Abstract

Objective

Opioid use disorder (OUD) is a significant problem among US veterans with increasing rates of OUD and overdose, and thus has substantial importance for service delivery within the Veterans Health Administration (VHA). Among individuals with OUD, several sex- specific differences have begun to emerge regarding co-occurring medical, psychiatric and pain-related diagnoses. The rates of such multimorbidities are likely to vary between men and women with OUD and may have important implications for treatment within the VHA but have not yet been studied. Methods: The present study utilized a data set that included all veterans receiving VHA health care during Fiscal Year (FY) 2012 (October 1, 2011 through September 30, 2012), who were diagnosed during the year with opioid dependence or abuse. VHA patients diagnosed with OUD nationwide in FY 2012 were compared by sex on proportions with OUD, and among those with OUD, on sociodemographic characteristics, medical, psychiatric and pain-related diagnoses, as well as on service use, and psychotropic and opioid agonist prescription fills. Results: During FY 2012, 48,408 veterans were diagnosed with OUD, 5.77% of whom were women. Among those veterans with OUD, few sociodemographic differences were observed between sexes. Female veterans had a higher rate of psychiatric diagnoses, notably mood, anxiety and personality disorders, as well as higher rates of pain-related diagnoses, such as headaches and fibromyalgia, while male veterans were more likely to have concurrent, severe medical co-morbidities, including hepatic disease, HIV, cancers, peripheral vascular disease, diabetes and related complications, and renal disease. There were few differences in health service utilization, with women reporting greater receipt of prescriptions for anxiolytic/sedative/hypnotics, stimulants and lithium. Men and women did not differ in receipt of opioid agonist medications or mental health/substance use treatments. Conclusions: There are substantial sex-specific differences in patterns of multimorbidity among veterans with OUD, spanning medical, psychiatric and pain-related diagnoses. These results illustrate the need to view OUD as a multimorbid condition and design interventions to target such multimorbidities. The present study highlights the potential benefits of sex-specific treatment and prevention efforts among female veterans with OUD and related co-occurring disorders.

中文翻译：

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退伍军人健康管理局全国范围内阿片类药物使用障碍患病率和多发病率的性别差异

摘要

客观的

阿片类药物使用障碍 (OUD) 是美国退伍军人中的一个重要问题，其 OUD 和过量服用率不断增加，因此对于退伍军人健康管理局 (VHA) 内的服务提供具有重要意义。在患有 OUD 的个体中，关于同时发生的医学、精神病学和疼痛相关诊断，一些性别特异性差异已经开始出现。这种多种疾病的发生率在患有 OUD 的男性和女性之间可能有所不同，并且可能对 VHA 内的治疗具有重要意义，但尚未进行研究。方法：本研究使用的数据集包括所有在 2012 财年 (FY)（2011 年 10 月 1 日至 2012 年 9 月 30 日）期间接受 VHA 医疗保健的退伍军人，他们在这一年被诊断出患有阿片类药物依赖或滥用。对 2012 财年在全国范围内诊断为 OUD 的 VHA 患者进行了性别比较，包括 OUD 患者的社会人口特征、医学、精神病学和疼痛相关诊断，以及服务使用、精神药物和阿片类激动剂处方等方面的性别比例填满。结果：2012 财年，48,408 名退伍军人被诊断出患有 OUD，其中 5.77% 是女性。在那些患有 OUD 的退伍军人中，几乎没有观察到性别之间的社会人口统计学差异。女性退伍军人的精神病诊断率更高，尤其是情绪、焦虑和人格障碍，以及与疼痛相关的诊断率更高，例如头痛和纤维肌痛，而男性退伍军人更有可能同时患有严重的医疗合并症，包括肝病、HIV、癌症、外周血管疾病、糖尿病和相关并发症以及肾病。在医疗服务利用方面几乎没有差异，女性报告称收到更多抗焦虑药/镇静药/催眠药、兴奋剂和锂的处方。结论：在患有 OUD 的退伍军人中，多种疾病的模式存在显着的性别差异，包括医学、精神病学和疼痛相关的诊断。这些结果说明需要将 OUD 视为一种多病症，并设计针对此类多病症的干预措施。本研究强调了针对患有 OUD 和相关并发疾病的女性退伍军人进行针对性别的治疗和预防工作的潜在益处。