scholarly journals Persistent opioid use and opioid-related harm after hospital admissions for surgery and trauma in New Zealand: a population-based cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e044493
Author(s):  
Jiayi Gong ◽  
Alan Forbes Merry ◽  
Kebede A Beyene ◽  
Doug Campbell ◽  
Chris Frampton ◽  
...  
Keyword(s):  
Cohort Study ◽  
New Zealand ◽  
Hospital Discharge ◽  
Linked Data ◽  
Hospital Admissions ◽  
Population Based ◽  
Study Cohort ◽  
Opioid Use ◽  
Secondary Outcomes ◽  
Related Harm

IntroductionOpioid use has increased globally for the management of chronic non-cancer-related pain. There are concerns regarding the misuse of opioids leading to persistent opioid use and subsequent hospitalisation and deaths in developed countries. Hospital admissions related to surgery or trauma have been identified as contributing to the increasing opioid use internationally. There are minimal data on persistent opioid use and opioid-related harm in New Zealand (NZ), and how hospital admission for surgery or trauma contributes to this. We aim to describe rates and identify predictors of persistent opioid use among opioid-naïve individuals following hospital discharge for surgery or trauma.Methods and analysisThis is a population-based, retrospective cohort study using linked data from national health administrative databases for opioid-naïve patients who have had surgery or trauma in NZ between January 2006 and December 2019. Linked data will be used to identify variables of interest including all types of hospital surgeries in NZ, all trauma hospital admissions, opioid dispensing, comorbidities and sociodemographic variables. The primary outcome of this study will be the prevalence of persistent opioid use. Secondary outcomes will include mortality, opioid-related harms and hospitalisation. We will compare the secondary outcomes between persistent and non-persistent opioid user groups. To compute rates, we will divide the total number of outcome events by total follow-up time. Multivariable logistic regression will be used to identify predictors of persistent opioid use. Multivariable Cox regression models will be used to estimate the risk of opioid-related harms and hospitalisation as well as all-cause mortality among the study cohort in a year following hospital discharge for surgery or trauma.Ethics and disseminationThis study has been approved by the Auckland Health Research Ethics Committee (AHREC- AH1159). Results will be reported in accordance with the Reporting of studies Conducted using Observational Routinely collected health data statement (RECORD).

scholarly journals Causes and consequences of the opioid epidemic in the Netherlands: a population-based cohort study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Ajda Bedene ◽  
Eveline L. A. van Dorp ◽  
Tariq Faquih ◽  
Suzanna C. Cannegieter ◽  
Dennis O. Mook-Kanamori ◽  
...  
Keyword(s):  
Cohort Study ◽  
The Netherlands ◽  
Daily Living ◽  
Hospital Admissions ◽  
Population Based ◽  
Opioid Use ◽  
Opioid Prescription ◽  
The Past ◽  
Pain Prevalence ◽  
Observation Period

Abstract Over the past decade opioid use has risen globally. The causes and consequences of this increase, especially in Europe, are poorly understood. We conducted a population-based cohort study using national statistics on analgesics prescriptions, opioid poisoning hospital admissions and deaths in the Netherlands from 2013 to 2017. Pain prevalence and severity was determined by using results of 2014–2017 Health Interview Surveys. Between 2013 and 2017 the proportion of residents receiving opioid prescription rose from 4.9% to 6.0%, and the proportion of those receiving NSAIDs decreased from 15.5% to 13.7%. Self-reported pain prevalence and severity remained constant, as 44.7% of 5,119 respondents reported no pain-impeded activities-of-daily-living in 2014 (aRR, 1.00 [95% CI, 0.95–1.06] in 2017 vs 2014). Over the observation period, the incidence of opioid poisoning hospitalization and death increased from 8.6 to 12.9 per 100,000 inhabitants. The incidence of severe outcomes related to opioid use increased, as 3.9% of 1,343 hospitalized for opioid poisoning died in 2013 and 4.6% of 2,055 in 2017. We demonstrated that NSAIDs prescription decreased and opioid prescription increased in the Netherlands since 2013, without an increase in pain prevalence and severity. Consequently, the incidence of severe outcomes related to opioids increased.

