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Taha SA, Westra JR, Tacker DH, Raji MA, Kuo YF. Trends in co-prescribed opioids and benzodiazepines, non-prescribed opioids and benzodiazepines, and schedule-I drugs in the United States, 2013 to 2019. Prev Med Rep 2024; 38:102584. [PMID: 38292029 PMCID: PMC10827545 DOI: 10.1016/j.pmedr.2023.102584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 08/22/2023] [Accepted: 12/27/2023] [Indexed: 02/01/2024] Open
Abstract
Concurrent opioid and benzodiazepine users are at increased risk of overdose death, compared to opioid-only users. The objective of this study was to understand recent time trends in opioid and benzodiazepine concurrent use, misuse, and schedule-I drug use, and how these differ by age, sex and geographic region. Commercial, United States medical insurance claims data and urine drug test results from 2013 to 2019 were used to study the outcomes of concurrent use (n = 756,258), schedule-I drug use (n = 746,672) and prescription misuse (n = 452,523). Drug use outcomes were studied at quarterly time points for each year. Data analysis included joinpoint regression models to estimate quarterly drug use rates, determined by positive urine tests for corresponding drug categories, and was conducted from November 2021 through January 2022. Concurrent use decreased from 19.3% to 9.8%, misuse generally decreased from 75.6% to 55.1%, and schedule-I use increased from 8.9% to 13.8%, from 2013 to 2019. Concurrent use decreased at greater rates after 2016, after the Centers for Disease Control and Food and Drug Administration guidelines against concurrent use were released, while schedule-I use increased, notably after the 2014 hydrocodone reschedule. This indicates a potential shift from prescription use to non-prescribed drug use, where most affected groups included males, younger individuals, and those residing in Northeastern regions. Study results support public health initiatives focused on policy that increases access to multimodal pain management and substance use disorder management programs-critical steps in preventing patients from seeking non-prescribed drugs for self- medicating due to pain or addiction.
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Affiliation(s)
- Shaden A. Taha
- Center for Metabolic Health, University of Texas Medical Branch, Galveston, TX, USA
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Jordan R. Westra
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
| | - Danyel H. Tacker
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University, WV, USA
| | - Mukaila A. Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
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Cicalese L, Westra JR, O'Connor CM, Kuo YF. Increased Risk of Malignancy with Immunosuppression: A Population-Based Analysis of Texas Medicare Beneficiaries. Cancers (Basel) 2023; 15:3144. [PMID: 37370754 DOI: 10.3390/cancers15123144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/03/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Immunosuppressive drugs (IMD) are widely utilized to treat many autoimmune conditions and to prevent rejection in organ transplantation. Cancer has been associated with prolonged use of IMD in transplant patients. However, no detailed, systematic analysis of the risk of cancer has been performed in patients receiving IMD for any condition and duration. We analyzed Medicare data from Texas Medicare beneficiaries, regardless of their age, between 2007 and 2018, from the Texas Cancer Registry. We analyzed the data for the risk of cancer after IMD use associated with demographic characteristics, clinical conditions, and subsequent cancer type. Of 29,196 patients who used IMD for a variety of indications, 5684 developed cancer. The risk of cancer (standardized incidence ratio) was particularly high for liver (9.10), skin (7.95), lymphoma (4.89), and kidney (4.39). Patients receiving IMD had a four fold greater likelihood of developing cancer than the general population. This risk was higher within the first 3 years of IMD utilization and in patients younger than 65 years and minorities. This study shows that patients receiving IMD for any indications have a significantly increased risk of cancer, even with short-term use. Caution is needed for IMD use; in addition, an aggressive neoplastic diagnostic screening is warranted.
