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  • Study: Among Individuals Who Qualify for Medicare Due to Disability, Opioid Overdose Deaths Nearly 5 Times Higher Than Total US Rate

    In this review: Association of Disability With Mortality From Opioid Overdose Among US Medicare
    (JAMA Network Open, November 15, 2019)

    The message
    While Medicare beneficiaries who qualify for Medicare because of disability account for one quarter of all deaths from prescription opioid overdose annually, not much research has focused on the relationship between various combinations of conditions in this population and their correlations to overdose mortality. It's a connection that authors of a recent study believe is essential to developing successful evidence-based interventions addressing Medicare enrollees with disabilities.

    The study
    Authors examined Medicare data linked to the National Death Index for a random sample of 20% of Medicare enrollees between the ages of 21 and 100 during the time period from 2012 to 2016. They calculated the rate of opioid overdose deaths for the entire Medicare population as well as for individuals with any of 55 chronic or potentially disabling conditions contained within the Centers for Medicare & Medicaid Services Chronic Disease Data Warehouse.

    Opioid overdose deaths were identified by codes for opium, heroin, natural or semisynthetic opioids, methadone, synthetic opioids other than methadone, or other and unspecified narcotics prescribed for their underlying conditions.

    Findings

    • Enrollees younger than age 65 who qualify for Medicare due to disability comprise approximately 15% of the overall Medicare population. However, they account for 81% of opioid overdose deaths among Medicare beneficiaries overall.
    • While 32% of enrollees who are qualified for disability had at least 2 major condition categories, these individuals accounted for 78% of all opioid overdose deaths among Medicare beneficiaries.
    • Opioid overdose mortality in the disability group increased from 57.4 per 100,000 in 2012 to 77.6 per 100,000 in 2016.
    • Among beneficiaries who qualified for Medicare because of disability, opioid overdose deaths were highest for those aged 51–64. In addition, those who were male and white, had higher income, had Medicare Part D coverage, had been enrolled under disability for less than 15 years, and who lived in metropolitan areas had higher rates of opioid overdose death.
    • Of the disabling conditions examined, substance abuse, psychiatric diseases, and chronic pain were significantly associated with higher rate of opioid overdose deaths. The opioid overdose mortality rate among those with all 3 conditions was 363.7 per 100,000—23.4 times higher than for those with no disabling conditions. Chronic kidney disease, pressure and chronic ulcers, and hepatitis also were associated with a higher likelihood over opioid overdose death.
    • The opioid overdose mortality rate among those who qualify for Medicare due to disability is nearly 5 times higher than that of the general United States population.

    Why it matters
    Subgroups of Medicare beneficiaries "present different risk profiles for opioid overdose death, authors say. "Patients qualifying for Medicare disability have the highest rates of opioid use compared with older Medicare beneficiaries and commercial insurance beneficiaries." Future studies can help develop targeted interventions to decrease opioid overdose deaths in high-risk populations.

    More from the study
    Researchers were surprised to see a positive association between high income and opioid overdose death, as one previous study found that lower-income individuals "were more likely to misuse opioids and had higher rates of opioid use disorder than the general US population" and another showed that higher-income Medicare enrollees had lower rates of long-term opioid prescriptions.

    Authors suggest that future research should examine these associations by opioid type.

    Keep in mind…
    Authors note that "the quality and accuracy of death certificate data associated with overdose varies across states." Likewise, the validity of medical conditions in claims data varies. From the available data, researchers could not distinguish between accidental, suicide, or homicide deaths or whether they occurred in the inpatient or outpatient setting.

    In addition, because they analyzed data only from enrollees with 2 years of continuous enrollment with fee-for-service coverage, the results "may not be generalizable to health maintenance organization populations."

    Authors also did not examine "competing causes of death" or the association of drug interactions or contaminated street drugs with opioid overdose death. They suggest future research on overdose deaths due to different types of opioids.

    Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.