Fibromyalgia and the Risk of a Subsequent Motor Vehicle Crash

Implications of using administrative healthcare data to identify risk of motor vehicle crash-related injury: the importance of distinguishing crash from crash-related injury

BACKGROUND

Administrative healthcare databases, such as Medicare, are increasingly used to identify groups at risk of a crash. However, they only contain information on crash-related injuries, not all crashes. If the driver characteristics associated with crash and crash-related injury differ, conflating the two may result in ineffective or imprecise policy interventions.

METHODS

We linked 10 years (2008-2017) of Medicare claims to New Jersey police crash reports to compare the demographics, clinical diagnoses, and prescription drug dispensings for crash-involved drivers ≥ 68 years with a police-reported crash to those with a claim for a crash-related injury. We calculated standardized mean differences to compare characteristics between groups.

RESULTS

Crash-involved drivers with a Medicare claim for an injury were more likely than those with a police-reported crash to be female (62.4% vs. 51.8%, standardized mean difference [SMD] = 0.30), had more clinical diagnoses including Alzheimer's disease and related dementias (13.0% vs. 9.2%, SMD = 0.20) and rheumatoid arthritis/osteoarthritis (69.5% vs 61.4%, SMD = 0.20), and a higher rate of dispensing for opioids (33.8% vs 27.6%, SMD = 0.18) and antiepileptics (12.9% vs 9.6%, SMD = 0.14) prior to the crash. Despite documented inconsistencies in coding practices, findings were robust when restricted to claims indicating the injured party was the driver or was left unspecified.

CONCLUSIONS

To identify effective mechanisms for reducing morbidity and mortality from crashes, researchers should consider augmenting administrative datasets with information from police crash reports, and vice versa. When those data are not available, we caution researchers and policymakers against the tendency to conflate crash and crash-related injury when interpreting their findings.

Kognition und Kraftfahreignung bei chronischem Schmerzsyndrom

Kognitive Auffälligkeiten bei Patienten mit chronischen Schmerzen finden in wissenschaftlichen Untersuchungen zunehmend Beachtung. Die Folgen dieser kognitiven Störungen in Bezug auf die Schmerzbewältigung, die Alltagsgestaltung und die Kraftfahreignung werden in der klinischen Praxis jedoch kaum berücksichtigt, obwohl die Hälfte aller Patienten davon betroffen ist. Die vorliegende Arbeit fasst die aktuelle Studienlage zusammen und diskutiert Möglichkeiten der Integration in die klinische und therapeutische Versorgung.

Epidemiology and Outcomes of Alcohol Use Hospitalizations in People With Gout, Rheumatoid Arthritis, Fibromyalgia, Osteoarthritis, or Low Back Pain: A National US Study

OBJECTIVE

To examine the incidence, time trends, and outcomes of alcohol use disorder (AUD) hospitalizations in people with gout, rheumatoid arthritis (RA), fibromyalgia, osteoarthritis, or low back pain (LBP).

METHODS

We used the US National Inpatient Sample data from 1998 to 2016. We examined the rates of AUD hospitalizations in musculoskeletal diseases (MSDs), based on the presence of diagnostic codes for AUD in the primary and MSDs in a secondary position. Multivariable-adjusted (age, sex, race, and income) health care utilization and in-hospital mortality were compared by the presence/absence of MSDs, using linear or logistic regression.

RESULTS

Alcohol use disorder hospitalizations increased over the 19-year study period from 1998 to 2014 to 3-fold higher in gout, osteoarthritis, or LBP; 3.5-fold in RA; and 4.5-fold in fibromyalgia. Compared with AUD hospitalizations in people without each respective MSD, adjusted total hospital charges were $3913 higher in people with gout and $1368 to $1614 lower for osteoarthritis, fibromyalgia, or LBP over the study period (all significant) and not significantly different for RA. The adjusted odds of hospital stay of more than 3 days were significantly higher for all 5 MSDs, with odds ratio ranging 1.10 for LBP to 1.34 for gout. The adjusted odds of in-hospital mortality were significantly lower for all 5 MSDs, with odds ratio ranging from 0.21 for fibromyalgia to 0.50 for gout.

