Socioeconomic Position and Chronic Opioid Use After Hip Fracture Surgery: A Danish Population-Based Cohort Study

IF 3.5 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-06-19 DOI:10.1002/ejp.70063

Nickolaj Risbo, Vera Ehrenstein, Per Hviid Gundtoft, Jan-Erik Gjertsen, Alma Becic Pedersen

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Abstract

Background

Chronic opioid use is a common and serious consequence of hip fracture. We examined the association between socioeconomic position (SEP) and chronic opioid use after hip fracture surgery.

Methods

Using nationwide Danish registries, we included patients aged ≥ 65 years undergoing hip fracture surgery in 2012–2021 (n = 52,801). Cohabitation, liquid assets, and education were markers of SEP. Chronic opioid use was defined as ≥ 2 prescriptions of opioids 31–365 days post-surgery. For the same period, all opioid doses were converted to morphine milligram equivalents (MME), mg/day. We used log-binomial regression to estimate adjusted risk ratios (aRR) with 95%-confidence intervals (CI) comparing patients within each SEP marker, adjusting for relevant confounding.

Results

The 1-year risks of chronic opioid use were 33% for patients living alone versus 30% for patients cohabiting (aRR 1.05 [CI 1.02–1.09]), 37% for low versus 28% for high levels of liquid assets (aRR 1.28 [CI 1.23–1.34]), and 33% for low versus 28% for high education (aRR 1.19 [CI 1.14–1.25]). Patients living alone used 11.5 MME mg/day versus 9.8 mg/day in patients cohabiting, patients with low liquid assets used 14.8 versus 7.9 mg/day in patients with high liquid assets, and patients with low education used 11.8 versus 7.9 mg/day in patients with high education.

Conclusions

About a third of hip fracture patients are using opioids continuously in the year after surgery. Living alone, less liquid assets, and low education were associated with a higher risk of opioid use and dosage of use, both in preoperative opioid users and non-users.

Significance Statement

This study shows that among patients undergoing hip fracture surgery, low socioeconomic position measured by living alone, having less liquid assets or low education is associated with a higher risk of chronic opioid use and higher dosage of use in the first year postoperatively. Clinicians should consider socioeconomic position when prescribing opioids after hip fracture. The integration of less addictive opioids and non-pharmacological approaches in the pain management may reduce opioid use and improve patient safety.

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髋部骨折术后社会经济地位和慢性阿片类药物使用：一项丹麦人群队列研究

背景：慢性阿片类药物使用是髋部骨折常见且严重的后果。我们研究了髋部骨折术后社会经济地位（SEP）与慢性阿片类药物使用之间的关系。方法采用丹麦全国登记系统，纳入2012-2021年年龄≥65岁接受髋部骨折手术的患者（n = 52,801）。同居、流动资产和教育程度是SEP的标志。慢性阿片类药物使用定义为术后31-365天服用阿片类药物处方≥2张。在同一时期，所有阿片类药物剂量都转换为吗啡毫克当量（MME），毫克/天。我们使用对数二项回归来估计校正风险比（aRR）， 95%置信区间（CI）比较每个SEP标记内的患者，并对相关混杂因素进行调整。结果1年慢性阿片类药物使用风险独居患者为33%，同居患者为30% (aRR 1.05 [CI 1.02-1.09])，低流动资产患者为37%，高流动资产患者为28% (aRR 1.28 [CI 1.23-1.34])，低教育患者为33%，高教育患者为28% （aRR 1.19 [CI 1.14-1.25]）。独居患者使用11.5 MME mg/天，而同居患者使用9.8 mg/天；流动资产低的患者使用14.8 mg/天，而流动资产高的患者使用7.9 mg/天；受教育程度低的患者使用11.8 mg/天，而受教育程度高的患者使用7.9 mg/天。结论约三分之一的髋部骨折患者在术后一年内持续使用阿片类药物。无论是术前阿片类药物使用者还是非使用者，独居、流动资产较少和受教育程度低都与阿片类药物使用和使用剂量的高风险相关。本研究表明，在髋部骨折手术患者中，独居、流动资产较少或受教育程度较低的社会经济地位与术后第一年慢性阿片类药物使用风险较高和使用剂量较高相关。临床医生在开阿片类药物处方时应考虑髋部骨折患者的社会经济地位。在疼痛管理中整合较少成瘾性的阿片类药物和非药物方法可以减少阿片类药物的使用并提高患者的安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.