阿片类药物使用障碍退伍军人住院后死亡率相关因素

IF 1.9 0 PSYCHOLOGY, CLINICAL

Journal of substance use and addiction treatment Pub Date : 2025-08-25 DOI:10.1016/j.josat.2025.209797

Michael A Incze, Sophia Huebler, Jacob D Baylis, Andrea Stofko, A Taylor Kelley, Ingrid A Binswanger, Gavin Bart, Andrew J Saxon, Ajay Manhapra, Adam J Gordon

{"title":"阿片类药物使用障碍退伍军人住院后死亡率相关因素","authors":"Michael A Incze, Sophia Huebler, Jacob D Baylis, Andrea Stofko, A Taylor Kelley, Ingrid A Binswanger, Gavin Bart, Andrew J Saxon, Ajay Manhapra, Adam J Gordon","doi":"10.1016/j.josat.2025.209797","DOIUrl":null,"url":null,"abstract":"Introduction: Hospitalizations are common among people with opioid use disorder (OUD). While hospitalizations represent opportunities to engage patients and offer treatment, they are also destabilizing events associated with an increased risk of death in the post-hospitalization period.Methods: We conducted a retrospective cohort study within the Veterans Health Administration including all Veterans with OUD who experienced at least one medical hospitalization between January 2011 and December 2021. We examined which patient-level clinical and demographic factors were associated with all-cause and opioid-related mortality within 0-30 and 0-365 days following an index medical hospitalization.Results: The cohort included 90,920 Veterans with OUD who experienced one or more medical hospitalizations during the study period. Median age was 58 years, and 93 % were male. Older age (adjusted Odds Ratio [aOR] range 30d: 1.50-2.66; 1y: 1.58-3.28), higher medical complexity (aOR range 30d: 2.11-6.23; 1y: 1.96-7.34), multiple substance use disorders (SUD; aOR 30d: 1.81 (95 % CI 1.44, 2.27) 1y: 1.48 [95 % CI 1.36, 1.62]), and length of hospitalization (aOR 30d: 6.78 [95 % CI 4.85, 9.47] 1y: 3.45 [95 % CI 2.96, 4.01]) were associated with increased all-cause mortality following hospitalization. Homelessness (aOR 30d: 0.75 [95 % CI 0.63, 0.90]; 1y: 0.85 [95 % CI 0.80, 0.91]), depression (aOR 1y: 0.89 [95 % CI 0.84, 0.95]), bipolar disorder (aOR 1y: 0.88 [95 % CI 0.82, 0.94]), buprenorphine receipt (aOR 1y: 0.79 [95 % CI 0.69, 0.91]), and service connection (aOR 30d: 0.76 [95 % CI 0.60, 0.97] 1y: 0.64 [95 % CI 0.59, 0.70]) were associated with reduced all-cause mortality. Younger age (aOR range 30d: 3.21-5.24; 1y: 2.71-2.38), homelessness (aOR 1y: 1.40 [95 % CI 1.20, 1.63]), and multiple SUD (aOR 1y: 1.78 [95 % CI 1.33, 2.38]) were among factors associated with increased opioid-related mortality after hospitalization. Black race (aOR 1y: 0.61 [95 % CI 0.50, 0.74]) and higher service connection (aOR 30d: 0.41 [95 % CI 0.21, 0.81]; 1y: 0.53 [95 % CI 0.43-0.66]) were associated with reduced opioid-related mortality after hospitalization.Conclusions: Several patient-level factors were associated with increased all-cause mortality (e.g., length of hospital stay), reduced all-cause mortality (e.g., homelessness), increased opioid-related mortality (e.g., multiple SUD), and reduced opioid-related mortality (e.g., service connection) after hospitalization. This information provides a roadmap for future development and study of tailored supports and risk stratification tools to enhance post-hospitalization transitional care for patients with OUD.","PeriodicalId":73960,"journal":{"name":"Journal of substance use and addiction treatment","volume":" ","pages":"209797"},"PeriodicalIF":1.9000,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488471/pdf/","citationCount":"0","resultStr":"{\"title\":\"Factors associated with mortality following hospitalization among veterans with opioid use disorder.