CONCLUSIONS

In a national US study, the rate of AUD hospitalizations increased in all 5 MSDs. Providers and patients with MSDs should be counseled regarding the risk and impact of alcohol use. Interventions to reduce AUD hospitalization-associated health care burden in MSD are needed.

Fibromyalgia in Older Individuals

Fibromyalgia (FM) is a condition of chronic widespread pain (CWP) that can occur throughout the life cycle and is likely underrecognized in older patients. FM is associated with considerable suffering and reduction in quality of life and may occur as a unique condition, but in older patients is most likely to be associated with another medical illness. Understood mechanistically to be a sensitization of the nervous system, recently identified as nociplastic pain, FM is accepted as a valid medical illness that requires a positive diagnosis and directed treatments. The cornerstone of treatments for FM are nonpharmacologic interventions, with the understanding that medications provide only modest benefit for most patients, and with particular concern about adverse effects in older patients. If FM is not recognized, treatments may be misdirected to the other medical condition, with failure to address FM symptoms, leading to overall poor outcome. In contrast, new complaints in older patients should not immediately be attributed to FM, and physicians should be vigilant to ensure that onset of a new illness is not ignored. As FM is most often a lifelong condition, patients should be encouraged to identify their own personal strategies that can attenuate symptoms, especially when symptoms flare. Continued life participation should be the outcome goal.

The impact of chronic pain on driving behaviour: a systematic review

ABSTRACT

Driving is a complex task that requires both the ability to rapidly identify potential hazards and to respond appropriately to driving situations to avoid crashing. A great deal of research has sought to increase road safety by focusing on risky behaviours, very few of which have explored the effects of chronic pain on driving behaviour. This systematic review aimed to assess driving behaviour and motor vehicle crash risk in drivers with chronic pain. Four databases (Embase, PubMed, Scopus, and PsycINFO) were searched using relevant search terms. From 8543 studies, 22 studies met the eligibility criteria for inclusion in this review. A driving behaviour framework, based on the Michon model of driving behaviour, is proposed to map the effect of chronic pain on driving behaviour. Findings suggest that drivers with chronic pain engage in risk-compensatory strategies that are positive from a precautionary perspective. However, there is considerable variability in the use of such strategies across different samples, suggesting that there are significant barriers and facilitators involved in these decisions. Moreover, our findings provide some evidence that chronic pain could increase crash risk and changes in driving behaviour among drivers. Evidence-based recommendations for practitioners and policymakers are proposed regarding the risks of driving in individuals experiencing chronic pain. Future research into chronic pain in driving could benefit from having a unified evidence-based approach to determine behaviour at all levels of the driving task.

Time-trends in cocaine, hallucinogen, amphetamine, and sedative/anxiolytic/hypnotic use disorder hospitalizations in rheumatic diseases: a national time-trends study

Musculoskeletal diseases (MSDs) are common in the general population, frequently associated with pain, functional limitation, and reduction in quality of life. Similarly, drug/substance use disorders are common in the general population. Recently, opioid drug use disorder has gained a lot of attention as a public health problem. To our knowledge, limited data exist regarding the non-opioid drug/substance use disorders in musculoskeletal diseases. This study's objective was to examine the frequency and rates of common drug/substance use disorder hospitalizations in five MSDs, namely gout, osteoarthritis, fibromyalgia, rheumatoid arthritis, and low back pain. This was achieved by using the diagnostic codes for cocaine, hallucinogen, amphetamine, or ASH use disorder hospitalization in five MSDs in the US National Inpatient Sample from 1998 to 2014. Cocaine, hallucinogen, amphetamine, or ASH use disorder hospitalizations per 1 million NIS total hospitalizations for five MSDs in 2013-2014 were as follows, respectively: gout, 10.2, 0.1, 2.8, and 1.5; osteoarthritis, 21.4, 0.4, 5.9, and 7.7; fibromyalgia, 5.5, 0.1, 2.0, and 2.3; rheumatoid arthritis, 8.7, 0.4, 4.5, and 7.7, and low back pain, 16.2, 0.5, 7.3, and 7.5. The frequency and the rate of each drug use disorder hospitalization increased in each of the five MSDs from 1998 to 2014. Key Points • Cocaine or hallucinogen use disorder hospitalization rates increased several-fold in people with MSDs from 1998 to 2014. • Amphetamine and anxiolytic, sedative, or hypnotic (ASH) use disorder hospitalization rates increased 9- to 23-fold vs. 4- to 7-fold, respectively, in people with common MSDs in the USA from 1998 to 2014.

