Trends in Opioid Use Disorder in the Veterans Health Administration, 2005-2022.

Autor:	Gorfinkel LR; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.; New York State Psychiatric Institute, New York., Malte CA; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington.; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington., Fink DS; New York State Psychiatric Institute, New York., Mannes ZL; Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York.; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York., Wall MM; New York State Psychiatric Institute, New York., Olfson M; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.; New York State Psychiatric Institute, New York., Livne O; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington.; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York., Keyhani S; San Francisco VA Medical Center, San Francisco, California.; Department of General Internal Medicine, University of California, San Francisco., Keyes KM; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York., Martins SS; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York., Cerdá M; Department of Population Health, Center for Opioid Epidemiology and Policy, New York University Langone Health, New York., Gutkind S; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York., Maynard CC; Department of Health Systems and Population Health, School of Public Health and Community Medicine, University of Washington, Seattle., Saxon AJ; Health Services Research and Development, Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington.; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington.; Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle., Simpson T; Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle., Gonsalves G; Department of Epidemiology, Yale University School of Public Health, New Haven, Connecticut., Lu H; Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut., McDowell Y; Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle, Washington., Hasin DS; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York.; New York State Psychiatric Institute, New York.; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2024 Dec 02; Vol. 7 (12), pp. e2451821. Date of Electronic Publication: 2024 Dec 02.
DOI:	10.1001/jamanetworkopen.2024.51821
Abstrakt:	Importance: Given the personal and social burdens of opioid use disorder (OUD), understanding time trends in OUD prevalence in large patient populations is key to planning prevention and treatment services. Objective: To examine trends in the prevalence of OUD from 2005 to 2022 overall and by age, sex, and race and ethnicity. Design, Setting, and Participants: This serial cross-sectional study included national Veterans Health Administration (VHA) electronic medical record data from the VHA Corporate Data Warehouse. Adult patients (age ≥18 years) with a current OUD diagnosis (using International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] codes) who received outpatient care at VHA facilities from January 1, 2005, to December 31, 2022, were eligible for inclusion in the analysis. Main Outcomes and Measures: The main outcome was OUD diagnoses. To test for changes in prevalence of OUD over time, multivariable logistic regression models were run that included categorical study year and were adjusted for sex, race and ethnicity, and categorical age. Results: The final sample size ranged from 4 332 165 to 5 962 564 per year; most were men (89.3%-95.0%). Overall, the annual percentage of VHA patients diagnosed with OUD almost doubled from 2005 to 2017 (0.60% [95% CI, 0.60%-0.61%] to 1.16% [95% CI, 1.15%-1.17%]; adjusted difference, 0.55 [95% CI, 0.54-0.57] percentage points) and declined thereafter (2022: 0.97% [95% CI, 0.97%-0.98%]; adjusted difference from 2017 to 2022, -0.18 [95% CI, -0.19 to -0.17] percentage points). This trend was similar among men (0.64% [95% CI, 0.63%-0.64%] in 2005 vs 1.22% [95% CI, 1.21%-1.23%] in 2017 vs 1.03% [95% CI, 1.02%-1.04%] in 2022), women (0.34% [95% CI, 0.32%-0.36%] in 2005 vs 0.68% [95% CI, 0.66%-0.69%] in 2017 vs 0.53% [95% CI, 0.52%-0.55%] in 2022), those younger than 35 years (0.62% [95% CI, 0.59%-0.66%] in 2005 vs 2.22% [95% CI, 2.18%-2.26%] in 2017 vs 1.00% [95% CI, 0.97%-1.03%] in 2022), those aged 35 to 64 years (1.21% [95% CI, 1.19%-1.22%] in 2005 vs 1.80% [95% CI, 1.78%-1.82%] in 2017 vs 1.41% [95% CI, 1.39%-1.42%] in 2022), and non-Hispanic White patients (0.44% [95% CI, 0.43%-0.45%] in 2005 vs 1.28% [95% CI, 1.27%-1.29%] in 2017 vs 1.13% [95% CI, 1.11%-1.14%] in 2022). Among VHA patients aged 65 years or older, OUD diagnoses increased from 2005 to 2022 (0.06% [95% CI, 0.06%-0.06%] to 0.61% [95% CI, 0.60%-0.62%]), whereas among Hispanic or Latino and non-Hispanic Black patients, OUD diagnoses decreased from 2005 (0.93% [95% CI, 0.88%-0.97%] and 1.26% [95% CI, 1.23%-1.28%], respectively) to 2022 (0.61% [95% CI, 0.59%-0.63%] and 0.82% [95% CI, 0.80%-0.83%], respectively). Conclusions and Relevance: This serial cross-sectional study of national VHA electronic health record data found that the prevalence of OUD diagnoses increased from 2005 to 2017, peaked in 2017, and declined thereafter, a trend primarily attributable to changes among non-Hispanic White patients and those younger than 65 years. Continued public health efforts aimed at recognizing, treating, and preventing OUD are warranted.
Databáze:	MEDLINE
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