Correlation of Opioid Mortality with Prescriptions and Social Determinants: A Cross-sectional Study of Medicare Enrollees

Grigoras, Christos; Karanika, Styliani; Velmahos, Elpida; Alevizakos, Michail; Flokas, Myrto-Eleni; Kaspiris-Rousellis, Christos; Evaggelidis, Ioannis-Nektarios; Artelaris, Panagiotis; Siettos, Constantinos; Mylonakis, Eleftherios

doi:10.1007/s40265-017-0846-6

Cited by 24 publications

(28 citation statements)

References 13 publications

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“…Open access association between county-level poverty and higher rates of opioid prescribing was previously demonstrated in a 2014 study of disabled Medicare and Medicaid beneficiaries, 11 though this was not examined in the general US population or linked directly to drug-related mortality. Nevertheless, addressing this epidemic will require sophisticated policy and public health approaches that consider a breadth of fundamental social determinants of health and cannot be fully captured by singular constructs such as age, race, sex or income.…”

Section: Introductionmentioning

confidence: 95%

“…Thus, the two outcomes-opioid prescribing and drug-poisoning mortality-should be tracked in parallel to assess the impact of limiting opioid use on overall drug mortality. Historically, areas with higher opioid prescription rates also experienced higher drug-related mortality, 11 but recent intensive policy and public health efforts aimed at reducing opioid prescribing may have inadvertently created a divergence between opioid prescribing and drug-poisoning mortality, particularly in areas where opioid use may be low, but mortality due to non-opioids remains high. There is, therefore, a need for a contemporary population-level evaluation of current trends in opioid-prescribing practices and drug-related mortality to identify populations at greatest risk of harm from opioid and non-opioid misuse.…”

Section: Introductionmentioning

confidence: 99%

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Place, poverty and prescriptions: a cross-sectional study using Area Deprivation Index to assess opioid use and drug-poisoning mortality in the USA from 2012 to 2017

Kurani

McCoy²,

Inselman

et al. 2020

BMJ Open

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ObjectiveTo identify the relationships between county-level area deprivation and patterns of both opioid prescriptions and drug-poisoning mortality.Design, setting and participantsFor this retrospective cross-sectional study, we used the IQVIA Xponent data to capture opioid prescriptions and Centres for Disease Control and Prevention National Vital Statistics System to assess drug-poisoning mortality. The Area Deprivation Index (ADI) is a composite measure of social determinants of health comprised of 17 US census indicators, spanning four socioeconomic domains. For all US counties with available opioid prescription (2712 counties) and drug-poisoning mortality (3133 counties) data between 2012 and 2017, we used negative binomial regression to examine the association between quintiles of county-level ADI and the rates of opioid prescriptions and drug-poisoning mortality adjusted for year, age, race and sex.Primary outcome measuresCounty-level opioid prescription fills and drug-poisoning mortality.ResultsBetween 2012 and 2017, overall rates of opioid prescriptions decreased from 96.6 to 72.2 per 100 people, while the rates of drug-poisoning mortality increased from 14.3 to 22.8 per 100 000 people. Opioid prescription and drug-poisoning mortality rates were consistently higher with greater levels of deprivation. The risk of filling an opioid prescription was 72% higher, and the risk of drug-poisoning mortality was 36% higher, for most deprived compared with the least deprived counties (both p<0.001).DiscussionCounties with greater area-level deprivation have higher rates of filled opioid prescriptions and drug-poisoning mortality. Although opioid prescription rates declined across all ADI quintiles, the rates of drug-poisoning mortality continued to rise proportionately in each ADI quintile. This underscores the need for individualised and targeted interventions that consider the deprivation of communities where people live.

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Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Place, poverty and prescriptions: a cross-sectional study using Area Deprivation Index to assess opioid use and drug-poisoning mortality in the USA from 2012 to 2017

Kurani

McCoy²,

Inselman

et al. 2020

BMJ Open

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“…[66] The devastating social impact of opioids directly affects impoverished families, as opioid-related deaths are correlated with poverty, even though prescription rates are lower for poorer communities. [67]…”