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Affiliation(s)
- Luca Cicalese
- Division of Transplant Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Jordan R Westra
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX 77555, USA
- Department of Biostatistics & Data Science, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Casey M O'Connor
- Division of Transplant Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Yong-Fang Kuo
- Office of Biostatistics, University of Texas Medical Branch, Galveston, TX 77555, USA
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555, USA
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Yu X, Giordano TP, Baillargeon J, Westra JR, Berenson AB, Raji MA, Kuo YF. Assessing incident depression among older people with and without HIV in U.S. Soc Psychiatry Psychiatr Epidemiol 2023; 58:299-308. [PMID: 36334100 PMCID: PMC10176598 DOI: 10.1007/s00127-022-02375-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Despite substantially higher prevalence of depression among people living with HIV/AIDS (PLWHA), few data exist on the incidence and correlates of depression in this population. This study assessed the effect of HIV infection, age, and cohort period on the risk of developing depression by sex among older U.S. Medicare beneficiaries. METHODS We constructed a retrospective matched cohort using a 5% nationally representative sample of Medicare beneficiaries (1996-2015). People with newly diagnosed (n = 1309) and previously diagnosed (n = 1057) HIV were individually matched with up to three beneficiaries without HIV (n = 6805). Fine-Gray models adjusted for baseline covariates were used to assess the effect of HIV status on developing depression by sex strata. RESULTS PLWHA, especially females, had higher risk of developing depression within five years. The relative subdistribution hazards (sHR) for depression among three HIV exposure groups differed between males and females and indicated a marginally significant interaction (p = 0.08). The sHR (95% CI) for newly and previously diagnosed HIV (vs. people without HIV) were 1.6 (1.3, 1.9) and 1.9 (1.5, 2.4) for males, and 1.5 (1.2, 1.8) and 1.2 (0.9, 1.7) for females. The risk of depression increased with age [sHR 1.3 (1.1, 1.5), 80 + vs. 65-69] and cohort period [sHR 1.3 (1.1, 1.5), 2011-2015 vs. 1995-2000]. CONCLUSIONS HIV infection increased the risk of developing depression within 5 years, especially among people with newly diagnosed HIV and females. This risk increased with older age and in recent HIV epidemic periods, suggesting a need for robust mental health treatment in HIV primary care.
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Affiliation(s)
- Xiaoying Yu
- Department of Biostatistics & Data Science, The University of Texas Medical Branch at Galveston, 700 Harborside Drive, Ewing Hall, 1.134, Galveston, TX, USA.
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
| | - Thomas P Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Jacques Baillargeon
- Department of Epidemiology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Jordan R Westra
- Department of Biostatistics & Data Science, The University of Texas Medical Branch at Galveston, 700 Harborside Drive, Ewing Hall, 1.134, Galveston, TX, USA
| | - Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Mukaila A Raji
- Department of Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - Yong-Fang Kuo
- Department of Biostatistics & Data Science, The University of Texas Medical Branch at Galveston, 700 Harborside Drive, Ewing Hall, 1.134, Galveston, TX, USA
- Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
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Yu X, Baillargeon J, Berenson AB, Westra JR, Giordano TP, Kuo YF. Incident depression among Medicare beneficiaries with disabilities and HIV. AIDS 2022; 36:1295-1304. [PMID: 35608114 PMCID: PMC9283374 DOI: 10.1097/qad.0000000000003268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite disproportionally high prevalence of HIV and depression in persons with disabilities, no data have been published on the incidence and correlates of depression in Medicare beneficiaries with disabilities. We assessed the effect of HIV infection on developing depression in this population. DESIGN We conducted a retrospective matched cohort study using a 5% sample of Medicare beneficiaries who qualified for disability coverage (1996-2015). METHODS Beneficiaries with incident ( n = 2438) and prevalent ( n = 5758) HIV were individually matched with beneficiaries without HIV (HIV-, n = 20 778). Fine-Gray models with death as a competing risk were used to assess the effect of HIV status, age, and cohort period on developing depression by sex strata. RESULTS Beneficiaries with HIV had a higher risk of developing depression within 5 years ( P < 0.0001). Sex differences were observed ( P < 0.0001), with higher subdistribution hazard ratios (sHR) in males with HIV compared with controls. The risk decreased with age ( P < 0.0001) and increased in recent years ( P < 0.0001). There were significant age-HIV ( P = 0.004) and period-HIV ( P = 0.006) interactions among male individuals, but not female individuals. The sHR was also higher within the first year of follow-up among male individuals, especially those with incident HIV. CONCLUSION Medicare enrollees with disabilities and HIV had an increased risk of developing depression compared to those without HIV, especially among males and within the first year of HIV diagnosis. The HIV-depression association varied by sex, age, and cohort period. Our findings may help guide screening and comprehensive management of depression among subgroups in this vulnerable population.