scholarly journals Death and readmissions after hospital discharge during the December holiday period: cohort study

BMJ ◽  
2018 ◽  
pp. k4481 ◽  
Author(s):  
Lauren Lapointe-Shaw ◽  
Peter C Austin ◽  
Noah M Ivers ◽  
Jin Luo ◽  
Donald A Redelmeier ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Hospital Discharge ◽  
Hospital Admissions ◽  
Healthcare Utilisation ◽  
Population Based ◽  
Emergency Department Visits ◽  
Risk Of Death ◽  
Holiday Period

Abstract Objective To determine whether patients discharged from hospital during the December holiday period have fewer outpatient follow-ups and higher rates of death or readmission than patients discharged at other times. Design Population based retrospective cohort study. Setting Acute care hospitals in Ontario, Canada, 1 April 2002 to 31 January 2016. Participants 217 305 children and adults discharged home after an urgent admission, during the two week December holiday period, compared with 453 641 children and adults discharged during two control periods in late November and January. Main outcome measures The primary outcome was death or readmission, defined as a visit to an emergency department or urgent rehospitalisation, within 30 days. Secondary outcomes were death or readmission and outpatient follow-up with a physician within seven and 14 days after discharge. Multivariable logistic regression with generalised estimating equations was used to adjust for characteristics of patients, admissions, and hospital. Results 217 305 (32.4%) patients discharged during the holiday period and 453 641 (67.6%) discharged during control periods had similar baseline characteristics and previous healthcare utilisation. Patients who were discharged during the holiday period were less likely to have follow-up with a physician within seven days (36.3% v 47.8%, adjusted odds ratio 0.61, 95% confidence interval 0.60 to 0.62) and 14 days (59.5% v 68.7%, 0.65, 0.64 to 0.66) after discharge. Patients discharged during the holiday period were also at higher risk of 30 day death or readmission (25.9% v 24.7%, 1.09, 1.07 to 1.10). This relative increase was also seen at seven days (13.2% v 11.7%, 1.16, 1.14 to 1.18) and 14 days (18.6% v 17.0%, 1.14, 1.12 to 1.15). Per 100 000 patients, there were 2999 fewer follow-up appointments within 14 days, 26 excess deaths, 188 excess hospital admissions, and 483 excess emergency department visits attributable to hospital discharge during the holiday period. Conclusions Patients discharged from hospital during the December holiday period are less likely to have prompt outpatient follow-up and are at higher risk of death or readmission within 30 days.

scholarly journals Frailty modifies the association between opioid use and mortality in chronic kidney disease patients with diabetes: a population-based cohort study

Aging ◽  
2020 ◽  
Vol 12 (21) ◽  
pp. 21730-21746
Author(s):  
Szu-Ying Lee ◽  
Jui Wang ◽  
Chia-Ter Chao ◽  
Kuo-Liong Chien ◽  
Jenq-Wen Huang ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Population Based ◽  
Opioid Use ◽  
Patients With Diabetes

scholarly journals Refugee-like migrants have similar health needs to refugees: a New Zealand post-settlement cohort study

BJGP Open ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. bjgpopen20X101013
Author(s):  
Jonathan Donald Kennedy ◽  
Serena Moran ◽  
Sue Garrett ◽  
James Stanley ◽  
Jenny Visser ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
New Zealand ◽  
Primary Care Practice ◽  
Social Care ◽  
Hospital Admissions ◽  
Outpatient Service ◽  
Care Practice ◽  
Care Needs ◽  
Health And Social Care

