Dataset Information

Opioid prescription and diabetes among Medicare beneficiaries.

ABSTRACT:

Aims

To determine the prevalence of opioid prescriptions among U.S. Medicare beneficiaries by diabetes status, and predictors of opioid prescription among those with diabetes.

Methods

This retrospective study used claims data from the Centers for Medicare and Medicaid Services among beneficiaries age ≥ 65 years who were continuously enrolled in Part A, Part B, and Part D Medicare between 2017 and 2019 (N = 709,374). Logistic regression was used to determine the odds of opioid prescription among those with vs without diabetes; and, among those with diabetes, significant predictors of opioid prescription.

Results

Overall, the prevalence of any opioid prescription was 30.8 % among persons with diabetes and 24.2 % in those without diabetes (p < 0.001); chronic use was 8.0 % and 7.4 %, respectively (p < 0.001). Those with diabetes had a 45 % higher odds of having an opioid prescription compared to those without diabetes after adjusting for sociodemographic characteristics (OR = 1.45, 1.44-1.47). After adjustment for comorbidities/complications, the association reversed (OR = 0.83, 0.82-0.84). Persons with diabetes who had hypertension, obesity, CVD, neuropathy, amputation, liver disease, COPD, cancer, osteoporosis, depression, or alcohol/drug abuse had a 20 %-140 % higher odds of opioid prescription compared to those without these conditions.

Conclusions

Comorbidities and complications accounted for the higher odds of opioid prescriptions among those with diabetes.

SUBMITTER: Casagrande SS

PROVIDER: S-EPMC9974602 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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Publications

Opioid prescription and diabetes among Medicare beneficiaries.

Casagrande Sarah S SS Beccera Adan Z AZ Rust Keith F KF Cowie Catherine C CC

Diabetes research and clinical practice 20230104

<h4>Aims</h4>To determine the prevalence of opioid prescriptions among U.S. Medicare beneficiaries by diabetes status, and predictors of opioid prescription among those with diabetes.<h4>Methods</h4>This retrospective study used claims data from the Centers for Medicare and Medicaid Services among beneficiaries age ≥ 65 years who were continuously enrolled in Part A, Part B, and Part D Medicare between 2017 and 2019 (N = 709,374). Logistic regression was used to determine the odds of opioid pres ...[more]

PMID: 36610545

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Project description:The objective is to estimate the take-up of the Medicare Part D Low-Income Subsidy (LIS) among Medicare beneficiaries with diabetes and examine differences in out-of-pocket costs and prescription drug use between LIS enrollees and LIS-eligible non-enrollees. The LIS reduces out-of-pocket drug costs for low-income beneficiaries; however, not all LIS-eligible individuals are enrolled. Take-up of the LIS, and consequences of forgoing this benefit among beneficiaries with diabetes, remains unknown. Health and Retirement Study linked to Medicare administrative data from 2008 to 2016. We conducted two analyses among beneficiaries with diabetes. First, we estimated LIS take-up stratified by income (≤100% of the Federal Poverty Level [FPL] and >100% to ≤150% of FPL). Second, to assess the consequences of forgoing the LIS among near-poor beneficiaries (incomes >100% to ≤150% of FPL), we conducted propensity score-weighted regression analyses to compare out-of-pocket costs, the prescription drug use, and cost-related medication non-adherence among LIS enrollees and LIS-eligible non-enrollees. N/A. Among Medicare beneficiaries with diabetes, 68.1% of those with incomes >100% to ≤150% of FPL received the LIS, while 90.3% with incomes ≤100% of FPL received the LIS. Among near-poor beneficiaries, LIS-eligible non-enrollees incurred higher annual out-of-pocket drug spending ($518; 95 [in USD]% CI: $370 [in USD], $667 [in USD]; p < 0.001), filled 7.3 fewer prescriptions for diabetes, hypertension, and hyperlipidemia drugs (95% CI: -11.1, -3.5; p < 0.001), and were 8.9 percentage points more likely to report skipping drugs due to cost (95% CI: 0.3, 18.0; p = 0.04), all compared to LIS enrollees. Despite providing substantial financial assistance with prescription drug costs, the LIS is under-utilized among beneficiaries with chronic conditions requiring routine medication use. As policy makers discuss Part D reforms to address rising out-of-pocket drug costs, they should consider strategies to increase participation in existing programs that alleviate cost burdens among low-income Medicare beneficiaries.

Project description:BackgroundDespite the rising number of older adults with medical encounters for opioid misuse, dependence, and poisoning, little is known about patterns of prescription opioid dose and their association with risk for opioid-related adverse events (ORAEs) in older patients. The study aims to compare trajectories of prescribed opioid doses in 6 months preceding an incident ORAE for cases and a matched control group of older patients with chronic noncancer pain (CNCP).Methods and findingsWe conducted a nested case-control study within a cohort of older (≥65 years) patients diagnosed with CNCP who were new users of prescription opioids, assembled using a 5% national random sample of Medicare beneficiaries from 2011 to 2018. From the cohort with a mean follow-up of 2.3 years, we identified 3,103 incident ORAE cases with ≥1 opioid prescription in 6 months preceding the event, and 3,103 controls matched on sex, age, and time since opioid initiation. Key exposure was trajectories of prescribed opioid morphine milligram equivalent (MME) daily dosage over 6 months before the incident ORAE or matched controls. Among the cases and controls, 2,192 (70.6%) were women, and the mean (SD) age was 77.1 (7.1) years. Four prescribed opioid trajectories before the incident ORAE diagnosis or matched date emerged: gradual dose discontinuation (from ≤3 to 0 daily MME, 1,456 [23.5%]), gradual dose increase (from 0 to >3 daily MME, 1,878 [30.3%]), consistent low dose (between 3 and 5 daily MME, 1,510 [24.3%]), and consistent moderate dose (>20 daily MME, 1,362 [22.0%]). Few older patients (<5%) were prescribed a mean daily dose of ≥90 daily MME during 6 months before diagnosis or matched date. Patients with gradual dose discontinuation versus those with a consistent low dose, moderate dose, and increase dose were more likely to be younger (65 to 74 years), Midwest US residents, and receiving no low-income subsidy. Compared to patients with gradual dose discontinuation, those with gradual dose increase (adjusted odds ratio [aOR] = 3.4; 95% confidence interval (CI) 2.8 to 4.0; P < 0.001), consistent low dose (aOR = 3.8; 95% CI 3.2 to 4.6; P < 0.001), and consistent moderate dose (aOR = 8.5; 95% CI 6.8 to 10.7; P < 0.001) had a higher risk of ORAE, after adjustment for covariates. Our main findings remained robust in the sensitivity analysis using a cohort study with inverse probability of treatment weighting analyses. Major limitations include the limited generalizability of the study findings and lack of information on illicit opioid use, which prevents understanding the clinical dose threshold level that increases the risk of ORAE in older adults.ConclusionsIn this sample of older patients who are Medicare beneficiaries, 4 prescription opioid dose trajectories were identified, with most prescribed doses below 90 daily MME within 6 months before ORAE or matched date. An increased risk for ORAE was observed among older patients with a gradual increase in dose or among those with a consistent low-to-moderate dose of prescribed opioids when compared to patients with opioid dose discontinuation. Whether older patients are susceptible to low opioid doses warrants further investigations.

Dataset Information

Opioid prescription and diabetes among Medicare beneficiaries.

Aims

Methods

Results

Conclusions

Publications

Opioid prescription and diabetes among Medicare beneficiaries.

Similar Datasets

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