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Affiliation(s)
- Xiaoying Yu
- Department of Preventive Medicine and Population Health
- Center for Interdisciplinary Research in Women's Health
| | | | - Abbey B Berenson
- Center for Interdisciplinary Research in Women's Health
- Department of Obstetrics & Gynecology, University of Texas Medical Branch at Galveston
| | | | - Thomas P Giordano
- Department of Medicine, Baylor College of Medicine
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health
- Center for Interdisciplinary Research in Women's Health
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Abstract
OBJECTIVE People with HIV infection experience excessive mortality compared with their noninfected counterparts. It is unclear whether the impact of HIV infection on mortality varies by comorbidities or whether sex difference exists in this relationship. This study assessed the effect of newly diagnosed HIV infection on overall mortality among Medicare beneficiaries for both disabled and older adults (≥65 years old) based on their original entitlement. METHODS We constructed a retrospective matched cohort using a 5% nationally representative sample of Medicare beneficiaries between 1996 and 2015. People with incident HIV diagnoses were individually matched to up to three controls based on demographics. Cox proportional hazards models adjusted for baseline demographics and comorbidities were used to assess the effect of HIV status on survival among four disabled groups by sex strata. Within each stratum, interactions between comorbidity variables and HIV status were examined. RESULTS People with HIV, especially older women, had a higher prevalence of baseline comorbidities than controls. HIV--mortality association varied according to sex in older adults (P = 0.004). Comorbidity--HIV interactions were more pronounced in disabled groups (P < 0.0001). People with HIV with more chronic conditions had a less pronounced increase in the risk of death than those with fewer conditions, compared with uninfected controls. CONCLUSION Medicare enrollees with newly diagnosed HIV had more prevalent baseline comorbidities and were at higher risk of death than people without HIV. HIV infection has a more pronounced effect among those with fewer comorbidities. Sex differences in HIV--mortality association exist among older Medicare enrollees.
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Affiliation(s)
- Xiaoying Yu
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Center for Interdisciplinary Research in Women’s Health, The University of Texas Medical Branch at Galveston, TX, USA
| | - Jordan R. Westra
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Thomas P. Giordano
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Abbey B. Berenson
- Center for Interdisciplinary Research in Women’s Health, The University of Texas Medical Branch at Galveston, TX, USA
- Department of Obstetrics & Gynecology, The University of Texas Medical Branch at Galveston, TX, USA
| | - Jacques G. Baillargeon
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Office of Biostatistics, Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, TX, USA
- Center for Interdisciplinary Research in Women’s Health, The University of Texas Medical Branch at Galveston, TX, USA
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Pritchard KT, Hong I, Goodwin JS, Westra JR, Kuo YF, Ottenbacher KJ. Association of Social Behaviors With Community Discharge in Patients with Total Hip and Knee Replacement. J Am Med Dir Assoc 2021; 22:1735-1743.e3. [PMID: 33041232 PMCID: PMC8026771 DOI: 10.1016/j.jamda.2020.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/07/2020] [Accepted: 08/18/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Understand the association between social determinants of health and community discharge after elective total joint arthroplasty. DESIGN Retrospective cohort design using Optum de-identified electronic health record dataset. SETTING AND PARTICIPANTS A total of 38 hospital networks and 18 non-network hospitals in the United States; 79,725 patients with total hip arthroplasty and 136,070 patients with total knee arthroplasty between 2011 and 2018. METHODS Logistic regression models were used to examine the association among pain, weight status, smoking status, alcohol use, substance disorder, and postsurgical community discharge, adjusted for patient demographics. RESULTS Mean ages for patients with hip and knee arthroplasty were 64.5 (SD 11.3) and 65.9 (SD 9.6) years; most patients were women (53.6%, 60.2%), respectively. The unadjusted community discharge rate was 82.8% after hip and 81.1% after knee arthroplasty. After adjusting for demographics, clinical factors, and behavioral factors, we found obesity [hip: odds ratio (OR) 0.81, 95% confidence interval (CI) 0.76-0.85; knee: OR 0.73, 95% CI 0.69-0.77], current smoking (hip: OR 0.82, 95% CI 0.77-0.88; knee: OR 0.90, 95% CI 0.85-0.95), and history of substance use disorder (hip: OR 0.55, 95% CI 0.50-0.60; knee: OR 0.57, 95% CI 0.53-0.62) were associated with lower odds of community discharge after hip and knee arthroplasty, respectively. CONCLUSIONS AND IMPLICATIONS Social determinants of health are associated with odds of community discharge after total hip and knee joint arthroplasty. Our findings demonstrate the value of using electronic health record data to analyze more granular patient factors associated with patient discharge location after total joint arthroplasty. Although bundled payment is increasing community discharge rates, post-acute care facilities must be prepared to manage more complex patients because odds of community discharge are diminished in those who are obese, smoking, or have a history of substance use disorder.
