华盛顿州工伤后阿片类药物相关死亡率:考虑工伤前阿片类药物使用情况。

IF 3.9 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Leslie I Boden, Abay Asfaw, Paul K O'Leary, Yorghos Tripodis, Andrew Busey, Katie M Applebaum, Matthew P Fox
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引用次数: 0

摘要

目的估计职业伤病对阿片类药物相关死亡率的影响,同时考虑受伤前使用阿片类药物的混杂因素:我们采用了一种回顾性队列研究设计,利用华盛顿州 1994-2000 年工伤赔偿数据与美国社会保障局收入和死亡率数据以及 1994-2018 年国家死亡指数(NDI)死因数据进行关联。我们将工伤分为损失工时工伤和纯医疗工伤,前者涉及超过 3 天的停工或永久性残疾。我们根据 NDI 记录确定死亡状态和死因。我们为受伤男性和女性建立了单独的 Fine 和 Gray 亚分布危险比 (sHR) 模型和 95% CIs 模型,用于计算截至 2018 年的阿片类药物相关死亡率和所有药物相关死亡率。我们使用定量偏差分析来考虑受伤前使用阿片类药物的未测量混杂因素:与单纯医疗伤害相比,工伤工人与阿片类药物相关的死亡风险更高:男性的 sHR 为 1.53,95% CI 为 1.41 至 1.66;女性的 sHR 为 1.31,95% CI 为 1.16 至 1.48。考虑到受伤前阿片类药物的使用,效应大小有所降低,但仍然较高:男性的sHR为1.43,95%模拟区间(SI)为1.20至1.69;女性为1.27,95%模拟区间(SI)为1.10至1.45:严重到需要请假 3 天以上的职业伤病与阿片类药物相关死亡率的增加有关。如果考虑到受伤前使用阿片类药物的情况,估计增加的死亡率会有所降低,但仍然很高。减少工伤和伤后阿片类药物处方,改善就业和收入保障,可降低与阿片类药物相关的死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Opioid-related mortality after occupational injury in Washington State: accounting for preinjury opioid use.

Objectives: To estimate the impact of occupational injury and illness on opioid-related mortality while accounting for confounding by preinjury opioid use.

Methods: We employed a retrospective cohort study design using Washington State workers' compensation data for 1994-2000 injuries linked to US Social Security Administration earnings and mortality data and National Death Index (NDI) cause of death data from 1994 to 2018. We categorised injuries as lost-time versus medical-only, where the former involved more than 3 days off work or permanent disability. We determined death status and cause of death from NDI records. We modelled separate Fine and Gray subdistribution hazard ratios (sHRs) and 95% CIs for injured men and women for opioid-related and all drug-related mortality through 2018. We used quantitative bias analysis to account for unmeasured confounding by preinjury opioid use.

Results: The hazard of opioid-related mortality was elevated for workers with lost-time relative to medical-only injuries: sHR for men: 1.53, 95% CI 1.41 to 1.66; for women: 1.31, 95% CI 1.16 to 1.48. Accounting for preinjury opioid use, effect sizes were reduced but remained elevated: sHR for men was 1.43, 95% simulation interval (SI) 1.20 to 1.69; for women: 1.27, 95% SI 1.10 to 1.45.

Conclusions: Occupational injuries and illnesses severe enough to require more than 3 days off work are associated with an increase in the hazard of opioid-related mortality. The estimated increase is reduced when we account for preinjury opioid use, but it remains substantial. Reducing work-related injuries and postinjury opioid prescribing and improving employment and income security may decrease opioid-related mortality.

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来源期刊
Occupational and Environmental Medicine
Occupational and Environmental Medicine 医学-公共卫生、环境卫生与职业卫生
CiteScore
8.30
自引率
2.00%
发文量
98
审稿时长
2 months
期刊介绍: Occupational and Environmental Medicine is an international peer reviewed journal covering current developments in occupational and environmental health worldwide. Occupational and Environmental Medicine publishes high-quality research relating to the full range of chemical, physical, ergonomic, biological and psychosocial hazards in the workplace and to environmental contaminants and their health effects. The journal welcomes research aimed at improving the evidence-based practice of occupational and environmental research; including the development and application of novel biological and statistical techniques in addition to evaluation of interventions in controlling occupational and environmental risks.
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