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Research ArticleOriginal Research

Opioid Overdose Hospitalizations among Medicare-Disability Beneficiaries

Jillian L. Peters, Wesley M. Durand, Kristina A. Monteiro, Luba Dumenco and Paul George
The Journal of the American Board of Family Medicine November 2018, 31 (6) 881-896; DOI: https://doi.org/10.3122/jabfm.2018.06.180152
Jillian L. Peters
Alpert Medical School, Brown University, Providence, RI.
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Wesley M. Durand
Alpert Medical School, Brown University, Providence, RI.
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Kristina A. Monteiro
Alpert Medical School, Brown University, Providence, RI.
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Luba Dumenco
Alpert Medical School, Brown University, Providence, RI.
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Paul George
Alpert Medical School, Brown University, Providence, RI.
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Article Figures & Data

Figures

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  • Figure 1.
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    Figure 1.

    Opioid overdose hospitalizations among patients <65 years of age, by payer type (National Inpatient Sample, 1998 to 2013). MDB, Medicare-disability beneficiary.

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    Figure 2.

    Opioid overdose hospitalizations: percentage of female patients among those <65 years of age, by payer type (National Inpatient Sample, 1998 to 2013). MDB, Medicare-disability beneficiary.

  • Figure 3.
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    Figure 3.

    Opioid overdose hospitalizations: patient age among medicare-disability beneficiary (MDBs) (National Inpatient Sample, 1998 to 2013). The 0 to 17 age-group constitutes a very small proportion of the overall population and may not, therefore, be visible graphically.

  • Figure 4.
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    Figure 4.

    Non-heroin opioid overdose (NHOD): percentage among those <65 years of age, by payer type (National Inpatient Sample, 1998 to 2013). MDB, Medicare-disability beneficiary.

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    Figure 5.

    Odds ratios for comorbidities among those <65 years of age, by payer type (National Inpatient Sample, 1998 to 2013).

  • Appendix Figure 1.
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    Appendix Figure 1.

    Incidence of Opioid Overdose Hospitalization by Age.

  • Appendix Figure 2.
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    Appendix Figure 2.

    Opioid Overdose Hospitalizations: Percentage of White Patients Among Those <65 years of Age, by Payer Type.

Tables

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    Appendix Table 1.

    ICD-9-CM Coding Algorithms

    Musculoskeletal Comorbidity71600716017160271603716047160571606716077160871609
    71610716117161271613716147161571616716177161871619
    71620716217162271623716247162571626716277162871629
    71630716317163271633716347163571636716377163871639
    71640716417164271643716447164571646716477164871649
    71650716517165271653716547165571656716577165871659
    71660716617166271663716647166571666716677166871680
    71681716827168371684716857168671687716887168971690
    71691716927169371694716957169671697716987169971500
    71504715097151071511715127151371514715157151671517
    71518715207152171522715237152471525715267152771528
    71530715317153271533715347153571536715377153871580
    71589715907159171592715937159471595715967159771598
    724007240172402724037240972417242724372447245
    7246724707247172479724872499050905190529053
    9054905590569057905890599060906190629063
    906490659066906790689069
    Prescription Opioid Overdose965009650296509E8501E8502
    Heroin Overdose96501E8500
    • View popup
    Appendix Table 2.

