Does Transient Opioid Use Increase Risk of Short-Term Respiratory Exacerbation among Older Adults with Chronic Obstructive Pulmonary Disease?

Ramachandran, Sujith; Rong, Yiran; Bhattacharya, Kaustuv; Salkar, Monika; McGwin, Gerald; Yang, Yi; Bentley, John P.

doi:10.1080/15412555.2021.2013460

Cited by 2 publications

(4 citation statements)

References 28 publications

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“…Of the 114 included articles, the case‐crossover design was the most common (100, 88%), 18–117 followed by the case‐time‐control (19, 17%), 38,63,67,71,86,118–131 and case‐case‐time‐control (4, 3%) 33,47,48,86 . (Table 1) The most common outcomes measured in these studies were hospitalization (43, 38%), cardiovascular events (22, 19%) and fall‐related injury/fracture (15, 13%).…”

Section: Resultsmentioning

confidence: 99%

“…Researchers sometime use multiple control windows in case‐crossover studies to increase study power and use washout periods to eliminate carryover effects of drugs or to account for non‐adherence to medications, especially when non‐transient medications are evalauted 10 . Of 48 articles that used multiple control windows, half of the articles reported no washout period between each control period 19,24,25,27,28,37,39,41,44,46,53,55,59,66,72,73,77,79,81,84,90,103,104,106,113,114 . It is unclear whether these multiple control windows were analyzed as a single large control window or time‐dependent control windows.…”

Section: Discussionmentioning

confidence: 99%

“…10 Of 48 articles that used multiple control windows, half of the articles reported no washout period between each control period. 19,24,25,27,28,37,39,41,44,46,53,55,59,66,72,73,77,79,81,84,90,103,104,106,113,114 It is unclear whether these multiple control windows were analyzed as a single large control window or time-dependent control windows.…”

Section: Publication Yearmentioning

confidence: 99%

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Evaluating the use of methods to mitigate bias from non‐transient medications in the case‐crossover design: A systematic review

Huang

Tadrous

et al. 2023

Pharmacoepidemiology and Drug

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Purpose The case‐crossover design is a self‐controlled study design used to compare exposure immediately preceding an event occurrence with exposure in earlier control periods. The design is most suitable for transient exposures in order to avoid biases that can be problematic when using the case‐crossover design for non‐transient (i.e., chronic) exposures. Our goal was to conduct a systematic review of case‐crossover studies and its variants (case‐time‐control and case‐case‐time‐control) in order to compare design and analysis choices by medication type. Methods We conducted a systematic search to identify recent case‐crossover, case‐time‐control, and case‐case‐time‐control studies focused on medication exposures. Articles indexed in MEDLINE and EMBASE using these study designs that were published between January 2015 and December 2021 in the English language were identified. Reviews, methodological studies, commentaries, articles without medications as the exposure of interest, and articles with no available full text were excluded. Study characteristics including study design, outcome, risk window, control window, reporting of discordant pairs, and inclusion of sensitivity analyses were summarized overall and by medication type. We further evaluated the implementation of recommended methods to account for biases introduced by non‐transient exposures among articles that used the case‐crossover design on a non‐transient exposure. Results Of the 2036 articles initially identified, 114 articles were included. The case‐crossover was the most common study design (88%), followed by the case‐time‐control (17%), and case‐case‐time‐control (3%). Fifty‐three percent of the articles included only transient medications, 35% included only non‐transient medications, and 12% included both. Across years, the proportion of case‐crossover articles evaluating a non‐transient medication ranged from 30% in 2018 to 69% in 2017. We found that 41% of the articles that evaluated a non‐transient medication did not apply any of the recommended methods to account for biases and more than half of which were conducted by authors with no previous publication history of case‐crossover studies. Conclusion Using the case‐crossover design to evaluate a non‐transient medication remains common in pharmacoepidemiology. Researchers should apply appropriate design and analysis choices when opting to use a case‐crossover design with non‐transient medication exposures.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Publication Yearmentioning

confidence: 99%

See 1 more Smart Citation

Evaluating the use of methods to mitigate bias from non‐transient medications in the case‐crossover design: A systematic review

Huang

Tadrous

et al. 2023

Pharmacoepidemiology and Drug

View full text Add to dashboard Cite

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“…However, evidence showcasing the efficacy of opioids for this purpose is mixed and of low quality ( Barnes et al, 2016 ; Chen et al, 2022 ; Verberkt et al, 2017 ). In fact, opioid use has been implicated in the exacerbation of COPD symptoms, especially at higher doses ( Ramachandran et al, 2021 ). Although low doses of opioids for breathlessness do not increase risk of mortality ( Chen et al, 2022 ; Ekstrom et al, 2014 ), clinicians should be cautious as the burden of opioid side effects (e.g., respiratory depression, nausea, and vomiting) may outweigh provided benefits.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Multiwave Opioid Use Among Older American Adults

Fennell

Jacobson

Grol-Prokopczyk

2023

Innovation in Aging

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Background and Objectives Despite limited analgesic benefits, long-term opioid therapy (L-TOT) is common among older adults with chronic pain. Extended opioid use poses a threat to older adults as aging metabolisms retain opioids for longer, increasing the risk of injury, overdose, and other negative health outcomes. In contrast to predictors of general opioid use, predictors of L-TOT in older adults are not well-documented. We aimed to identify such predictors using all available data on self-reported opioid use in the Health and Retirement Study. Research Design and Methods Using five waves of data, respondents (N=10,713) aged 51 and older were identified as reporting no opioid use (n= 8,621), a single wave of use (n=1,410), or multiple waves of use (n=682). We conducted a multinomial logistic regression to predict both single- and multi-wave opioid use relative to no use. Demographic, socioeconomic, geographic, health, and healthcare-related factors were included in our model. Results Multivariable findings show that, relative to non-users, both single- and multi-wave users were significantly more likely to be younger (RRR=1.33;RRR=2.88); report lower household wealth (RRR=1.47;RRR=2.88); live in the US Midwest (RRR=1.29;RRR=1.56), South (RRR=1.34;RRR=1.58), or West (RRR=1.46;RRR=2.34); experience interfering pain (RRR=1.59; RRR=3.39), back pain (RRR=1.35;RRR=1.53), or arthritic pain (RRR=1.46;RRR=2.32); and see the doctor frequently (RRR=1.50;RRR=2.02). Multi-wave users were less likely to be Black (RRR=0.69) or Hispanic (RRR=0.45), and less likely to be never married (RRR=0.52). Discussion and Implications We identified demographic, socioeconomic, geographic, and healthcare-related predictors of chronic multi-year opioid use. Our focus on individuals taking opioids for this extended duration is novel. Differences in opioid use by geographic region and frequency of doctor visits particularly warrant attention from policymakers and researchers. We make additional recommendations based on a sensitivity analysis limited to 2016-2020 data.

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Does Transient Opioid Use Increase Risk of Short-Term Respiratory Exacerbation among Older Adults with Chronic Obstructive Pulmonary Disease?

Cited by 2 publications

References 28 publications

Evaluating the use of methods to mitigate bias from non‐transient medications in the case‐crossover design: A systematic review

Evaluating the use of methods to mitigate bias from non‐transient medications in the case‐crossover design: A systematic review

Predictors of Multiwave Opioid Use Among Older American Adults

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