Healthcare use by people who use illicit opioids (HUPIO): development of a cohort based on electronic primary care records in England

Abstract

Background: People who use illicit opioids such as heroin have substantial health needs, but there are few longitudinal studies of general health and healthcare in this population. Most research to date has focused on a narrow set of outcomes, including overdoses and HIV or hepatitis infections. We developed and validated a cohort using UK primary care electronic health records (Clinical Practice Research Datalink GOLD and AURUM databases) to facilitate research into healthcare use by people who use illicit opioid use (HUPIO). Methods: Participants are patients in England with primary care records indicating a history of illicit opioid use. We identified codes including prescriptions of opioid agonist therapies (methadone and buprenorphine) and clinical observations such as ‘heroin dependence’. We constructed a cohort of patients with at least one of these codes and aged 18-64 at cohort entry, with follow-up between January 1997 and March 2020. We validated the cohort by comparing patient characteristics and mortality rates to other cohorts of people who use illicit opioids, with different recruitment methods. Results: Up to March 2020, the HUPIO cohort included 138,761 patients with a history of illicit opioid use. Demographic characteristics and all-cause mortality were similar to existing cohorts: 69% were male; the median age at index for patients in CPRD AURUM (the database with more included participants) was 35.3 (interquartile range 29.1-42.6); the average age of new cohort entrants increased over time; 76% had records indicating current tobacco smoking; patients disproportionately lived in deprived neighbourhoods; and all-cause mortality risk was 6.6 (95% CI 6.5-6.7) times the general population of England. Conclusions: Primary care data offer new opportunities to study holistic health outcomes and healthcare of this population. The large sample enables investigation of rare outcomes, whilst the availability of linkage to external datasets allows investigation of hospital use, cancer treatment, and mortality.

Causes of death among people who used illicit opioids in England, 2001–18: a matched cohort study

“…First, our sample of patients from general practices might not represent the population of people who use illicit opioids in England. In a validation study, 18 we found the cohort had similar demographic characteristics and mortality rates as other studies of people who use illicit opioids, and 90% of patients being treated in hospital who received a diagnosis of opioid dependence were also captured by primary care records. This suggests that the cohort represents people with more severe opioid use or dependence but might under-represent people who use opioids for shorter periods, less frequently, or have not sought treatment.…”

“…We have previously published a full codelist and validation showing that this sample has similar demographic characteristics and all-cause mortality rates as other samples of people who use illicit opioids (eg, heroin) or are receiving opioid agonist therapy. 18 The entry date was Jan 1, 2001; 12 months after entry to CPRD; or the first record of illicit opioid use. We used a washout of 12 months to avoid the unusual period after joining a database such as CPRD because this period often coincides with registration at a doctor's surgery and might be associated with poor health, diagnosis, or recording of pre-existing health problems.…”

Health‐care resource use among patients who use illicit opioids in England, 2010–20: A descriptive matched cohort study

“…These observations are recorded by GPs either during a clinical consultation or following information shared with the GP from another health service. We previously published the full code list and showed that patients meeting these criteria have similar characteristics to other samples of people who use illicit opioids in the United Kingdom, including an increasing average age (currently in the early 40%), approximately 70% being male, and very high mortality rates [19]. We excluded participants with no recorded sex (0.002%).…”

Prevalence of Opioid Use in Nursing Homes Over the Last Decade: A Systematic Literature Review

“…There is a large corpus of observational research on opioid use and safety among the elderly worldwide, including studies based in the United States, [13][14][15] Canada, 16,17 and Europe. [18][19][20][21] However, it is not known whether these data sources were used to study opioid use in nursing homes (NHs).…”