    Age Distribution of Opioid Overdoses, Overall

    1998199920002001200220032004200520062007200820092010201120122013
    Population (million)
        0–1771.972.172.472.672.973.273.473.673.974.074.174.274.474.875.275.7
        18–49111.6112.0112.3112.4112.4112.5112.5112.4112.4112.5112.8113.0113.2113.7114.1114.6
        50–6458.760.562.464.466.568.670.772.874.876.578.079.681.082.182.482.7
        65–8430.630.730.830.931.031.131.331.631.932.332.933.534.134.836.137.4
        85+3.94.14.34.44.64.74.95.15.35.65.75.96.16.36.46.6
    Age Group (Discharges)
        0–171,0661,2101,3221,1621,3271,5451,6591,7201,4371,5321,7191,7182,3241,6441,9801,695
        18–4912,57613,87515,11016,89218,38520,09822,37321,56323,85225,34928,70728,30232,05633,26233,19532,115
        50–645,2115,8107,1039,14711,11412,99815,32716,26319,91421,61926,34527,81331,09132,67834,10034,035
        65–842,0502,1482,1322,8203,1203,5714,3624,6305,5286,2637,5407,3158,8089,86810,57010,535
        85+3093703303314775404986686877179408681,0091,2501,1851,190
    Age Group (%)
        0–175.0%5.2%5.1%3.8%3.9%4.0%3.8%3.8%2.8%2.8%2.6%2.6%3.1%2.1%2.4%2.1%
        18–4959.3%59.3%58.1%55.7%53.4%51.9%50.6%48.1%46.4%45.7%44.0%42.9%42.6%42.3%41.0%40.4%
        50–6424.6%24.8%27.3%30.1%32.3%33.5%34.7%36.3%38.7%39.0%40.4%42.1%41.3%41.5%42.1%42.8%
        65–849.7%9.2%8.2%9.3%9.1%9.2%9.9%10.3%10.8%11.3%11.6%11.1%11.7%12.5%13.0%13.2%
        85+1.5%1.6%1.3%1.1%1.4%1.4%1.1%1.5%1.3%1.3%1.4%1.3%1.3%1.6%1.5%1.5%
    Age Group (Discharges per Million)
        0–1714.816.818.316.018.221.122.623.419.520.723.223.231.222.026.322.4
        18–49112.7123.9134.6150.3163.5178.7198.9191.9212.2225.3254.5250.4283.1292.6290.9280.3
        50–6488.896.0113.8141.9167.0189.4216.9223.4266.3282.5337.6349.6383.8398.3413.9411.5
        65–8467.070.069.291.3100.7114.7139.2146.6173.5193.9228.9218.1258.1283.3292.7281.7
        85+78.590.277.274.8104.3114.1101.4130.5128.7129.1163.7146.2164.8198.9184.2181.0
    • View popup
    Appendix Table 3.

    Characteristics of Opioid Overdose Hospitalizations Among Patients <65 Years of Age

