目的:阿片类镇痛药(OA)和其他药物与药物引起的死亡有关。然而,缺乏关于这些药物在人群中的使用模式和这种关联的知识。我们确定并描述了具有不同类型的OA和其他相关药物处方的人群亚组,并检查了与药物引起的死亡的关联。此外,我们估计了服用OA处方的药物诱导死亡的比例和OA作为死亡原因的比例.
方法:一项基于挪威人群的巢式病例对照登记研究,其中包括病例(2010-2018年药物诱导死亡,N=2388)和年龄匹配的人口对照,性别和纳入年份(N=21465)。阿片类镇痛药(OA)的填充处方模式,苯二氮卓类药物和苯二氮卓类药物相关药物,gabapentinoids,通过k均值聚类分析探索ADHD药物和抗抑郁药/抗精神病药。通过调整社会人口统计学特征的条件逻辑回归估计与药物诱导死亡的关联。估计填充OA处方和OA作为死亡原因的重叠。
结果:确定了五个群集:\'很少处方\',\'弱OA\',\'ADHD药物\',“镇静/精神病发病率”和“强OA”。与其他组相比,“强OA”组具有更高的社会经济地位。药物诱导死亡的风险在该集群中也最高(OR=35.5;CI25.6-49.3),对于68%(CI64-73)的病例,符合处方的OA被认为是死亡的根本原因.
结论:聚类分析确定了一个亚组,其处方为OA和其他药物,社会经济地位高于其他亚组。这个亚组的药物诱导死亡风险很高,需要解决。
OBJECTIVE: Opioid analgesics (OA) and other pharmaceuticals have been associated with drug-induced deaths. However, there is a lack of knowledge regarding patterns of use of these pharmaceuticals in the population and regarding such associations. We identify and describe subgroups of people with different patterns of filled prescriptions of OA and other relevant pharmaceuticals and examine associations with drug-induced deaths. In addition, we estimate the proportion of drug-induced deaths with a filled OA prescription and OA as cause of death.
METHODS: A Norwegian population-based nested
case-control register study with cases (drug-induced deaths 2010-2018, N = 2388) and population controls matched for age, gender and year of inclusion (N = 21 465). Patterns of filled prescriptions for opioid analgesics (OA), benzodiazepines and benzodiazepine-related drugs, gabapentinoids, ADHD medication and
antidepressants/antipsychotics were explored by k-means cluster analysis. Associations with drug-induced deaths were estimated by conditional logistic regression adjusted for sociodemographic characteristics. Overlap of filled OA prescriptions and OA as cause of death was estimated.
RESULTS: Five clusters were identified: \'few prescriptions\', \'weak OA\', \'ADHD medication\', \'sedative/psychiatric morbidity\' and \'strong OA\'. The \'strong OA\' cluster had higher socioeconomic status compared to the other groupings. The risk of drug-induced death was also highest in this cluster (OR = 35.5; CI 25.6-49.3) and, for 68% (CI 64-73) of cases, filled prescriptions for OA was indicated as the underlying cause of death.
CONCLUSIONS: The cluster analysis identified a subgroup with filled prescriptions of OA and other pharmaceuticals and a higher socioeconomic status than other subgroups. This subgroup had a high risk of drug-induced death that needs to be addressed.