Table 1.
Characteristics of OUD-Related Index Events in Medicare Beneficiaries, According to Race and Ethnic Group.*
| Characteristic | Overall (N = 25,904) | Black (N = 3937) | Hispanic (N =2105) | White (N = 19,862) |
|---|---|---|---|---|
| No. of unique beneficiarie† | 23,370 | 3524 | 1858 | 17,988 |
| Index event characteristics | ||||
| Type of OUD-related index event (%)‡ | ||||
| Opioid overdose | 34.1 | 37.1 | 30.5 | 33.9 |
| Inpatient rehabilitation or detoxification | 25.7 | 28.2 | 25.0 | 25.2 |
| Intravenous drug use-related infection with hospitalization | 43.5 | 37.4 | 49.1 | 44.1 |
| Beneficiary characteristics § | ||||
| Age at event (yr) | 50.5±12.4 | 53.4±11.4 | 49.0±11.8 | 50.0±12.5 |
| Female sex (%) | 46.7 | 42.0 | 37.2 | 48.6 |
| Low-income subsidy (%)¶ | 88.6 | 94.3 | 93.9 | 86.8 |
| Dually eligible for Medicaid (%) | 81.8 | 89.4 | 89.0 | 79.6 |
| Long-term care resident (%)|| | 4.3 | 3.9 | 3.8 | 4.5 |
| Coexisting conditions** | ||||
| No. of coexisting conditions | 9.1±5.2 | 9.4±5.5 | 8.7±5.4 | 9.1±5.2 |
| Hepatitis C (%) | 27.7 | 28.3 | 34.6 | 26.8 |
| HIV infection or AIDS (%) | 3.6 | 10.2 | 7.1 | 2.0 |
| Depression (%) | 58.7 | 51.0 | 56.3 | 60.4 |
| Fibromyalgia, chronic pain, or fatigue (%) | 58.5 | 52.7 | 48.6 | 60.6 |
| Schizophrenia or other psychosis (%) | 20.7 | 23.5 | 24.6 | 19.7 |
| Bipolar disorder (%) | 37.4 | 28.0 | 35.0 | 39.4 |
| Alcohol use disorder (%) | 31.1 | 33.8 | 32.7 | 30.4 |
| Drug use disorder (%) | 64.8 | 64.7 | 67.8 | 64.6 |
| OUD (%)†† | 58.1 | 54.8 | 62.0 | 58.3 |
| Cancer (%)‡‡ | 2.9 | 4.0 | 1.7 | 2.7 |
| Prescription fill for medications for OUD within 6 mo before index event (%) | ||||
| Buprenorphine | 18.2 | 9.2 | 16.0 | 20.2 |
| Naloxone | 17.4 | 10.1 | 16.6 | 19.0 |
| Naltrexone | 1.6 | 1.3 | 1.5 | 1.7 |
| Benzodiazepine | 37.7 | 25.3 | 30.6 | 41.0 |
Plus-minus values are means ±SD. The characteristics listed are those of Medicare beneficiaries with an opioid use disorder (OUD)-related index event and are summarized on the basis of index events. Race and ethnic group were determined on the basis of the Research Triangle Institute variable in the Medicare Beneficiary Summary File. Groups were defined as non-Hispanic Black (Black), Hispanic of any race (Hispanic), and non-Hispanic White (White). AIDS denotes acquired immunodeficiency syndrome, and HIV human immunodeficiency virus.
One beneficiary may have contributed more than one index event if 12 months had elapsed since the date of the previous index event.
Index events were defined as a nonfatal opioid overdose treated in the emergency department or inpatient setting, hospitalization with intravenous drug use-related infection (e.g., acute hepatitis C, phlebitis, septic arthritis, or endocarditis, combined with an OUD diagnosis in the previous 30 days), or an inpatient or residential rehabilitation or detoxification stay with a primary diagnosis of OUD. Percentages in this section total more than 100% because a small number of patients had more than one type of event during their index encounter. For example, a patient who had been hospitalized with diagnoses of opioid overdose and an intravenous drug use-related infection would have contributed a single index event but would have had two types of OUD-related index events.
Beneficiary characteristics are reported at the level of the index event, such that the same individual beneficiary may have contributed more than once to the mean or the percentage shown.
Low-income subsidy was defined as the Medicare Part D low-income subsidy, a signal of poverty, which was dichotomized in this study as any or none.
Long-term care resident status was assigned to beneficiaries who had at least 50% of their prescription fills in the 6 months before the index event dispensed from a pharmacy at a long-term care facility.
For the total count, data on the presence of 60 conditions were gathered from the Chronic Condition Data Warehouse, which uses claims since 1999 to describe Medicare beneficiaries’ accumulated chronic disease burden. Ten of the most relevant conditions for OUD are shown here, with the remaining conditions listed in Table S6. Coexisting conditions were defined as any condition that was present by the end of the calendar year before the index event.
Because OUD diagnoses are included in the Chronic Condition Data Warehouse flag for drug use disorder, this flag was not used in the count of coexisting conditions.
The “cancer” designation reflects whether a patient had a flag for breast, colorectal, endometrial, lung, or prostate cancer in the Chronic Condition Data Warehouse file. This flag was not used in the count of coexisting conditions.