Background
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the occurrence of pain (and types of diagnoses indicating pain),
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the prescribing of analgesics (and which agents and formulations) and
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factors associated with the prescription of analgesics within the incidence year.
Methods
Design and study population
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age of at least 65 years,
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at least one ICD-10 code for dementia from the following list (F00.x, F01.x, F02.0, F02.3, F03, G30.x, G31.0, G31.1, G31.82, G31.9, and R54) in ambulatory medical care in at least 3 of 4 consecutive quarters,
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at least 4 quarters free from this diagnoses before and
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continuous insurance period of four quarters before and after the first code was recorded.
Diagnoses indicating pain, analgesic prescribing and covariates
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Cancer pain (ICD-10: C20, C34, C64, C77-C80, C85, C90, Z51),
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Pain due to arthritis or osteoarthritis (ICD-10: M06, M13, M15-M19, M25),
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Pain due to fractures (ICD-10: S12, S22, S32, S42, T02, T08, T91),
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Pain due to multimorbidity and care dependency (ICD-10: L89, L97, L98),
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Headache (ICD-10: G43, G44, R51),
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Neuropathic pain (ICD-10: G50, G54, G56-G58, G62, G63, M79, M89),
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Back pain (ICD-10: M43, M45-M51, M53, M54, M81, M82) and
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Pain, not elsewhere classified (ICD-10: R52).
Statistical analysis
Results
Characteristics of the study cohort
Baseline characteristics | Dementia group (n = 1,848) | Control group (n = 7,385) |
---|---|---|
Mean age, in years (SD) | 78.7 (7.4) | 78.7 (7.4) |
Age groups, in years | ||
65-74 | 30.6% | 30.6% |
75-84 | 47.1% | 47.3% |
85+ | 22.3% | 22.1% |
Sex | ||
Male | 52.4% | 52.5% |
Female | 47.6% | 47.5% |
Level of long term care | ||
None | 55.6% | 87.1% |
I | 20.7% | 7.6% |
II | 18.5% | 4.4% |
III | 5.3% | 0.9% |
Place of residence | ||
Nursing home | 20.1% | 3.2% |
Community-dwelling | 79.9% | 96.8% |
Number of prescribed medications; mean (SD) | 9.7 (5.7) | 7.6 (5.4) |
25th percentile (Q1) | 6 | 4 |
50th percentile (Q2) | 9 | 7 |
75th percentile (Q3) | 13 | 11 |
Type of pain | Dementia group (n = 1,848) (in %) | Control group (n = 7,385) (in %) | p-value |
---|---|---|---|
Back pain | 51.7 | 53.2 | 0.23 |
Pain due to arthritis or osteoarthritis | 41.2 | 41.8 | 0.64 |
Neuropathic pain | 19.4 | 16.5 | 0.0037 |
Pain due to fractures | 4.6 | 3.0 | 0.0006 |
Pain due to multimorbidity and care dependency | 9.8 | 4.0 | <0.0001 |
Pain, not elsewhere classified | 9.0 | 6.0 | <0.0001 |
Headache | 6.3 | 5.0 | 0.0331 |
Cancer pain | 5.0 | 5.9 | 0.14 |
Total (at least one pain type) | 74.4 | 72.5 | 0.11 |
Prescribing of analgesic drugs
Dementia group (n = 1,848; 4,441 prescriptions) | Control group (n = 7,385; 14,427 prescriptions) | ||
---|---|---|---|
Substance | Proportion (in %) | Substance | Proportion (in %) |
Metamizole (dipyrone) | 27.4 | Diclofenac (mono) | 26.3 |
Diclofenac (mono) | 18.9 | Metamizole (dipyrone) | 17.8 |
Tramadol | 13.5 | Ibuprofen | 13.3 |
Ibuprofen | 12.5 | Tramadol | 10.2 |
Fentanyl | 6.7 | Tilidine/naloxone | 7.9 |
Tilidine/naloxone | 6.0 | Fentanyl | 6.3 |
Oxycodone | 1.8 | Oxycodone | 2.1 |
Codeine/paracetamol | 1.8 | Codeine/paracetamol | 2.1 |
Buprenorphine | 1.7 | Morphine | 2.0 |
Flupirtine | 1.6 | Buprenorphine | 1.7 |
Characteristics | Dementia group (n = 1,848) (in %) | Control group (n = 7,385) (in %) | p-value |
---|---|---|---|
WHO step I drugs | |||
Diclofenac (mono) | 19.5 | 21.6 | 0.04 |
Metamizole | 18.7 | 12.8 | <0.0001 |
Total | 42.8 | 40.7 | 0.11 |
WHO step II drugs | |||
Tramadol | 8.8 | 6.0 | <0.0001 |
Tilidine/naloxone | 4.1 | 3.9 | 0.77 |
Total | 14.7 | 11.4 | 0.0001 |
WHO step III drugs | |||
Fentanyl | 2.5 | 2.0 | 0.16 |
Oxycodone | 0.8 | 0.9 | 0.65 |
Total | 4.2 | 3.6 | 0.19 |
Route of administration | |||
Liquid oral | 19.2 | 12.8 | <0.0001 |
Transdermal | 3.1 | 2.3 | 0.03 |
Total (at least one analgesic) | 47.5 | 44.7 | 0.03 |
Factors associated with prescribing
Model 1: ORcrude(95% CI) | Model 2: ORadj.(95% CI) | Model 3: ORadj.(95% CI) | |
---|---|---|---|
Dementia group (vs. control group) | 1.12 (1.01-1.24) | 0.96 (0.86-1.07) | 0.78 (0.68-0.88) |
Female sex (vs. male) | 1.39 (1.28-1.52) | 1.16 (1.05-1.28) | |
Age groups, in years | |||
65-74 | 1 | 1 | |
75-84 | 1.09 (0.99-1.20) | 0.96 (0.86-1.07) | |
85+ | 1.10 (0.97-1.24) | 1.10 (0.96-1.27) | |
Level of long term care | |||
None | 1 | 1 | |
I | 1.46 (1.25-1.70) | 1.08 (0.91-1.30) | |
II | 1.69 (1.40-2.03) | 1.30 (1.05-1.62) | |
III | 1.26 (0.91-1.76) | 1.06 (0.73-1.55) | |
Nursing home residence (vs. community-dwelling) | 1.15 (0.94-1.41) | 1.11 (0.88-1.40) | |
Number of prescribed medications | |||
Q1 (0–4) | 1 | ||
Q2 (5–7) | 2.22 (1.94-2.54) | ||
Q3 (8–11) | 3.79 (3.31-4.34) | ||
Q4 (12–51) | 7.65 (6.58-8.89) | ||
Cancer pain (vs. no) | 1.08 (0.88-1.32) | ||
Pain due to arthritis or osteoarthritis (vs. no) | 2.39 (2.17-2.64) | ||
Pain due to fractures (vs. no) | 2.86 (2.11-3.88) | ||
Pain due to multimorbidity and care dependency (vs. no) | 1.11 (0.89-1.38) | ||
Headache (vs. no) | 1.03 (0.83-1.28) | ||
Neuropathic pain (vs. no) | 1.24 (1.09-1.41) | ||
Back pain (vs. no) | 2.29 (2.07-2.53) | ||
Pain, not elsewhere classified (vs. no) | 2.77 (2.21-3.47) |