Time Trends in Opioid Use Disorder Hospitalizations in Gout, Rheumatoid Arthritis, Fibromyalgia, Osteoarthritis, and Low Back Pain

OBJECTIVE

To examine opioid use disorder (OUD)-related hospitalizations and associated healthcare utilization outcomes in people with 5 common musculoskeletal diseases (MSD).

METHODS

We used the US National Inpatient Sample (NIS) data from 1998 to 2014 to examine the rates of OUD hospitalizations (per 100,000 NIS claims overall), time trends, and outcomes in 5 common rheumatic diseases: gout, rheumatoid arthritis (RA), fibromyalgia (FM), osteoarthritis (OA), and low back pain (LBP).

RESULTS

OUD hospitalization rate per 100,000 total NIS claims in 1998-2000 vs 2015-2016 (and increase) were as follows: gout, 0.05 vs 1.88 (36-fold); OA, 0.68 vs 10.22 (14-fold); FM, 0.53 vs 6.98 (12-fold); RA, 0.30 vs 3.16 (9.5-fold); and LBP, 1.17 vs 7.64 (5.5-fold). The median hospital charges and hospital stays for OUD hospitalizations were as follows: gout, $18,363 and 2.5 days; RA, $17,398 and 2.4 days; FM, $15,772 and 2.1 days; OA, $16,795 and 2.4 days; and LBP, $13,722 and 2.0 days. In-hospital mortality rates ranged from 0.9% for LBP and FM to 1.7% for gout with OUD hospitalizations. Compared to those without each MSD, age-, sex-, race-, and income-adjusted total hospital charges (inflation-adjusted) for OUD hospitalizations with each rheumatic disease were as follows: gout, $697 higher; OA, $4759 lower; FM, $2082 lower; RA, $1258 lower; and LBP, $4944 lower.

CONCLUSION

OUD hospitalizations increased in all 5 MSD studied, but the rate of increase differed. Awareness of these OUD hospitalization trends in 5 MSD among providers, policy makers, and patients is important. Development and implementation of interventions, policies, and practices to potentially reduce OUD-associated effects in people with rheumatic diseases is needed.

Gambling and Subsequent Road Traffic Injuries: A Longitudinal Cohort Analysis

BACKGROUND

To compare the risks of a road traffic injury (RTI) crash among adults who were involved in high-risk gambling and those who did not gamble.

METHODS

We conducted a linked longitudinal cohort analysis of adult persons in large population survey conducted during 2007 and 2008 in Ontario, Canada. We used responses to Problem Gambling Severity Index to distinguish persons as nongamblers, no-risk, low-risk, or high-risk gamblers. All persons were subsequently monitored for a subsequent RTI crash as a driver, pedestrian, or bicyclist up to March 31, 2014, through health insurance databases. We estimated relative risks as rate ratios (RRs) with 95% confidence intervals (95% CIs).

RESULTS

In all, 30,652 adults were included, of whom 52% self-identified as gamblers, including 49% as no-risk gamblers, 2% as low-risk gamblers, and 1% as high-risk gamblers. During a median follow-up period of 6.8 years, 708 participants (2%) were involved in 821 RTI crashes. The absolute risks of an RTI were 6.4 per 1000 person-years (95% CI 3.7-10.4) in high-risk gamblers and 3.6 per 1000 person-years (95% CI 3.2-4.0) in nongamblers. The relative risks for RTI crashes were significantly higher in high-risk gamblers than in nongamblers (adjusted RR 1.68, 95% CI 1.03-2.76). The risks for RTI crashes as a driver were augmented in high-risk gamblers than in nongamblers (RR 1.97, 95% CI 1.13-3.43).

