Nationally, there is a sharp increase in older adults with opioid use disorder (OUD). However, we know little of the acute healthcare utilization patterns and medical comorbidities among this population.
This study describes the prevalence of chronic conditions, patterns of inpatient utilization, and correlates of high inpatient utilization among older adults with OUD in New York City (NYC).
Retrospective longitudinal cohort study.
Patients aged ≥55 with OUD hospitalized in NYC in 2012 identified using data from New York State’s Statewide Planning and Research Cooperative System (SPARCS).
The prevalence of comorbid substance use diagnoses, chronic medical disease, and mental illness was measured using admission diagnoses from the index hospitalization. We calculated the ICD-Coded Multimorbidity-Weighted Index (MWI-ICD) for each patient to measure multimorbidity. We followed the cohort through September 30, 2015 and the outcome was the number of rehospitalizations for inpatient services in NYC. We compared patient-level factors between patients with the highest use of inpatient services (≥7 rehospitalizations) during the study period to low utilizers. We used multiple logistic regression to examine possible correlates of high inpatient utilization.
Of 3669 adults aged ≥55 with OUD with a hospitalization in 2012, 76.4% (n=2803) had a subsequent hospitalization and accounted for a total of 22,801 rehospitalizations during the study period. A total of 24.7% of the cohort (n=906) were considered high utilizers and had a higher prevalence of alcohol and cocaine-related diagnoses, congestive heart failure, diabetes, schizophrenia, and chronic obstructive pulmonary disease. Multivariable predictors of high utilization included being a Medicaid beneficiary (adjusted odds ratio [aOR]=1.70, 95% confidence interval [CI]=1.37–2.11), alcohol-related diagnoses (aOR=1.43, 95% CI: 1.21–1.69), and increasing comorbidity measured by MWI-ICD (highest MWI-ICD quartile: aOR=1.98, 95% CI=1.59–2.48).
Among older adults with OUD admitted to the hospital, multimorbidity is strongly associated with high inpatient utilization.
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Han BH, Moore AA. Prevention and Screening of Unhealthy Substance Use by Older Adults. Clinics in Geriatric Medicine. 2018;34(1):117-129.
Arndt S, Clayton R, Schultz SK. Trends in substance abuse treatment 1998-2008: increasing older adult first-time admissions for illicit drugs. Am J Geriatr Psychiatry. 2011;19(8):704-11.
Huhn AS, Strain EC, Tompkins DA, Dunn KE. A hidden aspect of the U.S. opioid crisis: Rise in first-time treatment admissions for older adults with opioid use disorder. Drug Alcohol Depend. 2018;193:142–147.
Han B, Polydorou S, Ferris R, Blaum CS, Ross S, McNeely J. Demographic trends of adults in new York City opioid treatment programs-an aging population. Subst Use Misuse. 2015;50(13):1660–1667.
Lintzeris N., Rivas C., Monds L. A., Leung S., Withall A., Draper B. Substance use, health status and service utilization of older clients attending specialist drug and alcohol services: older drug and alcohol clients. Drug Alcohol Rev 2016; 35: 223– 231.
Rosen D, Hunsaker A, Albert S, et al. Characteristics and consequences of heroin use among older adults in the United States: A review of the literature, treatment implications, and recommendations for further research. Addict Behav. 2011;36:279-285.
Zullo AR, Moyo P, Jutkowitz E, Zhang W, Thomas KS. Opioid Use Disorder Among Hospitalized Older Adults: Prevalence, Characteristics, and Discharge Status. J Am Med Dir Assoc. 2020;21(4):557-559.
Szekendi MK, Williams MV, Carrier D, Hensley L, Thomas S, Cerese J. The characteristics of patients frequently admitted to academic medical centers in the United States. J Hosp Med 2015;10:563–8.
Smith GM, Cenzer IS, Covinsky K, Reuben DB, Smith AK. Who Becomes a High Utilizer? A Case-Control Study of Older Adults in the USA. J Gen Intern Med. 2020;35(2):596-598.
Peterson C, Xu L, Florence C, Mack KA. Opioid-related US hospital discharges by type, 1993–2016. Journal of Substance Abuse Treatment. 2019;103:9-13.
Fingar KR, Skinner H, Johann J, Coenen N, Freeman WJ, Heslin KC. Geographic Variation in Substance-Related Inpatient Stays Across States and Counties in the United States, 2013-2015. HCUP Statistical Brief #245. November 2018. Agency for Healthcare Research and Quality, Rockville, MD. Available from: www.hcup-us.ahrq.gov/reports/statbriefs/sb244-Opioid-Inpatient-Stays-ED-Visits-Older-Adults.pdf. Accessed January 31, 2021.
Han BH, Ko R, Palamar JJ. Substance Use by Adults with Medical Multimorbidity in the United States, 2015–2016. J Gen Intern Med. 2019;34(8):1394-1396.
New York State Department of Health. Statewide Planning and Research Cooperative System (SPARCS). https://www.health.ny.gov/statistics/sparcs/ Accessed July 31, 2021.
Heslin KC, Owens PL, Karaca Z, et al. Trends in opioid-related inpatient stays shifted after the US transitioned to ICD-10-CM diagnosis coding in 2015. Med Care. 2017;55:918-923.
Moreno JL, Wakeman SE, Duprey MS, Roberts RJ, Jacobson JS, Devlin JW. Predictors for 30- Day and 90-Day Hospital Readmission Among Patients With Opioid Use Disorder: Journal of Addiction Medicine. 2019;13(4):306-313.
