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Commonly Initiated Opioids and Risk of Fracture Hospitalizations in United States Nursing Homes
Authors
Hunnicutt, Jacob N.Hume, Anne L
Liu, Shao-Hsien
Ulbricht, Christine M.
Tjia, Jennifer
Lapane, Kate L
UMass Chan Affiliations
Morningside Graduate School of Biomedical SciencesDepartment of Quantitative Health Sciences
Document Type
Journal ArticlePublication Date
2018-10-01Keywords
EpidemiologyGeriatrics
Health Services Administration
Health Services Research
Pharmaceutical Preparations
Therapeutics
Metadata
Show full item recordAbstract
OBJECTIVES: The aim of this study was to estimate the comparative safety of initiating commonly used opioids among older, long-stay United States nursing home residents with fracture hospitalizations. METHODS: We conducted a new-user retrospective cohort study of nursing home residents initiating short-acting oxycodone, hydrocodone, or tramadol by merging the 2011-2013 Minimum Data Set 3.0 to Medicare hospitalization and pharmacy claims. Residents ( > /= 65 years, no cancer or hospice use) contributed treatment episodes ( > 120 days with no prior opioid claims) and were followed for 180 days until incident fracture hospitalization (hip, femur, humerus, pelvis, radius/ulna), death (competing risk), treatment changes (e.g., discontinuation), or administrative censoring. Competing risks models with inverse probability of treatment weighting were used to estimate subdistribution hazard ratios (HRSD) and 95% confidence intervals (CI). RESULTS: Overall, 110,862 residents contributed 134,432 treatment episodes: 14,373 oxycodone; 69,182 hydrocodone; and 50,877 tramadol initiators. The incidences of fracture hospitalizations per 100 person-years were 9.4 (95% CI 7.5-11.7) for oxycodone, 7.9 (95% CI 7.1-8.8) for hydrocodone, and 5.0 (95% CI 4.3-5.7) for tramadol initiators. In weighted models, oxycodone initiators had a similar rate of fractures to hydrocodone initiators (HRSD 1.08, 95% CI 0.79-1.48). Tramadol initiators had lower fracture rates than hydrocodone initiators (HRSD 0.67, 95% CI 0.56-0.80). CONCLUSIONS: The lower rate of fractures that we documented among tramadol initiators compared with hydrocodone initiators is consistent, albeit attenuated compared with prior studies among community-dwelling older adults. However, overall fracture rates were lower than in community settings, potentially due to the limited risk of falling in this population with limited mobility.Source
Drugs Aging. 2018 Oct;35(10):925-936. doi: 10.1007/s40266-018-0583-x. Link to article on publisher's site
DOI
10.1007/s40266-018-0583-xPermanent Link to this Item
http://hdl.handle.net/20.500.14038/46758PubMed ID
30187291Related Resources
ae974a485f413a2113503eed53cd6c53
10.1007/s40266-018-0583-x