METHODS: A historical cohort study in Clalit Health Services, using a data repository including all adult patients prescribed opiates between 2010 and 2020, excluding patients with oncologic diagnoses. Patients were classified into three groups according to opioid use: below 50 Morphine milligram equivalents (MME) per day, 50 to 90 MME per day, and above 90 MME per day. Sex, Charlson comorbidity score, age and socioeconomic status were recorded. Mortality rates were compared between the dosage groups and compared to age-standardized mortality rates in the general population.
RESULTS: On multivariate analysis, patients receiving 90 or more MME per day were 2.37 (95%CI 2.1 to 2.68) more likely to have died compared to patients receiving below 50 MME per day. The respective hazard ratio among patients receiving between 50 and 90 MME per day was 2.23 (2.01 to 2.46). Among patients aged 18 to 50, standardized mortality ratios (SMRs) compared to the general population ranged between 5.4 to 8.6 among women, receiving between 50 and 90 MME per day, and between 8.07 and 10.7 among women receiving 90 or more MME per day. The respective SMRs among men were 1.2 to 3.8 and 2.7 to 5.4.
CONCLUSIONS: Increased opioid use is independently associated with increased all-cause mortality among non-oncological patients. This result is most notable among young adults with little or no known comorbidities. These findings are consistent with results in other countries and seem more credible than previous Israeli reports. Healthcare regulators and providers should, therefore, act to curtail the increasing opioid prescriptions and devise and enhance controls in the healthcare system, which, until 2020, had very limited mechanisms in place.
方法:ClalitHealthServices的一项历史队列研究,使用数据存储库,包括2010年至2020年期间服用阿片类药物的所有成年患者,不包括有肿瘤诊断的患者。根据阿片类药物的使用将患者分为三组:每天低于50吗啡毫克当量(MME),每天50到90个MME,每天90以上的MME。性,Charlson合并症评分,记录了年龄和社会经济地位。比较剂量组之间的死亡率,并与普通人群的年龄标准化死亡率进行比较。
结果:关于多变量分析,与每天接受低于50个MME的患者相比,每天接受90个或更多MME的患者死亡的可能性为2.37(95CI2.1~2.68).每天接受50至90个MME的患者的风险比分别为2.23(2.01至2.46)。在18至50岁的患者中,与普通人群相比,女性的标准化死亡率(SMR)介于5.4至8.6之间。每天接收50到90个MME,在每天接受90或更多MME的女性中,介于8.07和10.7之间。男性的SMR分别为1.2至3.8和2.7至5.4。
结论:在非肿瘤患者中,阿片类药物使用增加与非肿瘤患者全因死亡率增加独立相关。这一结果在很少或没有已知合并症的年轻人中最为明显。这些发现与其他国家的结果一致,似乎比以色列以前的报告更可信。医疗保健监管机构和提供者应该,因此,采取行动减少日益增长的阿片类药物处方,并设计和加强医疗保健系统的控制,which,直到2020年,机制非常有限。