    1998199920002001200220032004200520062007200820092010201120122013
    Payer Type (Discharges)
        Non-Medicare16,56517,98120,31722,84625,95328,75132,52232,04936,23238,51344,54245,07150,67251,66451,90551,070
        Medicare2,1972,7723,1084,2564,7905,7356,7747,4738,8599,85912,03912,52114,46915,64817,15516,610
    Payer Type (%)
        Non-Medicare88.3%86.6%86.7%84.3%84.4%83.4%82.8%81.1%80.4%79.6%78.7%78.3%77.8%76.8%75.2%75.5%
        Medicare11.7%13.4%13.3%15.7%15.6%16.6%17.2%18.9%19.6%20.4%21.3%21.7%22.2%23.2%24.8%24.5%
    Sex (Discharges)
        Non-Medicare
            Male8,6889,09710,66411,19713,09014,19216,12716,17018,90319,15923,13922,89825,68725,81326,22526,230
            Female7,8778,8839,64911,64912,85914,52016,38615,84617,30219,31121,39822,15424,94525,83625,68024,810
        Medicare
            Male1,2051,4611,6222,1092,4762,7603,1423,3434,0134,6345,6315,7736,3976,8647,3707,120
            Female9931,3111,4862,1472,3142,9753,6324,1294,8475,2256,4086,7488,0738,7849,7809,485
    Sex (%)
        Non-Medicare
            Male52.4%50.6%52.5%49.0%50.4%49.4%49.6%50.5%52.2%49.8%52.0%50.8%50.7%50.0%50.5%51.4%
            Female47.6%49.4%47.5%51.0%49.6%50.6%50.4%49.5%47.8%50.2%48.0%49.2%49.3%50.0%49.5%48.6%
        Medicare
            Male54.8%52.7%52.2%49.6%51.7%48.1%46.4%44.7%45.3%47.0%46.8%46.1%44.2%43.9%43.0%42.9%
            Female45.2%47.3%47.8%50.4%48.3%51.9%53.6%55.3%54.7%53.0%53.2%53.9%55.8%56.1%57.0%57.1%
    Age (Discharges)
        Non-Medicare
            0–171,0611,2001,3031,1531,3271,5031,6411,7031,4181,5141,7051,7092,2971,6381,9551,675
            18–294,1084,3604,6715,2806,1757,0378,0957,8888,6899,81711,10311,38912,54913,52412,91012,985
            30–394,8425,1175,9866,4456,5457,0227,5896,8947,8848,1379,2039,38510,67011,08811,25010,690
            40–494,3914,9665,4756,3317,3477,8358,7738,5389,7229,31510,57110,02910,98310,75910,66510,220
            50–591,7121,8752,4223,0093,8574,3935,3475,8296,8748,0849,74910,09511,24611,42811,93012,050
            60–644504534546297019421,0681,1891,6351,6412,2072,4602,8993,2223,1853,445
        Medicare
            0–17****************
            18–29*106114112180185300265290360401393580511645560
            30–395586656618729029751,0041,0401,1341,2851,2391,3371,7991,6111,8001,795
            40–498371,0821,1701,5341,7722,1692,4232,6222,7383,0623,7313,4143,7133,8643,8203,615
            50–594786688711,3531,4691,7422,2532,6713,5323,7054,7865,3116,0176,7297,6157,400
            60–642302512883854686587898711,1601,4381,8782,0662,3612,9333,2653,225
    Age (%)
        Non-Medicare
            0–176.4%6.7%6.4%5.0%5.1%5.2%5.0%5.3%3.9%3.9%3.8%3.8%4.5%3.2%3.8%3.3%
            18–2924.8%24.3%23.0%23.1%23.8%24.5%24.9%24.6%24.0%25.5%24.9%25.3%24.8%26.2%24.9%25.4%
            30–3929.2%28.5%29.5%28.2%25.2%24.4%23.3%21.5%21.8%21.1%20.7%20.8%21.1%21.5%21.7%20.9%
            40–4926.5%27.6%27.0%27.7%28.3%27.3%27.0%26.6%26.8%24.2%23.7%22.3%21.7%20.8%20.6%20.0%
            50–5910.3%10.4%11.9%13.2%14.9%15.3%16.4%18.2%19.0%21.0%21.9%22.4%22.2%22.1%23.0%23.6%
            60–642.7%2.5%2.2%2.8%2.7%3.3%3.3%3.7%4.5%4.3%5.0%5.5%5.7%6.2%6.1%6.7%
        Medicare
            0–17****************
            18–29*3.8%3.7%2.6%3.8%3.2%4.4%3.5%3.3%3.7%3.3%3.1%4.0%3.3%3.8%3.4%
            30–3925.4%24.0%21.3%20.5%18.8%17.0%14.8%13.9%12.8%13.0%10.3%10.7%12.4%10.3%10.5%10.8%
            40–4938.1%39.0%37.6%36.0%37.0%37.8%35.8%35.1%30.9%31.1%31.0%27.3%25.7%24.7%22.3%21.8%
            50–5921.8%24.1%28.0%31.8%30.7%30.4%33.3%35.7%39.9%37.6%39.8%42.4%41.6%43.0%44.4%44.6%
            60–6410.4%9.0%9.3%9.1%9.8%11.5%11.7%11.7%13.1%14.6%15.6%16.5%16.3%18.7%19.0%19.4%
    Race (Discharges)
        Non-Medicare
            White9264103241194312984144191682118467193062046322099280013088234788370413868037670
            Black2046204919091989237820962350177224262462260330274158394042704525
            Hispanic1258120816571449166717631886169022742059215326783256354038003835
            Asian or Pacific Islander**103125150141209157163218239316336327325305
            Native American******202183261242287456421466450360
            Other307464387297588569503726576654110314081026133412651090
        Medicare
            White14411939215027853035365043014908547061718198895910403118391339513060
            Black2022602432763433444364376077217619591367139415851490
            Hispanic8977146143178246208287306341470500612720825795
            Asian or Pacific Islander****************
            Native American********119***161118145*
            Other**********176161218224340145
    Race (%)
        Non-Medicare
            White71.2%72.7%74.4%76.8%74.9%78.5%78.2%81.0%78.2%79.7%81.4%79.7%79.1%79.4%79.3%78.8%
            Black15.7%14.4%11.9%11.8%12.4%9.8%10.0%7.4%9.3%8.9%7.6%7.8%9.5%8.4%8.8%9.5%
            Hispanic9.7%8.5%10.3%8.6%8.7%8.2%8.0%7.1%8.7%7.4%6.3%6.9%7.4%7.6%7.8%8.0%
            Asian or Pacific Islander**0.6%0.7%0.8%0.7%0.9%0.7%0.6%0.8%0.7%0.8%0.8%0.7%0.7%0.6%
            Native American******0.9%0.8%1.0%0.9%0.8%1.2%1.0%1.0%0.9%0.8%
            Other2.4%3.3%2.4%1.8%3.1%2.7%2.1%3.0%2.2%2.4%3.2%3.6%2.3%2.9%2.6%2.3%
        Medicare
            White81.9%83.4%83.6%85.3%84.4%84.6%84.4%85.8%82.9%83.5%84.9%83.7%81.2%82.5%81.9%83.3%
            Black11.5%11.2%9.5%8.5%9.5%8.0%8.6%7.6%9.2%9.8%7.9%9.0%10.7%9.7%9.7%9.5%
            Hispanic5.1%3.3%5.7%4.4%4.9%5.7%4.1%5.0%4.6%4.6%4.9%4.7%4.8%5.0%5.0%5.1%
            Asian or Pacific Islander****************
            Native American********1.8%***1.3%0.8%0.9%*
            Other**********1.8%1.5%1.7%1.6%2.1%0.9%
    Overdose Type (Discharges)
        Non-medicare
            Prescription Opioid Only11476123771495718258204722357027655275323011133838375423872943937443294250039625
            Both203208183222269265171218298258338339478562545630
            Heroin Only48865397517743665212491746964299582344186662600362566772886010815
        Medicare
            Prescription Opioid Only1923238528013932436353826365712683679455113331196813864150911624515600
            Both****************
            Heroin Only269362292305414314390328451372655519545517845925
    Overdose Type (%)
        Non-medicare
            Prescription Opioid Only69.3%68.8%73.6%79.9%78.9%82.0%85.0%85.9%83.1%87.9%84.3%85.9%86.7%85.8%81.9%77.6%
            Both1.2%1.2%0.9%1.0%1.0%0.9%0.5%0.7%0.8%0.7%0.8%0.8%0.9%1.1%1.0%1.2%
            Heroin Only29.5%30.0%25.5%19.1%20.1%17.1%14.4%13.4%16.1%11.5%15.0%13.3%12.3%13.1%17.1%21.2%
        Medicare
            Prescription Opioid Only87.5%86.0%90.1%92.4%91.1%93.8%94.0%95.4%94.4%95.9%94.1%95.6%95.8%96.4%94.7%93.9%
            Both*****************
            Heroin Only12.3%13.1%9.4%7.2%8.6%5.5%5.8%4.4%5.1%3.8%5.4%4.1%3.8%3.3%4.9%5.6%
    • View popup
    Appendix Table 4.

