镰状细胞病阿片类药物处方和血管闭塞危象的十年趋势：一项基于人群的国家队列研究（2011-2022）

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Americas Pub Date : 2025-08-21 DOI:10.1016/j.lana.2025.101214

Kevin Y. Xu , Terri V. Newman , Lakeya S. McGill , Enrico M. Novelli , Cheryl A. Hillery , Joanna L. Buss , Lisa Gong , Ruizhi Huang , Fanghong Dong , Dustin Stwalley , Joanne Salas , Shiyuan A. Liu , Jeffrey F. Scherrer , Tashalee R. Brown , Tae Woo Park , Marc R. LaRochelle , Richard A. Grucza , Charles R. Jonassaint

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引用次数: 0

摘要

在不同保险类型和年龄组的镰状细胞病（SCD）患者中，阿片类药物处方和血管闭塞危象（VOCs）的模式特征不明显。我们的目的是评估美国公共和商业保险的SCD患者在10年期间的阿片类药物处方和VOC趋势。方法：我们对美国行政索赔（2011-2022）进行了回顾性队列研究，分析了45,726名患有SCD的商业和医疗补助受益人。主要结局是每月门诊阿片类药物处方率和与voc相关的急性护理遭遇。我们使用连接点回归模型来估计趋势，没有预先指定断点，按保险类型（医疗补助vs商业）和年龄组（1-12岁、13-17岁、18-27岁、28-45岁、46-64岁）分层。主要结局是每月门诊阿片类药物处方率和与voc相关的急性护理遭遇。我们使用连接点回归模型来估计趋势，没有预先指定断点，按保险类型（医疗补助vs商业）和年龄组分层。在45,726名SCD患者（平均年龄[SD] = 25.1[16.2]； 39.7%为女性；52.9%为医疗补助，47.1%为商业保险）中，医疗补助受益人每月开具阿片类药物处方的比例高于商业受益人（18.3 vs 14.0 / 100）和VOC接触（16.6 vs 8.2 / 100）。每月阿片类药物处方每100人随年龄增加：1-12 y = 5.1；13-17 y = 11.3；18-27 y = 22.5；28-45 y = 24.6；46-64 y = 20.6 / 100。从2011年开始，医疗补助和商业受益人都经历了阿片类药物处方的下降（商业每月百分比变化[MPC] = - 0.3% [95% CI: - 0.3%, - 0.2%]；医疗补助MPC = - 0.5%[- 0.6%, 0.5%]）。在COVID-19大流行爆发之前，下降趋势的阿片类药物处方并不总是伴随着上升趋势的挥发性有机化合物。特别是在儿童和青少年中，在2020年之后，商业（MPC = 1.8%[1.5%, 2.2%]）和医疗补助（MPC = 0.6%[0.1%, 1.6%]）受益人中与voc相关的接触都显著增加。阿片类药物处方和VOC入院因保险和年龄而异。阿片类药物处方从2011年开始下降，但直到COVID-19之后才一直伴随着挥发性有机化合物的增加。对商业和多州医疗补助数据库的资金分析由NIH K12 DA041449资助（PI: KYX；数据分析师：JLB， DS）。部分人员的工作得到了P50 MH122351 (KYX, PI: Eric Lenze MD, Michael Avidan MBBCh), K08 K08 DA061258 (KYX)，美国精神病学协会（APA）精神病学研究奖学金（由NIDA和APA， KYX资助），NIH K12NS130673 (LSM), NIH L60HL170453 （LSM）和圣路易斯大学研究所奖学金（RAG， JS， JFS， RH）的支持；这些拨款没有资助Merative MarketScan商业和多州医疗补助数据库的数据提取。

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Ten-year trends in opioid prescribing and vaso-occlusive crises in sickle cell disease: a population-based national cohort study (2011–2022)

Background

Patterns of opioid prescribing and vaso-occlusive crises (VOCs) are poorly characterized among individuals with sickle cell disease (SCD) across diverse insurance types and age groups. We aimed to evaluate opioid prescribing and VOC trends in publicly and commercially insured individuals with SCD over a 10-year time period in the United States (US).

Methods

We conducted a retrospective cohort study of US administrative claims (2011–2022), analyzing 45,726 commercial and Medicaid beneficiaries with SCD. Primary outcomes were monthly rates of outpatient opioid prescriptions and VOC-related acute care encounters. We used joinpoint regression models to estimate trends without pre-specifying breakpoints, stratified by insurance type (Medicaid vs commercial) and age group (1–12, 13–17, 18–27, 28–45, 46–64 years). Primary outcomes were monthly rates of outpatient opioid prescriptions and VOC-related acute care encounters. We used joinpoint regression models to estimate trends without pre-specifying breakpoints, stratified by insurance type (Medicaid vs commercial) and age group.

Findings

Among 45,726 individuals with SCD (mean age [SD] = 25.1 [16.2]; 39.7% female; 52.9% Medicaid, 47.1% commercial insurance), Medicaid beneficiaries had higher rates than commercial beneficiaries for monthly opioid prescribing (18.3 vs 14.0 per 100) and VOC encounters (16.6 vs 8.2 per 100). Monthly opioid prescribing per 100 people increased with age: 1–12 y = 5.1; 13–17 y = 11.3; 18–27 y = 22.5; 28–45 y = 24.6; 46–64 y = 20.6 per 100. Both Medicaid and commercial beneficiaries experienced declining opioid prescribing beginning in 2011 (commercial monthly percentage change [MPC] = −0.3% [95% CI: −0.3%, −0.2%]; Medicaid MPC = −0.5% [−0.6%, 0.5%]). Down-trending opioid prescribing was not consistently accompanied by up-trending VOCs until the COVID-19 pandemic's onset. Particularly among children and adolescents, VOC-related encounters increased significantly after 2020 across both commercial (MPC = 1.8% [1.5%, 2.2%]) and Medicaid (MPC = 0.6% [0.1%, 1.6%]) beneficiaries.

Interpretation

Opioid prescribing and VOC admissions vary by insurance and age. Opioid prescribing declined from 2011 but was not consistently accompanied by increased VOCs until after COVID-19.

Funding

Analyses of Merative MarketScan Commercial and Multi-State Medicaid Database were funded by grants NIH K12 DA041449 (PI: KYX; data analysts: JLB, DS). Effort for some personnel was supported by P50 MH122351 (KYX, PI: Eric Lenze MD, Michael Avidan MBBCh), K08 K08 DA061258 (KYX), the American Psychiatric Association (APA) Psychiatric Research Fellowship (with funding by NIDA and the APA, KYX), NIH K12NS130673 (LSM), NIH L60HL170453 (LSM), and the St. Louis University Research Institute Fellowship (RAG, JS, JFS, RH); these grants did not fund Merative MarketScan Commercial and Multi-State Medicaid Database data pull.

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来源期刊

Lancet Regional Health-Americas Multiple-

CiteScore

8.00

自引率

0.00%

发文量

期刊介绍： The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.