\",\"authors\":\"Michael A Incze, Sophia Huebler, Jacob D Baylis, Andrea Stofko, A Taylor Kelley, Ingrid A Binswanger, Gavin Bart, Andrew J Saxon, Ajay Manhapra, Adam J Gordon\",\"doi\":\"10.1016/j.josat.2025.209797\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Introduction: Hospitalizations are common among people with opioid use disorder (OUD). While hospitalizations represent opportunities to engage patients and offer treatment, they are also destabilizing events associated with an increased risk of death in the post-hospitalization period.Methods: We conducted a retrospective cohort study within the Veterans Health Administration including all Veterans with OUD who experienced at least one medical hospitalization between January 2011 and December 2021. We examined which patient-level clinical and demographic factors were associated with all-cause and opioid-related mortality within 0-30 and 0-365 days following an index medical hospitalization.Results: The cohort included 90,920 Veterans with OUD who experienced one or more medical hospitalizations during the study period. Median age was 58 years, and 93 % were male. Older age (adjusted Odds Ratio [aOR] range 30d: 1.50-2.66; 1y: 1.58-3.28), higher medical complexity (aOR range 30d: 2.11-6.23; 1y: 1.96-7.34), multiple substance use disorders (SUD; aOR 30d: 1.81 (95 % CI 1.44, 2.27) 1y: 1.48 [95 % CI 1.36, 1.62]), and length of hospitalization (aOR 30d: 6.78 [95 % CI 4.85, 9.47] 1y: 3.45 [95 % CI 2.96, 4.01]) were associated with increased all-cause mortality following hospitalization. Homelessness (aOR 30d: 0.75 [95 % CI 0.63, 0.90]; 1y: 0.85 [95 % CI 0.80, 0.91]), depression (aOR 1y: 0.89 [95 % CI 0.84, 0.95]), bipolar disorder (aOR 1y: 0.88 [95 % CI 0.82, 0.94]), buprenorphine receipt (aOR 1y: 0.79 [95 % CI 0.69, 0.91]), and service connection (aOR 30d: 0.76 [95 % CI 0.60, 0.97] 1y: 0.64 [95 % CI 0.59, 0.70]) were associated with reduced all-cause mortality. Younger age (aOR range 30d: 3.21-5.24; 1y: 2.71-2.38), homelessness (aOR 1y: 1.40 [95 % CI 1.20, 1.63]), and multiple SUD (aOR 1y: 1.78 [95 % CI 1.33, 2.38]) were among factors associated with increased opioid-related mortality after hospitalization. Black race (aOR 1y: 0.61 [95 % CI 0.50, 0.74]) and higher service connection (aOR 30d: 0.41 [95 % CI 0.21, 0.81]; 1y: 0.53 [95 % CI 0.43-0.66]) were associated with reduced opioid-related mortality after hospitalization.Conclusions: Several patient-level factors were associated with increased all-cause mortality (e.g., length of hospital stay), reduced all-cause mortality (e.g., homelessness), increased opioid-related mortality (e.g., multiple SUD), and reduced opioid-related mortality (e.g., service connection) after hospitalization. This information provides a roadmap for future development and study of tailored supports and risk stratification tools to enhance post-hospitalization transitional care for patients with OUD.\",\"PeriodicalId\":73960,\"journal\":{\"name\":\"Journal of substance use and addiction treatment\",\"volume\":\" \",\"pages\":\"209797\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-08-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488471/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of substance use and addiction treatment\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1016/j.josat.2025.209797\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"0\",\"JCRName\":\"PSYCHOLOGY, CLINICAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of substance use and addiction treatment","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1016/j.josat.2025.209797","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"0","JCRName":"PSYCHOLOGY, CLINICAL","Score":null,"Total":0}

