美国髋部骨折老年人过渡到社区护理时阿片类药物处方的种族差异

IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Journal of the American Geriatrics Society Pub Date : 2024-09-11 DOI:10.1111/jgs.19160
Kaleen N. Hayes, Meghan A. Cupp, Richa Joshi, Melissa R. Riester, Francesca L. Beaudoin, Andrew R. Zullo
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引用次数: 0

摘要

背景髋部骨折后,当患者重返社区环境时,适当的疼痛管理可促进康复。我们对髋部骨折的美国老年医疗保险受益人进行了一项回顾性队列研究,以考察黑人和白人患者在重返社区的过程中接受阿片类药物治疗的情况和剂量是否存在差异。我们根据受益人是否接受机构性急性期后护理 (PAC) 对他们进行了分层。结果包括:(1)接受阿片类药物治疗;(2)在社区的前 90 天内阿片类药物的剂量(以毫克吗啡当量(MMEs)为单位;也以毫克羟考酮(mg oxycodone)为单位)。我们使用泊松模型和线性回归模型分别估算了接受阿片类药物的相对比率和风险差异以及剂量差异,并使用参数 g 公式对年龄和性别进行了标准化处理。结果我们确定了 164170 名髋部骨折的老年人(平均年龄 = 82.7 岁;75% 为女性;72% 患有 PAC;46% 在骨折后使用过阿片类药物)。黑人和白人受益人在社区使用阿片类药物的总体情况相似。黑人受益人在最初 90 天内的平均总累积剂量较低(PAC 组:165 [95% CI -0.5 -0.6减少 165 [95% CI -264 至 -69]个 MME [-248 毫克羟考酮];无 PAC 组:减少 167 [95% CI -264 至 -69] 个 MME [-248 毫克羟考酮]:167[95%CI-274至-62]次[-251毫克羟考酮])和每日均用药量(PAC:-每天减少 3.0 [-4.6 至 -1.4] 次[-4.5 毫克羟考酮];无 PAC:-无 PAC:每天减少 4.7 [-4.6 至 -1.4] 个 MME [-7.1 毫克羟考酮])。在二次分析中,亚裔受益人的差异最大(例如,累计减少 617-653 毫克羟考酮)。未来的工作应研究这些差异是否会导致短期和长期健康结果的差异。
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Differences in opioid prescriptions by race among U.S. older adults with a hip fracture transitioning to community care
BackgroundAppropriate pain management can facilitate rehabilitation after a hip fracture as patients transition back to the community setting. Differences in opioid prescribing by race may exist during this critical transition period.MethodsWe conducted a retrospective cohort study of older adult U.S. Medicare beneficiaries with a hip fracture to examine whether the receipt and dose of opioids differs between Black and White patients as they transitioned back to the community setting. We stratified beneficiaries by whether they received institutional post‐acute care (PAC). Outcomes were (1) receipt of an opioid and (2) opioid doses in the first 90 days in the community in milligram morphine equivalents (MMEs; also presented in mg oxycodone). We estimated relative rates and risk differences of opioid receipt and dose differences using Poisson and linear regression models, respectively, using the parametric g‐formula to standardize for age and sex.ResultsWe identified 164,170 older adults with hip fracture (mean age = 82.7 years; 75% female; 72% with PAC; 46% with opioid use after fracture). Overall use of opioids in the community was similar between Black and white beneficiaries. Black beneficiaries had lower average doses in their first 90 days in both total cumulative doses (PAC group: 165 [95% CI −264 to −69] fewer MMEs [−248 mg oxycodone]; no PAC: 167 [95% CI −274 to −62] fewer MMEs [−251 mg oxycodone]) and average MME per days' supply of medication (PAC: −3.0 [−4.6 to −1.4] fewer MMEs per day [−4.5 mg oxycodone]; no PAC: −4.7 [−4.6 to −1.4] fewer MMEs per day [−7.1 mg oxycodone]). In secondary analyses, Asian beneficiaries experienced the greatest differences (e.g., 617–653 fewer cumulative mg oxycodone).ConclusionRacial differences exist in pain management for Medicare beneficiaries after a hip fracture. Future work should examine whether these differences result in disparities in short‐ and long‐term health outcomes.
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来源期刊
CiteScore
10.00
自引率
6.30%
发文量
504
审稿时长
3-6 weeks
期刊介绍: Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.
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