炎症性腸疾患による指標入院後のオピオイド使用障害の1年リスク

One-year risk of opioid use disorder after index hospitalization for inflammatory bowel disease.

• Mishal Reja
• Nitya Hajela
• Michael Makar
• Daniel Marino
• Abhishek Bhurwal
• Vinod Rustgi

抄録

目的:

炎症性腸疾患の患者には，痛みのためにアヘン薬が処方されることが多い。炎症性腸疾患（IBD）入院後のアヘン薬使用障害の発生率を 1 年間にわたって調査し，死亡率と病院資源利用率に与える影響を調べた．

PURPOSE: Patients with inflammatory bowel disease are commonly prescribed opiates for pain. We sought to determine the incidence of opiate use disorder after inflammatory bowel disease (IBD) admission over a 1-year period as well as its impact on mortality and hospital resource utilization.

方法:

Nationalwide Readmission Database 2016 を用いて、IBD の主診断を受けた成人患者で、その後オピオイド使用障害の主診断を受けて再入院した患者を同定した。主要アウトカムは，オピオイド使用障害の 1 年再入院率であった．予測因子は多変量ロジスティック回帰を用いて解析した。副次的転帰は、死亡率、在院期間、病院の総費用と費用であった。

METHODS: The Nationwide Readmission Database 2016 was used to identify adult patients with a principal diagnosis of IBD who were subsequently readmitted with a primary diagnosis of opioid use disorder. The primary outcome was 1-year readmission rate for opiate use disorder. Predictors were analyzed using multivariate logistic regression. Secondary outcomes were mortality rate, length of stay, and total hospital costs and charges.

結果:

IBDの指標入院6340例のうち、4.7％（クローン病6.0％、潰瘍性大腸炎2.6％）がアヘン使用障害で1年以内に再入院していた。再入院は、追加の死亡率（0.32％）と病院利用率（在院日数4.80日、平均総費用9503ドル、平均総費用38,288ドル）と関連していた。潰瘍性大腸炎は、クローン病と比較して死亡率と病院利用率のコストが有意に高かった。多変量解析では、再入院のオッズは、女性性（OR 1.51、CI 1.19～1.92）、民間保険（OR 0.20、CI 0.11～0.37）、Charlson Comorbidity Index（OR 0.20、CI 0.11～0.37）、不安（OR 1.65、CI 1.02～2.63）、うつ病（OR 2.07、CI 1.28～3.34）と関連していた。層別化分析では、精神科合併症はクローン病と潰瘍性大腸炎の両方と関連していた。

RESULTS: Among the 6340 index hospitalizations for IBD, 4.7% (6.0% Crohn's and 2.6% ulcerative colitis) were readmitted within 1 year for opiate use disorder. Readmission hospitalizations were associated with additional mortality (0.32%) and hospital utilization (length of stay 4.80 days, mean total costs $9503, and mean total charges $38,288). Ulcerative colitis had significantly higher mortality and hospital utilization costs compared with Crohn's disease. In multivariable analysis, odds of readmission were associated with female sex (OR 1.51, CI 1.19-1.92), private insurance (OR 0.20, CI 0.11-0.37), Charlson Comorbidity Index (OR 0.20, CI 0.11-0.37), anxiety (OR 1.65, CI 1.02-2.63), and depression (OR 2.07, CI 1.28-3.34). On stratification analysis, psychiatric comorbidities were associated with both Crohn's and ulcerative colitis.

結論:

IBD患者はしばしばアヘン使用障害のために再入院し、重大な死亡率と病院費用をもたらした。精神疾患の併存疾患、性別、保険の状態が再入院のオッズに影響を与え、介入の対象となった。

CONCLUSION: Patients with IBD were often readmitted for opiate use disorder and sustained significant mortality and hospital costs. Psychiatric comorbidities, gender, and insurance status impacted the odds of readmission and represent targets for intervention.