CONCLUSIONS

We found an increased risk of an RTI crash among drivers who self-identified as high-risk gamblers. Further research exploring the underlying mechanisms of these associations might interest health professionals to monitor RTI risks in adults involved in high-risk gambling.

Motor vehicle crashes during pregnancy and cerebral palsy during infancy: a longitudinal cohort analysis

OBJECTIVES

To assess the incidence of cerebral palsy among children born to mothers who had their pregnancy complicated by a motor vehicle crash.

DESIGN

Retrospective longitudinal cohort analysis of children born from 1 April 2002 to 31 March 2012 in Ontario, Canada.

PARTICIPANTS

Cases defined as pregnancies complicated by a motor vehicle crash and controls as remaining pregnancies with no crash.

MAIN OUTCOME

Subsequent diagnosis of cerebral palsy by age 3 years.

RESULTS

A total of 1 325 660 newborns were analysed, of whom 7933 were involved in a motor vehicle crash during pregnancy. A total of 2328 were subsequently diagnosed with cerebral palsy, equal to an absolute risk of 1.8 per 1000 newborns. For the entire cohort, motor vehicle crashes correlated with a 29% increased risk of subsequent cerebral palsy that was not statistically significant (95% CI -16 to +110, p=0.274). The increased risk was only significant for those with preterm birth who showed an 89% increased risk of subsequent cerebral palsy associated with a motor vehicle crash (95% CI +7 to +266, p=0.037). No significant increase was apparent for those with a term delivery (95% CI -62 to +79, p=0.510). A propensity score-matched analysis of preterm births (n=4384) yielded a 138% increased relative risk of cerebral palsy associated with a motor vehicle crash (95% CI +27 to +349, p=0.007), equal to an absolute increase of about 10.9 additional cases per 1000 newborns (18.2 vs 7.3, p=0.010).

CONCLUSIONS

Motor vehicle crashes during pregnancy may be associated with an increased risk of cerebral palsy among the subgroup of cases with preterm birth. The increase highlights a specific role for traffic safety advice in prenatal care.

Use of Self-Matching to Control for Stable Patient Characteristics While Addressing Time-Varying Confounding on Treatment Effect: A Case Study of Older Intensive Care Patients

Exposure-crossover design offers a non-experimental option to control for stable baseline confounding through self-matching while examining causal effect of an exposure on an acute outcome. This study extends this approach to longitudinal data with repeated measures of exposure and outcome using data from a cohort of 340 older medical patients in an intensive care unit (ICU). The analytic sample included 92 patients who received ≥1 dose of haloperidol, an antipsychotic medication often used for patients with delirium. Exposure-crossover design was implemented by sampling the 3-day time segments prior (Induction) and posterior (Subsequent) to each treatment episode of receiving haloperidol. In the full cohort, there was a trend of increasing delirium severity scores (Mean±SD: 4.4±1.7) over the course of the ICU stay. After exposure-crossover sampling, the delirium severity score decreased from the Induction (4.9) to the Subsequent (4.1) intervals, with the treatment episode falling in-between (4.5). Based on a GEE Poisson model accounting for self-matching and within-subject correlation, the unadjusted mean delirium severity scores was −0.55 (95% CI: −1.10, −0.01) points lower for the Subsequent than the Induction intervals. The association diminished by 32% (−0.38, 95%CI: −0.99, 0.24) after adjusting only for ICU confounding, while being slightly increased by 7% (−0.60, 95%CI: −1.15, −0.04) when adjusting only for baseline characteristics. These results suggest that longitudinal exposure-crossover design is feasible and capable of partially removing stable baseline confounding through self-matching. Loss of power due to eliminating treatment-irrelevant person-time and uncertainty around allocating person-time to comparison intervals remain methodological challenges.