    Prevalence of Comorbidities Among Patients <65 y/o

    ComorbidityNMIMDBOR95%CIp
    Hypertension21.940.62.442.372.52<.0001
    Drug Abuse46.336.80.680.660.70<.0001
    Fluid / Electrolyte Disorders29.435.41.311.281.35<.0001
    Psychosis22.930.11.451.411.50<.0001
    Chronic Pulmonary Disease15.929.82.262.182.34<.0001
    Depression23.625.11.081.051.12<.0001
    Other Neurological Disorders15.624.11.721.661.78<.0001
    Musculoskeletal Disease13.823.51.921.861.99<.0001
    Diabetes (uncomplicated)7.516.62.442.342.54<.0001
    Deficiency Anemia8.513.71.701.631.77<.0001
    Alcohol Abuse18.913.50.670.640.70<.0001
    Obesity5.710.82.001.912.10<.0001
    Hypothyroidism4.29.22.322.202.45<.0001
    Renal Failure2.48.53.723.503.95<.0001
    Congestive Heart Failure2.97.82.862.703.04<.0001
    Liver Disease5.17.31.471.391.56<.0001
    Diabetes (complicated)1.75.53.293.063.54<.0001
    Coagulopathy3.34.31.301.211.39<.0001
    Rheumatoid Arthritis1.64.12.572.372.79<.0001
    Weight Loss2.03.51.831.691.98<.0001
    Peripheral Vascular Disorders0.83.13.813.454.21<.0001
    Paralysis1.02.93.002.723.31<.0001
    Valvular Disease1.22.11.731.561.91<.0001
    Pulmonary Circulation Disorders0.81.72.191.942.46<.0001
    AIDS0.71.31.901.642.19<.0001
    Metastatic Cancer0.81.11.331.171.52<.0001
    Solid Tumor Without Metastasis0.81.11.361.181.56<.0001
    Lymphoma0.30.41.631.312.04<.0001
    Blood Loss Anemia0.30.41.140.921.420.243
    Peptic Ulcer Disease (excluding bleeding)0.10.11.651.012.680.043
    • Note: MDB (Medicare-Disability Beneficiaries); NMI (Non-Medicare-Insured)

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The Journal of the American Board of Family  Medicine: 31 (6)
The Journal of the American Board of Family Medicine
Vol. 31, Issue 6
November-December 2018
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Opioid Overdose Hospitalizations among Medicare-Disability Beneficiaries
Jillian L. Peters, Wesley M. Durand, Kristina A. Monteiro, Luba Dumenco, Paul George
The Journal of the American Board of Family Medicine Nov 2018, 31 (6) 881-896; DOI: 10.3122/jabfm.2018.06.180152

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Opioid Overdose Hospitalizations among Medicare-Disability Beneficiaries
Jillian L. Peters, Wesley M. Durand, Kristina A. Monteiro, Luba Dumenco, Paul George
The Journal of the American Board of Family Medicine Nov 2018, 31 (6) 881-896; DOI: 10.3122/jabfm.2018.06.180152
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Keywords

  • Drug Overdose
  • Hospitalization
  • Inpatients
  • Medicare
  • Opioid Analgesics
  • Retrospective Studies

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