A new study shows that prescribing of opioid pain medications for non-elderly Americans on disability is “significantly” related to county-level economic factors, such as unemployment and income levels.
According to the study, published in Medical Care, about half of Medicare beneficiaries under age 65 received an opioid prescription in 2014.
Researcher Chao Zhou, Ph.D., and colleagues at the Centers for Disease Control and Prevention found that opioid prescribing for disabled adults is higher outside of “large central metro” counties, even after accounting for local economic factors.
The researchers analyzed data on nearly 3.5 million adults younger than 65 who were medically disabled, without cancer, without end stage renal disease, not receiving hospice care, and receiving Medicare Part D (prescription drug) benefits for at least 12 months in 2014.
Most Medicare beneficiaries under age 65 are Social Security Disability Insurance (SSDI) recipients, the researchers noted.
The researchers analyzed measures of opioid prescribing by county, including demographic and geographic variations. They also looked at how local economic factors, such as household income, unemployment rate, and income inequality, affected opioid prescribing.
About half of the study population (49 percent) had at least one opioid prescription during 2014. More than one-fourth (28 percent) were long-term opioid users, with six or more prescriptions.
The proportions of opioid prescriptions were higher for women than men; for White and Native American beneficiaries compared to other racial/ethnic groups; and for patients between the ages of 55 and 64 compared to younger groups, the study found.
Analysis of county-level differences showed more than just an urban/rural divide, according to the researchers.
“Large central metro” counties (inner-city) had lower opioid prescribing than all other classifications, including “large fringe metro” (suburbs), “micropolitan” (small cities), and “noncore” (rural) areas, according to the study’s findings.
“Large central metro areas were different from the rest of categories,” the researchers wrote in the study. “Large fringe metro areas were similar to rural counties.”
Areas of more intensive opioid prescribing in the South, Southwest, and Midwest closely overlapped with “regions of economic hardship,” the study discovered.
Confirming those associations, opioid prescribing was higher in counties with lower median household income and higher unemployment, the researchers noted.
Income inequality was also a significant factor, although the relationship was the opposite of expected: Counties with higher income inequality had lower measures of opioid use.
“The metro/non-metro pattern of opioid prescribing was different from that of other health indicators, such as smoking, cerebrovascular disease (stroke), and mortality,” Zhou said.
The researchers say further studies are needed to identify the “distinctive mechanism” explaining the higher opioid prescribing outside of urban areas.
Research is also needed to clarify the negative association with income inequality, they add. The researchers suggest that low income inequality might be linked to other factors, such as economic conditions or differences in medical practice, that lead to higher opioid prescribing.
“The opioid epidemic is part of a larger challenge primarily faced by white rural working-class Americans,” Zhou said, adding the new findings add to previous evidence that disabled persons in the SSDI program are “a particularly vulnerable segment of this demographic.”
Zhou added that he believes investment in economically depressed areas might be a helpful part of comprehensive approaches to battling the opioid crisis.
Source: Wolters Kluwer Health