Correlation of Opioid Mortality with Prescriptions and Social Determinants: A Cross-sectional Study of Medicare Enrollees
Abstract
Background
The opioid epidemic is an escalating health crisis. We evaluated the impact of opioid prescription rates and socioeconomic determinants on opioid mortality rates, and identified potential differences in prescription patterns by categories of practitioners.
Methods
We combined the 2013 and 2014 Medicare Part D data and quantified the opioid prescription rate in a county level cross-sectional study with data from 2710 counties, 468,614 unique prescribers and 46,665,037 beneficiaries. We used the CDC WONDER database to obtain opioid-related mortality data. Socioeconomic characteristics for each county were acquired from the US Census Bureau.
Results
The average national opioid prescription rate was 3.86 claims per beneficiary that received a prescription for opioids (95% CI 3.86–3.86). At a county level, overall opioid prescription rates (p < 0.001, Coeff = 0.27) and especially those provided by emergency medicine (p < 0.001, Coeff = 0.21), family medicine physicians (p = 0.11, Coeff = 0.008), internal medicine (p = 0.018, Coeff = 0.1) and physician assistants (p = 0.021, Coeff = 0.08) were associated with opioid-related mortality. Demographic factors, such as proportion of white (p white < 0.001, Coeff = 0.22), black (p black < 0.001, Coeff = − 0.19) and male population (p male < 0.001, Coeff = 0.13) were associated with opioid prescription rates, while poverty (p < 0.001, Coeff = 0.41) and proportion of white population (p white < 0.001, Coeff = 0.27) were risk factors for opioid-related mortality (p model < 0.001, R 2 = 0.35). Notably, the impact of prescribers in the upper quartile was associated with opioid mortality (p < 0.001, Coeff = 0.14) and was twice that of the remaining 75% of prescribers together (p < 0.001, Coeff = 0.07) (p model = 0.03, R 2 = 0.03).
Conclusions
The prescription opioid rate, and especially that by certain categories of prescribers, correlated with opioid-related mortality. Interventions should prioritize providers that have a disproportionate impact and those that care for populations with socioeconomic factors that place them at higher risk.
Notes
Author Contributions
Guarantor of the article: CAG and EM accept full responsibility for the conduct of the study, have access to the data and have control of the decision to publish.
CAG and EM had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. CAG: conceptualized and designed the study, performed the literature search, participated in data collection, extraction and interpretation, prepared tables and figures, performed the statistical analysis, drafted the initial manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SK: conceptualized and designed the study, performed the literature search, participated in data collection, extraction and interpretation, prepared tables and figures, performed the statistical analysis, wrote and drafted the initial manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. EV: participated in literature search, participated in data collection, extraction and interpretation, reviewed and revised the manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MA: participated in literature search, reviewed and revised the manuscript, approved the final manuscript as submitted, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MEF: participated in literature search, reviewed and revised the manuscript, approved the final manuscript as submitted, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CKR: assisted in designing parts of the study, performed the literature search, participated in data collection, extraction and interpretation, reviewed and revised the manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. INE: assisted in designing parts of the study, performed the literature search, participated in data collection, extraction and interpretation, reviewed and revised the manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PA: assisted in designing parts of the study, interpreted the data, prepared tables and figures, performed the statistical analysis, reviewed and revised the manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CIS: conceptualized and designed the study, interpreted the data, reviewed and revised the manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. EM: Mylonakis conceptualized and designed the study, interpreted the data, reviewed and revised the manuscript, approved the final manuscript as submitted and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Compliance with Ethical Standards
Conflict of interest
All authors [CAG, SK, EV, MA, MEF, CKR, INE, PA, EM] declare no competing interests
Funding
None.
Ethical approval and informed consent
N/A.
Supplementary material
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