BackgroundRefugees and asylum seekers have specific health and social care needs on arrival in a resettlement country. A third group — migrants with a refugee-like background (refugee-like migrants) — are less well defined or understood.AimUsing routinely collected data, this study compared demographics, interpreter need, and healthcare utilisation for cohorts of refugee-like migrants and refugees.Design & settingA retrospective cohort study was undertaken in Wellington, New Zealand.MethodData were obtained for refugee-like migrants and refugees accepted under the national quota system (quota refugees), who enrolled in a New Zealand primary care practice between 2011 and 2015. Data from the primary care practice and nationally held hospital and outpatient service databases, were analysed. Age and sex standardisation adjusted for possible differences in cohort demographic profiles.ResultsThe cohorts were similar in age, sex, deprivation, and interpreter need. Refugee-like migrants were found to have similar, but not identical, health and social care utilisation to quota refugees. Primary care nurse utilisation was higher for refugee-like migrants. Clinical entries in the primary care patient record were similar in rate for the cohorts. Emergency department utilisation and hospital admissions were similar. Hospital outpatient utilisation was lower for refugee-like migrants.ConclusionThis research suggests that health, social care, and other resettlement services should be aligned for refugee-like migrants and quota refugees. This would mean that countries accepting quota refugees should plan for health and social care needs of subsequent refugee-like migrant family migration. Further research should investigate matched larger-scale national health and immigration datasets, and qualitatively explore factors influencing health-seeking behaviour of refugee-like migrants.

scholarly journals Chronic post‐operative opioid use after open cardiac surgery: A Danish population‐based cohort study

2020 ◽  
Vol 65 (1) ◽  
pp. 47-57
Author(s):  
Kasper Bonnesen ◽  
Lone Nikolajsen ◽  
Henrik Bøggild ◽  
Per Hostrup Nielsen ◽  
Carl‐Johan Jacobsen ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cohort Study ◽  
Population Based ◽  
Opioid Use ◽  
Danish Population

scholarly journals Insulin enhances and metformin reduces risk of colorectal carcinoma in type-2 diabetes

QJM ◽  
2019 ◽  
Author(s):  
C-H Chen ◽  
C-L Lin ◽  
C-Y Hsu ◽  
C-H Kao
Keyword(s):  
Colorectal Cancer ◽  
Type 2 Diabetes ◽  
Cohort Study ◽  
Dietary Habits ◽  
Occult Blood ◽  
Population Based ◽  
Study Cohort ◽  
Urbanization Level ◽  
Increased Risk

Abstract Background Identifying colorectal cancer associated risks is important for conducting a program for the survey and prevention of colorectal cancer. Aim To investigate the association between use of insulin or metformin with colorectal cancer (CRC) in type 2 diabetes (T2DM). Design Population-based cohort study. Methods Through analysis of National Health Insurance (NHI) database between 1998 and 2010 in Taiwan, we identified 66 324 T2DM patients aged ≥ 20 years and selected subjects without diabetes by 1: 1 randomly matching with the study cohort based on age, sex and index date. We followed up the participants until 31 December 2011 or when they withdrew from the NHI program. Results Compared with non-diabetic subjects, the T2DM patients exhibited an increased risk of CRC [adjusted HR (aHR) = 1.56, 95% confidence interval (CI) = 1.39–1.75], after adjustment for age, sex, urbanization level, comorbidities and examinations of colonoscopy, sigmoidoscopy, or stool occult blood test. Among the T2DM patients, insulin usage increased the risk of CRC (aHR = 1.86, 95% CI = 1.58–0–2.19) after adjustment for age, sex, urbanization level, comorbidities, metformin usage and examinations; nevertheless, metformin decreased the risk of CRC (aHR = 0.65, 95% CI = 0.54–0.77) after adjustment for age, sex, urbanization level, comorbidities, insulin usage and examinations. Compared with the non-insulin cohort, the risk of CRC tended to increase with the incremental dosage of insulin exposure. Conclusion Our population-based cohort study demonstrated an association between T2DM and CRC. Among the T2DM patients, insulin use was associated with an increased risk of CRC and metformin use was associated with a decreased risk of CRC. Inability to obtain information on several potential confounding factors, such as lifestyle and dietary habits, is the major limitation of the study.

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