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Affiliation(s)
- Kevin T Pritchard
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA
| | - Ickpyo Hong
- Department of Occupational Therapy, Yonsei University, Wonju-si, South Korea.
| | - James S Goodwin
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA; Department of Internal Medicine, School of Medicine, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
| | - Jordan R Westra
- Department of Preventive Medicine and Population Health, School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Department of Preventive Medicine and Population Health, School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Kenneth J Ottenbacher
- Division of Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA
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Taha SA, Westra JR, Raji MA, Kuo YF. Trends in Urine Drug Testing Among Long-term Opioid Users, 2012-2018. Am J Prev Med 2021; 60:546-551. [PMID: 33288392 PMCID: PMC8017600 DOI: 10.1016/j.amepre.2020.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Long-term opioid therapy increases the risk of opioid overdose death. Government agencies and medical societies, including the Center for Disease Control and Prevention and the American Society for Clinical Oncology, emphasized risk mitigation strategies, including urine drug testing, in published guidelines. Urine drug testing rates, time trends, and covariates among long-term opioid therapy users were examined to gauge guideline adherence. METHODS Using Optum's De-identified Clinformatics DataMart, an incidence cohort (n=28,790) and prevalence cohort (n=621,449) were created to measure baseline and annual urine drug testing, respectively, from 2012 to 2018. Urine drug testing time trends were evaluated by demographics, pain conditions, and Elixhauser comorbidity index. A multivariable generalized estimating model was developed in 2020 to examine the factors associated with urine drug testing. RESULTS Annual urine drug testing rates doubled from 25.6% in 2012 to 52.2% in 2018, whereas baseline urine drug testing also increased from 3.75% to 11.1%. Annual urine drug testing increased within each age group over time; however, older patients (OR=0.21, 95% CI=0.21, 0.22, aged >79 years) and patients with cancer (OR=0.82, 95% CI=0.80, 0.84) were less likely to receive urine drug testing. Patients residing in the South (OR=1.99, 95% CI=1.96, 2.01) and those with back pain (OR=2.04, 95% CI=2.02, 2.06) or with other chronic pain (OR=1.64, 95% CI=1.62, 1.66) were significantly more likely to be tested. Independent predictors of baseline urine drug testing were similar to predictors of annual urine drug testing. CONCLUSIONS Despite increasing urine drug testing trends from 2012 to 2018, annual and baseline urine drug testing remained low in 2018, relative to numerous guideline recommendations. Findings suggest a need for research on better guideline implementation strategies and the effectiveness of urine drug testing on patient outcomes.
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Affiliation(s)
- Shaden A Taha
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas; Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas.
| | - Jordan R Westra
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas; Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas
| | - Mukaila A Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
| | - Yong F Kuo
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Galveston, Texas; Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas; Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas; Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas
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Hong I, Westra JR, Goodwin JS, Karmarkar A, Kuo YF, Ottenbacher KJ. Association of Pain on Hospital Discharge with the Risk of 30-Day Readmission in Patients with Total Hip and Knee Replacement. J Arthroplasty 2020; 35:3528-3534.e2. [PMID: 32712118 PMCID: PMC7669554 DOI: 10.1016/j.arth.2020.06.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND It is not clear if there is a risk of 30-day readmissions following total hip and knee arthroplasty in patients reporting high levels of pain at hospital discharge. We examined the relationship between post-surgical pain on the day of discharge and 30-day readmission in patients who received total knee and hip arthroplasty. METHODS Retrospective cohort study was conducted of patients who received total knee (n = 155,284) or hip arthroplasty (n = 89,283) from 2011 to 2018 using electronic health records from the Optum database. Four categories of pain at discharge were created, from none to severe. Multivariate logistic regression models to predict 30-day all-cause readmission were adjusted for patient and clinical characteristics and built separately for knee and hip arthroplasty patients. RESULTS Mean ages for hip and knee patients were 64.4 (standard deviation 11.3) and 65.7 (standard deviation 9.7) years, respectively. The majority of patients were female (hip: 54.4%; knee: 61.5%). The unadjusted rate of 30-day readmission was 3.54% for hip replacement and 3.66% for knee replacement. In models adjusted for patient and clinical characteristics, for patients with total hip replacement, the odds of 30-day readmission for those with severe pain score at discharge vs those with no pain at discharge were 1.60 (95% confidence interval 1.33-1.92). Similarly, readmission likelihood increased as pain at discharge increased (severe pain vs no pain) for patients with total knee arthroplasty (odds ratio 1.38, 95% confidence interval 1.19-1.59). CONCLUSION Our findings demonstrated that the pain scores on the day of discharge are associated with 30-day hospital readmission.
