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Adverse drug reactions due to opioid analgesic use in New South Wales, Australia: a spatial-temporal analysis.
BMC Pharmacology and Toxicology ( IF 2.605 ) Pub Date : 2019-09-05 , DOI: 10.1186/s40360-019-0333-7
Wei Du 1 , Shanley Chong 2 , Andrew J McLachlan 3 , Lan Luo 1 , Nicholas Glasgow 1 , Danijela Gnjidic 3, 4
Affiliation  

BACKGROUND Pharmaceutical opioid analgesic use continues to rise and is associated with potentially preventable harm including hospitalisation for adverse drug reactions (ADRs). Spatial detection of opioid-related ADRs can inform future intervention strategies. We aimed to investigate the geographical disparity in hospitalised ADRs related to opioid analgesic use, and to evaluate the difference in patient characteristics between areas inside and outside the geographic clusters. METHODS We used the all-inclusive Admitted Patient Dataset for an Australian state (New South Wales, NSW) to identify patients admitted for opioid-related ADRs over a 10-year period (July 2004 to June 2014). A space-time analysis was conducted using Kulldroff's scan statistics to identify statistically significant spatial clusters over time. Relative risk (RR) was computed with p-value based on Monte Carlo Simulation. Chi-square test was used to compare proportional difference in patient clustering. RESULTS During the study period, we identified four statistically significant geographic clusters (RRs: 1.63-2.17) during 2004-08; and seven clusters (RRs: 1.23-1.69) during the period 2009-14. While identified high-risk clusters primarily covered areas with easier access to health services, those associated with socioeconomically disadvantaged areas and individuals with mental health disorders experienced more unmet healthcare needs for opioid analgesic safety than those from the rest of the State. Older people (≥65 years and over) accounted for 62.7% of the total study population and were more susceptible to opioid-related ADRs than younger people,. In the first five-year period the clusters included a greater proportion of people with cancer in contrast to the second five-year period in which there was a lesser proportion of people with cancer. CONCLUSIONS These results suggest that there is significant spatial-temporal variation in opioid-related ADRs and future interventions should target vulnerable populations and high-risk geographical areas to improve safer use of pharmaceutical opioid analgesics.

中文翻译:

澳大利亚新南威尔士州使用阿片类镇痛剂引起的药物不良反应:时空分析。

背景技术阿片类药物的止痛药的使用持续增长,并且与潜在的可预防的伤害相关联,包括因药物不良反应(ADR)住院治疗。与阿片类药物相关的ADR的空间检测可以为将来的干预策略提供参考。我们旨在调查与阿片类镇痛剂使用相关的住院ADR的地域差异,并评估地理区域内外区域之间患者特征的差异。方法我们使用了澳大利亚州(新南威尔士州,新南威尔士州)的全包入院患者数据集,以识别在10年期间(2004年7月至2014年6月)接受阿片类药物相关ADR的患者。使用Kulldroff的扫描统计数据进行了时空分析,以识别随时间变化具有统计意义的空间聚类。相对风险(RR)是根据蒙特卡洛模拟(Monte Carlo Simulation)以p值计算的。卡方检验用于比较患者聚类中的比例差异。结果在研究期间,我们确定了2004-08年间四个具有统计意义的地理聚类(RR:1.63-2.17);在2009-14年期间,有七个集群(RRs:1.23-1.69)。虽然已确定的高风险人群主要覆盖了较容易获得卫生服务的地区,但与社会经济弱势地区有关的人群和患有精神疾病的个人所经历的阿片类镇痛安全性的医疗需求却比该州其他地区要高。老年人(≥65岁及以上)占总研究人群的62.7%,比年轻人更容易受到阿片类药物相关的ADR的影响。在第一个五年期中,癌症人群所占比例更高,而在第二个五年期中,癌症患者所占比例较低。结论这些结果表明,与阿片类药物相关的ADR存在明显的时空变化,未来的干预措施应针对易感人群和高风险地理区域,以更安全地使用阿片类药物镇痛药。
更新日期:2019-09-05
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