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Association of Tram...
Association of Tramadol vs Codeine Prescription Dispensation with Mortality and Other Adverse Clinical Outcomes
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- Xie, Junqing (författare)
- University of Oxford
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- Strauss, Victoria Y. (författare)
- University of Oxford
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- Martinez-Laguna, Daniel (författare)
- Catalan Institute Of Health,Autonomous University of Barcelona,Carlos III Health Institute
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- Carbonell-Abella, Cristina (författare)
- University of Barcelona,Catalan Institute Of Health,Carlos III Health Institute
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- Diez-Perez, Adolfo (författare)
- Hospital del Mar Medical Research Institute,Carlos III Health Institute,Catalan Institute Of Health,Autonomous University of Barcelona
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- Nogues, Xavier (författare)
- Carlos III Health Institute,Hospital del Mar Medical Research Institute,Autonomous University of Barcelona
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- Collins, Gary S. (författare)
- Oxford University Hospital,University of Oxford
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- Khalid, Sara (författare)
- University of Oxford
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- Delmestri, Antonella (författare)
- University of Oxford
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- Turkiewicz, Aleksandra (författare)
- Lund University,Lunds universitet,Ortopedi, Lund,Sektion III,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Lund OsteoArthritis Division - Clinical Epidemiology Unit,Forskargrupper vid Lunds universitet,Orthopaedics (Lund),Section III,Department of Clinical Sciences, Lund,Faculty of Medicine,Lund University Research Groups
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- Englund, Martin (författare)
- Lund University,Lunds universitet,Ortopedi, Lund,Sektion III,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Lund OsteoArthritis Division - Clinical Epidemiology Unit,Forskargrupper vid Lunds universitet,Orthopaedics (Lund),Section III,Department of Clinical Sciences, Lund,Faculty of Medicine,Lund University Research Groups
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- Tadrous, Mina (författare)
- Women's College Hospital, Ontario,University of Toronto
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- Reyes, Carlen (författare)
- Carlos III Health Institute
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- Prieto-Alhambra, Daniel (författare)
- University of Oxford,Erasmus University Medical Center
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(creator_code:org_t)
- American Medical Association (AMA), 2021
- 2021
- Engelska 12 s.
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Ingår i: JAMA - Journal of the American Medical Association. - : American Medical Association (AMA). - 0098-7484. ; 326:15, s. 1504-1515
- Relaterad länk:
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http://dx.doi.org/10...
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https://lup.lub.lu.s...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Importance: Although tramadol is increasingly used to manage chronic noncancer pain, few safety studies have compared it with other opioids. Objective: To assess the associations of tramadol, compared with codeine, with mortality and other adverse clinical outcomes as used in outpatient settings. Design, Setting, and Participants: Retrospective, population-based, propensity score-matched cohort study using a primary care database with routinely collected medical records and pharmacy dispensations covering more than 80% of the population of Catalonia, Spain (≈6 million people). Patients 18 years or older with 1 or more year of available data and dispensation of tramadol or codeine (2007-2017) were included and followed up to December 31, 2017. Exposures: New prescription dispensation of tramadol or codeine (no dispensation in the previous year). Main Outcomes and Measures: Outcomes studied were all-cause mortality, cardiovascular events, fractures, constipation, delirium, falls, opioid abuse/dependence, and sleep disorders within 1 year after the first dispensation. Absolute rate differences (ARDs) and hazard ratios (HRs) with 95% confidence intervals were calculated using cause-specific Cox models. Results: Of the 1093064 patients with a tramadol or codeine dispensation during the study period (326921 for tramadol, 762492 for codeine, 3651 for both drugs concomitantly), a total of 368960 patients (184480 propensity score-matched pairs) were included after study exclusions and propensity score matching (mean age, 53.1 [SD, 16.1] years; 57.3% women). Compared with codeine, tramadol dispensation was significantly associated with a higher risk of all-cause mortality (incidence, 13.00 vs 5.61 per 1000 person-years; HR, 2.31 [95% CI, 2.08-2.56]; ARD, 7.37 [95% CI, 6.09-8.78] per 1000 person-years), cardiovascular events (incidence, 10.03 vs 8.67 per 1000 person-years; HR, 1.15 [95% CI, 1.05-1.27]; ARD, 1.36 [95% CI, 0.45-2.36] per 1000 person-years), and fractures (incidence, 12.26 vs 8.13 per 1000 person-years; HR, 1.50 [95% CI, 1.37-1.65]; ARD, 4.10 [95% CI, 3.02-5.29] per 1000 person-years). No significant difference was observed for the risk of falls, delirium, constipation, opioid abuse/dependence, or sleep disorders. Conclusions and Relevance: In this population-based cohort study, a new prescription dispensation of tramadol, compared with codeine, was significantly associated with a higher risk of subsequent all-cause mortality, cardiovascular events, and fractures, but there was no significant difference in the risk of constipation, delirium, falls, opioid abuse/dependence, or sleep disorders. The findings should be interpreted cautiously, given the potential for residual confounding..
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)
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Xie, Junqing
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Strauss, Victori ...
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Martinez-Laguna, ...
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Carbonell-Abella ...
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Diez-Perez, Adol ...
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Nogues, Xavier
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Collins, Gary S.
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Khalid, Sara
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Delmestri, Anton ...
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Turkiewicz, Alek ...
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Englund, Martin
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Tadrous, Mina
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Reyes, Carlen
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Prieto-Alhambra, ...
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