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Affiliation(s)
- Ickpyo Hong
- Department of Occupational Therapy, Yonsei University, School of Health Sciences, Wonju, Republic of Korea
| | - Jordan R. Westra
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch, School of Medicine, Galveston, TX
| | - James S. Goodwin
- Department of Internal Medicine, Sealy Center on Aging, University of Texas Medical Branch, School of Medicine, Galveston, TX
| | - Amol Karmarkar
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, VA
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Population Health, Sealy Center on Aging, University of Texas Medical Branch, School of Medicine, Galveston, TX
| | - Kenneth J. Ottenbacher
- Division of Rehabilitation Sciences, Sealy Center on Aging, University of Texas Medical Branch, School of Health Professions, Galveston, TX
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Baillargeon J, Urban RJ, Raji MA, Westra JR, Williams SB, Lopez DS, Kuo YF. Testosterone Prescribing Among Women in the USA, 2002-2017. J Gen Intern Med 2020; 35:1891-1893. [PMID: 31637649 PMCID: PMC7280376 DOI: 10.1007/s11606-019-05365-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/13/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Jacques Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA.
| | - Randall J Urban
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, USA
| | - Mukaila A Raji
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, USA
| | - Jordan R Westra
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Stephen B Williams
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, USA.,Division of Urology, University of Texas Medical Branch, Galveston, TX, USA
| | - David S Lopez
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA
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Baillargeon J, Raji MA, Urban RJ, Lopez DS, Williams SB, Westra JR, Kuo YF. Opioid-Induced Hypogonadism in the United States. Mayo Clin Proc Innov Qual Outcomes 2019; 3:276-284. [PMID: 31485565 PMCID: PMC6713891 DOI: 10.1016/j.mayocpiqo.2019.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/07/2019] [Accepted: 06/26/2019] [Indexed: 01/09/2023] Open
Abstract
Objective To examine the incidence of screening, diagnosis, and treatment of hypogonadism among men treated with opioids in the United States. Patients and Methods Using one of the nation's largest commercial insurance databases, we identified 53,888 men aged 20 years or older who had 90 or more days of opioid prescriptions in a single 12-month period between January 1, 2010, and December 31, 2017, with no history of hypogonadism or testosterone therapy in the preceding 12 months. We matched this cohort to 53,888 men with 14 or fewer days of opioid prescriptions based on age, opioid initiation date, opioid indication, and comparable exclusion criteria. We assessed whether men, 14 or fewer days after initiation of opioid treatment, received a serum testosterone test, a diagnosis of hypogonadism, or a prescription for testosterone therapy. All men were followed up until they lost coverage from the commercial insurance plan, experienced one of the study outcomes, or the end of study (December 31, 2017). Results In the multivariable analyses-adjusting for age, year of opioid initiation, region, comorbid disease, glucocorticoid use, and health care utilization-the 53,888 prolonged opioid users, in comparison with 53,888 short-term users, had an increased incidence of serum testosterone screening (5991 [17.15%; 95% CI, 16.70%-17.61%] vs 3514 [11.55%; 95% CI, 11.11%-12.01%] at 5 years; hazard ratio [HR], 1.46; 95% CI, 1.38-1.55), hypogonadism diagnosis (3125 [9.44%; 95% CI, 9.09%-9.80%] vs 1421 [4.85%; 95% CI, 4.55%-5.16%; HR, 1.74; 95% CI, 1.60-1.90]), and receipt of testosterone therapy (1919 [5.76%; 95% CI, 5.49%-6.05%] vs 631 [2.21%; 95% CI, 2.04%-2.43%; HR, 2.41; 95% CI, 2.13-2.74]). Each of these findings persisted across multiple sensitivity analyses. Conclusion Prolonged opioid exposure was associated with increased rates of screening, diagnosis, and treatment for opioid-induced hypogonadism, but these rates were much lower than expected based on previous serum-based studies.
