患者的毒理学筛查结果知之甚少。大辛辛那提北肯塔基卒中研究是一项以人口为基础的研究，在5个县的地区，包括130万人，我们报告了从电子病历审查中获得的记录物质使用（可卡因/大麻/阿片类药物/其他）的频率，在医生判定的卒中事件（缺血性和出血性）中，在20-54岁的成年人中，总体和按种族/性别亚组。二次分析包括大量饮酒和吸烟。报告了跨越22年（1993/4-2015）的5个一年期的数据，并测试了随时间的趋势。2015年，为了评估与毒理学筛选性能相关的因素，进行了多元逻辑回归。总共纳入2152例卒中：74.5%为缺血性卒中，平均年龄45.7±7.6岁，50.0%为女性，35.9%为黑人。1993/4年、1999年、2005年、2010年和2015年的药物使用率分别为4.4%、10.4%、19.2%、24.0%和28.8% （p趋势<0.001）。在1993/4至2015年期间，所有人口统计亚组中记录的物质使用都有所增加。调整性别、合共病和NIHSS后，毒理学筛查的预测因子包括黑人（aOR 1.58, 95%CI 1.02-2.45）、年龄更小（aOR 0.70, 95%CI 0.53-0.91，每10年）、当前吸烟（aOR 1.62, 95%CI 1.06-2.46）和在学术医院接受治疗（aOR 1.80, 95%CI 1.14-2.84）。在模型中加入报告药物使用的图表后，只有报告药物滥用的图表和年龄显著。在一项针对年轻中风患者的人群研究中，记录在案的药物使用随着时间的推移而增加，与白人相比，黑人的药物使用记录更高。考虑到筛选和记录中可能存在偏见，需要进一步的工作来确认基于种族的药物使用差异和趋势。研究结果表明，需要更标准化的毒理学筛查。
Though stroke risk factors such as substance use may vary with age, less is known about trends in substance use over time or about performance of toxicology screens in young adults with stroke. Using the Greater Cincinnati Northern Kentucky Stroke Study, a population-based study in a 5-county region comprising 1.3 million people, we reported the frequency of documented substance use (cocaine/marijuana/opiates/other) obtained from electronic medical record review, overall and by race/gender subgroups among physician-adjudicated stroke events (ischemic and hemorrhagic) in adults 20–54 years old. Secondary analyses included heavy alcohol use and cigarette smoking. Data were reported for 5 one-year periods spanning 22 years (1993/4–2015), and trends over time were tested. For 2015, to evaluate factors associated with performance of toxicology screens, multiple logistic regression was performed. Overall, 2152 strokes were included: 74.5% were ischemic, mean age was 45.7±7.6, 50.0% were women, and 35.9% were Black. Substance use was documented in 4.4%, 10.4%, 19.2%, 24.0% and 28.8% of cases in 1993/4, 1999, 2005, 2010 and 2015, respectively (ptrend<0.001). Between 1993/4 and 2015, documented substance use increased in all demographic subgroups. Adjusting for gender, comorbidities, and NIHSS, predictors of toxicology screens included Black race (aOR 1.58, 95%CI 1.02–2.45), younger age (aOR 0.70, 95%CI 0.53–0.91, per 10 years), current smoking (aOR 1.62, 95%CI 1.06–2.46) and treatment at an academic hospital (aOR 1.80, 95%CI 1.14–2.84). After adding chart reported substance use to the model, only chart reported substance abuse and age were significant. In a population-based study of young adults with stroke, documented substance use increased over time, and documentation of substance use was higher among Black compared with White individuals. Further work is needed to confirm race-based disparities and trends in substance use given the potential for bias in screening and documentation. Findings suggest a need for more standardized toxicology screening.