Abstract: FR-OR119
Geographic and Environmental Inequities and the Prescription Opioid Epidemic among Elderly CKD Patients in the United States
Session Information
- Towards Better Medication Usage in Patients with CKD
October 26, 2018 | Location: 26A, San Diego Convention Center
Abstract Time: 05:54 PM - 06:06 PM
Category: CKD (Non-Dialysis)
- 1902 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Han, Yun, Kidney Epidemiology and Cost Center, University of Michgian, Ann Arbor, Michigan, United States
- He, Kevin, Kidney Epidemiology and Cost Center, University of Michgian, Ann Arbor, Michigan, United States
- Kang, Jian, University of Michigan, Ann Arbor, Michigan, United States
- Bragg-Gresham, Jennifer L., University of Michigan, Ann Arbor, Michigan, United States
- Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
Background
CKD patients are vulnerable to opioid abuse due to high burden and suboptimal management of pain. We assessed geographic variation and the impact of environmental factors on long-term opioid use in elderly CKD patients.
Methods
We used a linked dataset from Medicare 5% sample claims data (2006-09), the American Community Survey Data (2005-09) and the Health Resources and Services Administration (HRSA) Primary Care Service Area (PCSA) data (2007). Medicare Part D enrollees age ≥65 years were included. County-level long-term opioid use was measured as % patients prescribed opioids for more than 90 days during a 1-year period after CKD diagnosis. County-level environmental factors included % of general physicians, elderly, population residing in Medically Underserved Areas (MUAs) and area deprivation index. A mixture model separating counties into different risk categories with subgroup analysis, was applied to investigate the relationship between environmental factors and county-level long-term opioid use.
Results
: The mixture model (Fig) clustered counties (n=1,794) into 4 risk subgroups. The average proportion of long-term opioid use of subgroups, which corresponded to mild, moderate, severe and very severe long-term opioid use were 3.0%, 5.3%, 13.0% and 31.2%. Counties in the Northeast and Midwest were more likely in mild and moderate risk groups, while the West andSouth counties were more likely in the severe and very severe group. Counties with aging adults and higher deprivation index were associated with greater long-term opioid use. Counties in MUAs were most likely in the very severe group.
Conclusion
Several environmental factors are associated with long-term prescription opioid use among elderly patients with CKD. This association varied across counties, highlighting the importance of allocating resources for this epidemic at county level.
Funding
- NIDDK Support