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Affiliation(s)
- Jacques Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston.,Sealy Center on Aging, University of Texas Medical Branch, Galveston
| | - Mukaila A Raji
- Sealy Center on Aging, University of Texas Medical Branch, Galveston.,Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - Randall J Urban
- Sealy Center on Aging, University of Texas Medical Branch, Galveston.,Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - David S Lopez
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
| | - Stephen B Williams
- Sealy Center on Aging, University of Texas Medical Branch, Galveston.,Department of Surgery, Division of Urology, University of Texas Medical Branch, Galveston
| | - Jordan R Westra
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston.,Sealy Center on Aging, University of Texas Medical Branch, Galveston
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11
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Raji MA, Abara NO, Salameh H, Westra JR, Kuo YF. Association between cannabis laws and opioid prescriptions among privately insured adults in the US. Prev Med 2019; 125:62-68. [PMID: 31125629 PMCID: PMC6582995 DOI: 10.1016/j.ypmed.2019.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 04/23/2019] [Accepted: 05/20/2019] [Indexed: 11/27/2022]
Abstract
We examine the association between opioid prescription patterns in privately insured adults and changes in state cannabis laws among five age groups (18-25, 26-35 36-45, 46-55 and 56-64 years). Using the 2016 Clinformatics Data Mart, a nationwide commercial health insurance database, we performed a cross-sectional analysis of two types of opioid prescribing (>30-day and >90-day prescriptions) among all adults aged 18-64 based on the stringency of cannabis laws. We found a significant interaction between age and cannabis law on opioid prescriptions. Age-stratified multilevel multivariable analyses showed lower opioid prescription rates in the four younger age groups only in states with medical cannabis laws, when considering both >30 day and >90 day opioid use [>30 day adjusted odds ratio (aOR) = 0.56, in 18-25, aOR = 0.67 in 26-35, aOR = 0.67 in 36-45, and aOR = 0.76 in 46-54 years; >90 day aOR = 0.56, in 18-25, aOR = 0.68 in 26-35, aOR = 0.69 in 36-45, and aOR = 0.77 in 46-54 years, P < 0.0001 for all]. This association was not significant in the oldest age group of 55-64 years. There was no significant association between opioid prescriptions and other categories of cannabis laws (recreational use and decriminalization) in any of the age groups studied.
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Affiliation(s)
- Mukaila A Raji
- Department of Internal Medicine, Division of Geriatrics, University of Texas Medical Branch, Galveston, TX 77555-0177, United States of America; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555-0177, United States of America.
| | - N Ogechi Abara
- Department of Internal Medicine, Division of Geriatrics, University of Texas Medical Branch, Galveston, TX 77555-0177, United States of America
| | - Habeeb Salameh
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Jordan R Westra
- Office of Biostatistics, Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555-1148, United States of America
| | - Yong-Fang Kuo
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX 77555-0177, United States of America; Office of Biostatistics, Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX 77555-1148, United States of America
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12
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Raji MA, Westra JR, Kuo YF. Pain Clinic Laws and Prescription-Opioid Toxicity Among Texas Medicare Enrollees. J Pharm Technol 2018; 34:233-234. [DOI: 10.1177/8755122518778091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Yong-Fang Kuo
- University of Texas Medical Branch, Galveston, TX, USA
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13
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Abstract
This study uses commercial claims database data to characterize trends in testosterone prescribing in the United States from 2002 to 2016.
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Affiliation(s)
- Jacques Baillargeon
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
| | - Yong-Fang Kuo
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
| | - Jordan R. Westra
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston
| | - Randall J. Urban
- Department of Internal Medicine, University of Texas Medical Branch, Galveston
| | - James S. Goodwin
- Department of Internal Medicine, University of Texas Medical Branch, Galveston
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