背景:在过去的10年中,抗抑郁药和阿片类药物的处方急剧增加,以及增加非处方药的供应。然而,对儿童药物中毒率的影响,特别是社会经济剥夺还不清楚。这项研究报告了英国0-11岁儿童中人群水平的药物中毒物质模式,帮助告知安全建议和中毒预防干预措施。
方法:从1998年至2018年,使用临床实践研究数据链对1,489,6200-11岁的人群进行了一项开放队列研究,检查住院患者是否中毒。按年龄计算中毒物质组的发病率和调整后的发病率比(aIRR),性别,社会经济匮乏和年份。
结果:确定了3,685例药物中毒住院患者。最常见的物质是扑热息痛(33.2%),依赖/戒断风险药物(DWRD-抗抑郁药,阿片类药物,gabapentinoids,苯二氮卓类药物)(13.5%)和其他非处方(OTC)镇痛药/抗普通感冒药(13.0%)。在研究期间,DWRD中毒下降了33%(aIRR0.67,95CI0.50-0.90,比较2013/14-2017/18至1998/99-2002/03),而扑热息痛中毒增加了43%(aIRR1.43,95CI1.20-1.70同期),其他OTC药物(aIRR0.82,95%CI0.60-1.12)或所有联合药物(aIRR0.97,95CI0.88-1.07)的发生率没有变化。所有药物均显示出按地区水平的社会经济剥夺的中毒梯度(最剥夺者的aIRR1.32,95CI1.18-1.47与最不剥夺者的五分之一相比),和DWRD(第4位最贫困的五分之一为aIRR2.03,95CI1.42-2.88,第5位最贫困的五分之一为aIRR1.88,95CI1.32-2.66,与最不贫困的五分之一相比),但不用于扑热息痛或其他非处方药物中毒。
结论:DWRD中毒减少了33%,而扑热息痛中毒在研究期间增加了43%。处方药物中毒按地区水平的社会经济剥夺存在梯度,包括有戒断/依赖风险的药物,但不是OTC药物中毒。社会经济较贫困地区的家庭有可能从改善药品安全储存的措施中受益最大,并且可能需要有针对性的干预措施,提供教育和安全设备。此外,处方者必须普遍促进OTC和处方药的安全储存,社区药房和其他此类药物的商店。
BACKGROUND: There have been sharp increases in antidepressant and opioid prescriptions over the last 10 years, as well as increased over-the-counter medicine availability. However, the impact on childhood medicinal poisonings rates, particularly by socioeconomic deprivation is unclear. This study reports population level medicinal poisoning substance patterns in England among children aged 0-11 years, helping inform safety advice and poisoning prevention interventions.
METHODS: An open cohort study of 1,489,620 0-11 year olds was conducted from 1998 to 2018, using the Clinical Practice Research Datalink, to examine inpatient hospital admissions for poisoning. Incidence rates and adjusted incidence rate ratios (aIRR) were calculated for poisoning substance groups by age, sex, socio-economic deprivation and year.
RESULTS: 3,685 medicinal poisoning hospital admissions were identified. The most common substances were paracetamol (33.2%), dependence/withdrawal risk drugs (DWRD - antidepressants, opioids, gabapentinoids, benzodiazepines) (13.5%) and other over-the-counter (OTC) analgesics/anti-common cold drugs (13.0%). Over the study period DWRD poisonings decreased 33% (aIRR 0.67, 95%CI 0.50-0.90 comparing 2013/14-2017/18 to 1998/99-2002/03), while paracetamol poisonings increased 43% (aIRR 1.43, 95%CI 1.20-1.70 for the same periods), with no change in incidence rates for other OTC drugs (aIRR 0.82, 95% CI 0.60-1.12) or all medications combined (aIRR 0.97, 95%CI 0.88-1.07). A gradient in poisonings by area-level socioeconomic deprivation was shown for all medications (aIRR 1.32, 95%CI 1.18-1.47 for most deprived compared to least deprived quintile), and DWRDs (aIRR 2.03, 95%CI 1.42-2.88 for 4th most deprived quintile and aIRR 1.88, 95%CI 1.32-2.66 for 5th most deprived quintile, compared to least deprived quintile), but not for paracetamol or other OTC drug poisonings.
CONCLUSIONS: Poisonings from DWRDs decreased by 33%, while paracetamol poisonings increased by 43% during the study period. There was a gradient by area-level socioeconomic deprivation in prescribed medication poisonings, including drugs with withdrawal/dependence risk, but not OTC medication poisonings. Households in more socioeconomically deprived areas have the potential to benefit most from measures to improve safe storage of medicines and are likely to require targeted interventions providing education and safety equipment. In addition, universal promotion of the safe storage of OTC and prescribed medicines must be provided by prescribers, community pharmacies and other outlets of such medication.