阿片类药物过量死亡人数在2000年至2016年间在马萨诸塞州增加了五倍可能不适当的阿片类药物处方实践(PIP)与过量剂量的增加有关。这项研究的目的是对新的综合关联数据进行空间流行病学分析,以识别过量和PIP热点。
16个管理数据集,包括处方监测,医疗索赔,生命统计,和法医数据,在2011年至2015年期间,超过98%的马萨诸塞州居民在2017年被联系到更好地调查阿片类药物的流行。PIP由六个指标定义:≥100吗啡毫克当量(MME),苯二氮卓类药物和阿片类药物的共同处方,现金购买阿片类药物处方,没有记录疼痛诊断的阿片类药物处方,和阿片类药物处方通过多个处方者或药房。利用空间自相关和聚类分析,在538个邮政编码中发现了用药过量和PIP热点。
超过一半的成年人(n=3,143,817,18岁及以上)服用阿片类药物。随着时间的推移,几乎所有邮政编码都显示出药物过量的发生率在增加。在伍斯特发现了用药过量的集群,北安普顿,Lee/Tyringham,Wareham/Bourne,林恩,和里维尔/切尔西(Getis-OrdGi*;p<0.05)。在马萨诸塞州西部确定了≥100MMEs和无疼痛诊断的处方的大型PIP集群;在楠塔基特,伯克希尔,和汉普登县(p<0.05)。共同处方和现金支付集群是本地化的,几乎相同(p<0.05)。在科德角和伯克希尔县发现了PIP的重叠和过量集群。然而,我们还在用药过量和PIP热点中发现了矛盾的模式。
确定了用药过量和PIP热点,以及两者重叠的区域,以及他们分歧的地方。结果表明,单独的PIP聚类不能解释过量的聚类模式。我们的发现可以为地方一级的公共卫生政策决策提供信息,其中包括关注PIP和滥用旨在遏制阿片类药物过量的海洛因和芬太尼。
Opioid overdose deaths quintupled in Massachusetts between 2000 and 2016. Potentially inappropriate opioid prescribing practices (PIP) are associated with increases in overdoses. The purpose of this
study was to conduct spatial epidemiological analyses of novel comprehensively linked data to identify overdose and PIP hotspots.
Sixteen administrative datasets, including prescription monitoring, medical claims, vital statistics, and medical examiner data, covering >98% of Massachusetts residents between 2011-2015, were linked in 2017 to better investigate the opioid epidemic. PIP was defined by six measures: ≥100 morphine milligram equivalents (MMEs), co-prescription of benzodiazepines and opioids, cash purchases of opioid prescriptions, opioid prescriptions without a recorded pain diagnosis, and opioid prescriptions through multiple prescribers or pharmacies. Using spatial autocorrelation and cluster analyses, overdose and PIP hotspots were identified among 538 ZIP codes.
More than half of the adult population (n = 3,143,817, ages 18 and older) were prescribed opioids. Nearly all ZIP codes showed increasing rates of overdose over time. Overdose clusters were identified in Worcester, Northampton, Lee/Tyringham, Wareham/Bourne, Lynn, and Revere/Chelsea (Getis-Ord Gi*; p < 0.05). Large PIP clusters for ≥100 MMEs and prescription without pain diagnosis were identified in Western Massachusetts; and smaller clusters for multiple prescribers in Nantucket, Berkshire, and Hampden Counties (p < 0.05). Co-prescriptions and cash payment clusters were localized and nearly identical (p < 0.05). Overlap in PIP and overdose clusters was identified in Cape Cod and Berkshire County. However, we also found contradictory patterns in overdose and PIP hotspots.
Overdose and PIP hotspots were identified, as well as regions where the two overlapped, and where they diverged. Results indicate that PIP clustering alone does not explain overdose clustering patterns. Our findings can inform public health policy decisions at the local level, which include a focus on PIP and misuse of heroin and fentanyl that aim to curb opioid overdoses.