引用次数: 0

摘要

住院治疗在阿片类药物使用障碍（OUD）患者中很常见。虽然住院是与患者接触并提供治疗的机会，但它们也是与住院后死亡风险增加相关的不稳定事件。方法：我们在退伍军人健康管理局进行了一项回顾性队列研究，包括2011年1月至2021年12月期间至少住院一次的所有OUD退伍军人。我们检查了哪些患者水平的临床和人口因素与全因死亡率和阿片类药物相关死亡率在指数医疗住院后0-30天和0-365 天内相关。结果：该队列包括90,920名在研究期间经历过一次或多次医疗住院治疗的OUD退伍军人。中位年龄为58 岁，93% 为男性。年龄较大（调整比值比[aOR]范围30d: 1.50-2.66; 1y: 1.58-3.28）、较高的医疗复杂性（aOR范围30d: 2.11-6.23; 1y: 1.96-7.34）、多种物质使用障碍（SUD; aOR 30d: 1.81(95 % CI 1.44, 2.27) 1y: 1.48[95 % CI 1.36, 1.62]）和住院时间（aOR 30d: 6.78[95 % CI 4.85, 9.47] 1y: 3.45[95 % CI 2.96, 4.01]）与住院后全因死亡率增加相关。无家可归（aOR 30d: 0.75[95 % CI 0.63, 0.90]; aOR: 0.85[95 % CI 0.80, 0.91]）、抑郁（aOR: 0.89[95 % CI 0.84, 0.95]）、双相情感障碍（aOR: 0.88[95 % CI 0.82, 0.94]）、丁丙诺啡接受（aOR: 0.79[95 % CI 0.69, 0.91]）和服务联系（aOR 30d: 0.76[95 % CI 0.60, 0.97] aOR: 0.64[95 % CI 0.59, 0.70]）与全因死亡率降低相关。年龄较小（aOR范围30d: 3.21-5.24; 1y: 2.71-2.38）、无家可归（aOR: 1.40[95 % CI 1.20, 1.63]）和多重SUD （aOR: 1.78[95 % CI 1.33, 2.38]）是住院后阿片类药物相关死亡率增加的相关因素。黑人（aOR: 0.61[95 % CI 0.50, 0.74]）和较高的服务连接（aOR: 0.41[95 % CI 0.21, 0.81]; aOR: 0.53[95 % CI 0.43-0.66]）与住院后阿片类药物相关死亡率降低相关。结论：几个患者层面的因素与住院后全因死亡率增加（例如，住院时间）、全因死亡率降低（例如，无家可归）、阿片类药物相关死亡率增加（例如，多发SUD）以及阿片类药物相关死亡率降低（例如，服务连接）有关。这一信息为未来开发和研究量身定制的支持和风险分层工具提供了路线图，以加强对OUD患者的住院后过渡护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Factors associated with mortality following hospitalization among veterans with opioid use disorder.

Introduction: Hospitalizations are common among people with opioid use disorder (OUD). While hospitalizations represent opportunities to engage patients and offer treatment, they are also destabilizing events associated with an increased risk of death in the post-hospitalization period.

Methods: We conducted a retrospective cohort study within the Veterans Health Administration including all Veterans with OUD who experienced at least one medical hospitalization between January 2011 and December 2021. We examined which patient-level clinical and demographic factors were associated with all-cause and opioid-related mortality within 0-30 and 0-365 days following an index medical hospitalization.

Results: The cohort included 90,920 Veterans with OUD who experienced one or more medical hospitalizations during the study period. Median age was 58 years, and 93 % were male. Older age (adjusted Odds Ratio [aOR] range 30d: 1.50-2.66; 1y: 1.58-3.28), higher medical complexity (aOR range 30d: 2.11-6.23; 1y: 1.96-7.34), multiple substance use disorders (SUD; aOR 30d: 1.81 (95 % CI 1.44, 2.27) 1y: 1.48 [95 % CI 1.36, 1.62]), and length of hospitalization (aOR 30d: 6.78 [95 % CI 4.85, 9.47] 1y: 3.45 [95 % CI 2.96, 4.01]) were associated with increased all-cause mortality following hospitalization. Homelessness (aOR 30d: 0.75 [95 % CI 0.63, 0.90]; 1y: 0.85 [95 % CI 0.80, 0.91]), depression (aOR 1y: 0.89 [95 % CI 0.84, 0.95]), bipolar disorder (aOR 1y: 0.88 [95 % CI 0.82, 0.94]), buprenorphine receipt (aOR 1y: 0.79 [95 % CI 0.69, 0.91]), and service connection (aOR 30d: 0.76 [95 % CI 0.60, 0.97] 1y: 0.64 [95 % CI 0.59, 0.70]) were associated with reduced all-cause mortality. Younger age (aOR range 30d: 3.21-5.24; 1y: 2.71-2.38), homelessness (aOR 1y: 1.40 [95 % CI 1.20, 1.63]), and multiple SUD (aOR 1y: 1.78 [95 % CI 1.33, 2.38]) were among factors associated with increased opioid-related mortality after hospitalization. Black race (aOR 1y: 0.61 [95 % CI 0.50, 0.74]) and higher service connection (aOR 30d: 0.41 [95 % CI 0.21, 0.81]; 1y: 0.53 [95 % CI 0.43-0.66]) were associated with reduced opioid-related mortality after hospitalization.

Conclusions: Several patient-level factors were associated with increased all-cause mortality (e.g., length of hospital stay), reduced all-cause mortality (e.g., homelessness), increased opioid-related mortality (e.g., multiple SUD), and reduced opioid-related mortality (e.g., service connection) after hospitalization. This information provides a roadmap for future development and study of tailored supports and risk stratification tools to enhance post-hospitalization transitional care for patients with OUD.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of substance use and addiction treatment Biological Psychiatry, Neuroscience (General), Psychiatry and Mental Health, Psychology (General)

自引率

0.00%

发文量