Section: Discussionmentioning

confidence: 99%

Current perspectives on the opioid crisis in the US healthcare system

Stoicea¹,

Costa²,

Periel³

et al. 2019

Medicine

158

119

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Introduction: The administration of opioids has been used for centuries as a viable option for pain management. When administered at appropriate doses, opioids prove effective not only at eliminating pain but further preventing its recurrence in long-term recovery scenarios. Physicians have complied with the appropriate management of acute and chronic pain; however, this short or long-term opioid exposure provides opportunities for long-term opioid misuse and abuse, leading to addiction of patients who receive an opioid prescription and/or diversion of this pain medication to other people without prescription. Several reviews attempted to summarize the epidemiology and management of opioid misuse, this integrative review seeks to summarize the current literature related with responsible parties of this opioid abuse crisis and discuss potential associations between demographics (ethnicity, culture, gender, religion) and opioid accessibility, abuse and overdose. Methods: We performed an extensive literature search in Google Scholar and Pub Med databases that were published between December 7, 1999 and January 9, 2018 in accordance with the Preferred Reporting Items for Systematic Reviews and meta-Analysis (PRISMA) guidelines. Searches were referenced using medical subject headings (MeSH) that included “opioids”, “over-prescription”, “opioid consumption”, or “opioid epidemic”. The final review of all data bases was conducted on July 24, 2018. Results: A total of 7160 articles were originally identified. After 3340 duplicate articles were removed, 3820 manuscripts were removed after title and abstract screening. Following this, 120 manuscripts underwent eligibility selection with only 70 publications being selected as reliable full-texts addressing related factors surrounding the opioid crisis. Conclusion: With approximately 100 million people suffering from both chronic and acute pain in the United States (US) in 2016, opiates will continue to remain a prominent class of medication in healthcare facilities and homes across the US. Over 66% of total overdose episodes in 2016 were opioid-related, a figure that attests to the severity and wide-spread nature of this issue. A three-point approach accentuating the prevention, treatment, and rehabilitation of both those currently affected and at-risk in the future may be the comprehensive solution.

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“…The OASIS database defines a rural county as any county with <35 000 total population per year 2000 census. Additional county level demographic data on age, gender (male/female), ethnicity (Hispanic/non‐Hispanic), race (White, Black, other), population, poverty rate (per cent living below federal poverty line) and median household income were gathered from the U.S. Census Bureau . The unemployment rate by county was from the Bureau of Labor Statistics in the U.S. Department of Labor .…”

Section: Methodsmentioning

confidence: 99%

“…Previous literature has examined social determinants that affect drug overdose mortality in the USA, including economic factors such as unemployment rate and poverty rate . Few have examined the association between the geographic variation and drug overdose mortality .…”

Section: Introductionmentioning

confidence: 99%

Drug overdose deaths in Georgia: impact of rural versus non-rural counties

Valentini

Jayawardhana

2019

J Pharm Health Serv Res

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Objectives The number of deaths due to all drugs and opioids has increased dramatically in Georgia within the last decade. However, the disparities in drug overdose deaths across the state remains a concern. Certain geographic areas may be adversely affected by this public health epidemic. While many studies have explored national trends of drug overdoses, few have specifically considered the epidemic in Georgia. This research examines the impact of rural versus non-rural county status on overdose death rates in Georgia due to all drugs and opioids. Methods We used county-level drug overdose death data from the Georgia Department of Public Health's Online Analytical Statistical Information System, along with other demographic data gathered from other sources. The analysis data sample included 2703 observations from all 159 counties in Georgia from 1999 to 2015. We used panel multivariate linear regression models to determine the impact of rural and non-rural county status on drug overdose death rates in Georgia due to all drugs and opioids. Key findings Descriptive data show that overdose death rates due to all drugs and opioids increased overtime in both rural and non-rural counties. Regression results indicate that rural counties in Georgia experienced a 23.5% decrease in overdose death rate due to all drugs compared with non-rural counties between 1999 and 2015 (P < 0.05). While rural counties also experienced a lower rate of opioid overdose deaths (18.7%) compared with non-rural counties, it was not statistically significant. Conclusions Although increasing drug overdose death rate is a significant public health concern in Georgia, rural counties in the state experienced a lower rate of drug overdose deaths compared with non-rural counties. Interventions targeted towards reducing drug overdose deaths both in rural and in non-rural counties are needed to address this public health priority in Georgia.

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Correlation of Opioid Mortality with Prescriptions and Social Determinants: A Cross-sectional Study of Medicare Enrollees

Cited by 24 publications

References 13 publications

Place, poverty and prescriptions: a cross-sectional study using Area Deprivation Index to assess opioid use and drug-poisoning mortality in the USA from 2012 to 2017

Place, poverty and prescriptions: a cross-sectional study using Area Deprivation Index to assess opioid use and drug-poisoning mortality in the USA from 2012 to 2017

Current perspectives on the opioid crisis in the US healthcare system

Drug overdose deaths in Georgia: impact of rural versus non-rural counties

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