Barocas JA, Morgan JR, Wang J, McLoone D, Wurcel A, Stein MD. Outcomes Associated with Medications for Opioid Use Disorder Among Persons Hospitalized for Infective Endocarditis [published online ahead of print, 2020 Jan 21]. Clin Infect Dis. 2020;72(3):472-478. doi:https://doi.org/10.1093/cid/ciaa062
Singh JA, Cleveland JD. National U.S. time-trends in opioid use disorder hospitalizations and associated healthcare utilization and mortality. PLoS One. 2020;15(2):e0229174.
United States Census Bureau, 2001. Census 2000 Summary File 1: New York. United States Department of Commerce, Washington DC.
Wei MY, Kabeto MU, Langa KM, Mukamal KJ. Multimorbidity and physical and cognitive function: performance of a new multimorbidity-weighted index. J Gerontol A Biol Sci Med Sci. 2018;73:225-232.
Wei MY, Ratz D, Mukamal KJ. Multimorbidity in Medicare Beneficiaries: Performance of an ICD-Coded Multimorbidity-Weighted Index. J Am Geriatr Soc. 2020;68(5):999-1006.
Wammes, J., van der Wees, P. J., Tanke, M., Westert, G. P., & Jeurissen, P. (2018). Systematic review of high-cost patients' characteristics and healthcare utilisation. BMJ open, 8(9), e023113.
Guilcher SJTT, Bronskill SE, Guan J, Wodchis WP. Who are the high-cost users? A method for person-centred attribution of health care spending. PLoS One. 2016;11:1–15.
Hunter G, Yoon J, Blonigen DM, Asch SM, Zulman DM. Health care utilization patterns among high-cost VA patients with mental health conditions. Psychiatr Serv. 2015;66:952–8.
Fareed A, Casarella J, Amar R, Vayalapalli S, Drexler K. Benefits of retention in methadone maintenance and chronic medical conditions as risk factors for premature death among older heroin addicts. J Psychiatr Pract. 2009;15:227–234.
Maruyama A, Macdonald S, Borycki E, Zhao J. Hypertension, chronic obstructive pulmonary disease, diabetes and depression among older methadone maintenance patients in British Columbia. Drug Alcohol Rev. 2013;32:412–418.
Rosen D, Smith ML, Reynolds CF3. The prevalence of mental and physical health disorders among older methadone patients. Am J Geriatr Psychiatry. 2008;16:488–497.
Podulka J, Barrett M, Jiang HJ, et al. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD): 2012. 30-Day Readmissions following Hospitalizations for Chronic vs. Acute Conditions, 2008: Statistical Brief #127.
Wei MY, Mukamal KJ. Multimorbidity and Mental Health-Related Quality of Life and Risk of Completed Suicide. J Am Geriatr Soc. 2019;67(3):511-519. doi:https://doi.org/10.1111/jgs.15678
Fingar KR, Barrett ML, Jiang HJ. A Comparison of All-Cause 7-Day and 30-Day Readmissions, 2014: Statistical Brief #230. 2017 Oct. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US). https://www.ncbi.nlm.nih.gov/books/NBK487973 Accessed January 31, 2021.
Boyd C.M., Fortin M. Future of multimorbidity research: how should understanding of multimorbidity inform health system design? Public Health Rev. 2010;32:451–474.
Herman M, Gourevitch MN. Integrating primary care and methadone maintenance treatment: implementation issues. J Addict Dis. 1997;16(1): 91-102.
Park TW, Cheng DM, Samet JH, Winter MR, Saitz R. Chronic care management for substance dependence in primary care among patients with co-occurring disorders. Psychiatr Serv. 2015;66(1):72–79.
Hunt GE, Siegfried N, Morley K, Sitharthan T, Cleary M. Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev. 2013;10:CD001088.
Perry AE, Neilson M, Martyn-St James M, et al. Interventions for drug-using offenders with co-occurring mental illness. Cochrane Database Syst Rev. 2015;6:CD010901.
Conroy SP, Stevens T, Parker SG, et al. A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: 'interface geriatrics'. Age and Ageing. 2011;40:436-443.
Reuben DB, Roth C, Kamberg C, et al. Restructuring primary care practices to manage geriatric syndromes: the ACOVE-2 intervention. J Am Geriatr Soc. 2003; 51:1787–1793.
Totten A, Carson S, Peterson K, et al. Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care. 2012 Jun. In: VA Evidence-based Synthesis Program Evidence Briefs [Internet]. Washington (DC): Department of Veterans Affairs (US); 2011. Available from: http://www.ncbi.nlm.nih.gov/books/NBK98020/
Fisher MA, Ma ZQ. Medicaid-insured and uninsured were more likely to have diabetes emergency/urgent admissions. Am J Manag Care. 2015;21(5):e312-e319.
Bharel M, Lin W-C, Zhang J, O’Connell E, Taube R, Clark RE. Health Care Utilization Patterns of Homeless Individuals in Boston: Preparing for Medicaid Expansion Under the Affordable Care Act. American Journal of Public Health. 2013;103(S2):S311-S317.
Doran KM, Ragins KT, Iacomacci AL, Cunningham A, Jubanyik KJ, Jenq GY. The revolving hospital door: hospital readmissions among patients who are homeless. Med Care. 2013;51(9):767-773.
Wakeman SE, Larochelle MR, Ameli O, et al. Comparative effectiveness of different treatment pathways for opioid use disorder. JAMA Netw Open. 2020;3(2):e1920622.
This research is funded by the following grants from the National Institute of Health: K23DA043651 (Han) from the National Institute on Drug Abuse and K23AG056638 (Wei) from the National Institute on Aging. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Han, B.H., Tuazon, E., Y Wei, M. et al. Multimorbidity and Inpatient Utilization Among Older Adults with Opioid Use Disorder in New York City. J GEN INTERN MED (2021). https://doi.org/10.1007/s11606-021-07130-8
- opioid use disorder