TY  - JOUR
PY  - 2024//
TI  - Association between opioid-benzodiazepine trajectories and injurious fall risk among US medicare beneficiaries
JO  - Journal of clinical medicine
A1  - Wang, Grace Hsin-Min
A1  - Hincapie-Castillo, Juan M.
A1  - Gellad, Walid F.
A1  - Jones, Bobby L.
A1  - Shorr, Ronald I.
A1  - Yang, Seonkyeong
A1  - Wilson, Debbie L.
A1  - Lee, Jeannie K.
A1  - Reisfield, Gary M.
A1  - Kwoh, Chian K.
A1  - Delcher, Chris
A1  - Nguyen, Khoa A.
A1  - Harle, Christopher A.
A1  - Marcum, Zachary A.
A1  - Lo-Ciganic, Wei-Hsuan
SP  - e3376
EP  - e3376
VL  - 13
IS  - 12
N2  - Background/Objectives: Concurrent opioid (OPI) and benzodiazepine (BZD) use may exacerbate injurious fall risk (e.g., falls and fractures) compared to no use or use alone. Yet, patients may need concurrent OPI-BZD use for co-occurring conditions (e.g., pain and anxiety). Therefore, we examined the association between longitudinal OPI-BZD dosing patterns and subsequent injurious fall risk. <br><br>METHODS: We conducted a retrospective cohort study including non-cancer fee-for-service Medicare beneficiaries initiating OPI and/or BZD in 2016-2018. We identified OPI-BZD use patterns during the 3 months following OPI and/or BZD initiation (i.e., trajectory period) using group-based multi-trajectory models. We estimated the time to first injurious falls within the 3-month post-trajectory period using inverse-probability-of-treatment-weighted Cox proportional hazards models. <br><br>RESULTS: Among 622,588 beneficiaries (age ≥ 65 = 84.6%, female = 58.1%, White = 82.7%; having injurious falls = 0.45%), we identified 13 distinct OPI-BZD trajectories: Group (A): Very-low OPI-only (early discontinuation) (44.9% of the cohort); (B): Low OPI-only (rapid decline) (15.1%); (C): Very-low OPI-only (late discontinuation) (7.7%); (D): Low OPI-only (gradual decline) (4.0%); (E): Moderate OPI-only (rapid decline) (2.3%); (F): Very-low BZD-only (late discontinuation) (11.5%); (G): Low BZD-only (rapid decline) (4.5%); (H): Low BZD-only (stable) (3.1%); (I): Moderate BZD-only (gradual decline) (2.1%); (J): Very-low OPI (rapid decline)/Very-low BZD (late discontinuation) (2.9%); (K): Very-low OPI (rapid decline)/Very-low BZD (increasing) (0.9%); (L): Very-low OPI (stable)/Low BZD (stable) (0.6%); and (M): Low OPI (gradual decline)/Low BZD (gradual decline) (0.6%). Compared with Group (A), six trajectories had an increased 3-month injurious falls risk: (C): HR = 1.78, 95% CI = 1.58-2.01; (D): HR = 2.24, 95% CI = 1.93-2.59; (E): HR = 2.60, 95% CI = 2.18-3.09; (H): HR = 2.02, 95% CI = 1.70-2.40; (L): HR = 2.73, 95% CI = 1.98-3.76; and (M): HR = 1.96, 95% CI = 1.32-2.91. <br><br>CONCLUSIONS: Our findings suggest that 3-month injurious fall risk varied across OPI-BZD trajectories, highlighting the importance of considering both dose and duration when assessing injurious fall risk of OPI-BZD use among older adults.<p />  <p>Language: en</p>
LA  - en
SN  - 2077-0383
UR  - http://dx.doi.org/10.3390/jcm13123376
ID  - ref1
ER  -