Table 6.
Adjusted HRs of death, discontinued dialysis, and hospitalization in 2011–2012 associated with 2010 prescription for ≥90 days of an opioid in the 2010 prevalent dialysis cohort (n=149,757)
| Characteristics | Outcome: Death | Outcome: Discontinued Dialysis | Outcome: Hospitalization | ||||||
|---|---|---|---|---|---|---|---|---|---|
| HR | 95% CI | P Value | HR | 95% CI | P Value | HR | 95% CI | P Value | |
| Opioid prescriptiona | |||||||||
| None | 1.00 | 1.00 | 1.00 | ||||||
| Short term | 1.05 | 1.02 to 1.07 | <0.001 | 1.13 | 1.05 to 1.22 | 0.002 | 1.13 | 1.11 to 1.14 | <0.001 |
| Chronic, <20 MME/d | 1.16 | 1.11 to 1.21 | <0.001 | 1.32 | 1.15 to 1.53 | <0.001 | 1.26 | 1.22 to 1.29 | <0.001 |
| Chronic, 20–50 MME/d | 1.26 | 1.22 to 1.30 | <0.001 | 1.36 | 1.22 to 1.51 | <0.001 | 1.29 | 1.27 to 1.32 | <0.001 |
| Chronic, 50+ MME/d | 1.39 | 1.34 to 1.44 | <0.001 | 1.47 | 1.30 to 1.66 | <0.001 | 1.38 | 1.35 to 1.41 | <0.001 |
| Analgesic prescription | |||||||||
| No | 1.00 | 1.00 | 1.00 | ||||||
| Yes | 0.96 | 0.93 to 0.98 | 0.001 | 0.94 | 0.85 to 1.03 | 0.16 | 1.03 | 1.02 to 1.05 | <0.001 |
| Sex | |||||||||
| Women | 1.00 | 1.00 | 1.00 | ||||||
| Men | 1.11 | 1.09 to 1.13 | <0.001 | 0.88 | 0.83 to 0.94 | <0.001 | 0.95 | 0.94 to 0.96 | <0.001 |
| Race | |||||||||
| White | 1.00 | 1.00 | 1.00 | ||||||
| Black | 0.82 | 0.80 to 0.83 | <0.001 | 0.61 | 0.57 to 0.66 | <0.001 | 0.96 | 0.95 to 0.98 | <0.001 |
| Other | 0.93 | 0.89 to 0.98 | 0.002 | 0.66 | 0.56 to 0.78 | <0.001 | 0.93 | 0.91 to 0.95 | <0.001 |
| Age group, yr | |||||||||
| 20–44 | 1.00 | 1.00 | 1.00 | ||||||
| 45–64 | 1.78 | 1.71 to 1.85 | <0.001 | 2.26 | 1.88 to 2.71 | <0.001 | 1.05 | 1.03 to 1.06 | <0.001 |
| 65+ | 3.06 | 2.93 to 3.19 | <0.001 | 6.83 | 5.70 to 8.19 | <0.001 | 1.20 | 1.18 to 1.22 | <0.001 |
| ESRD vintage, yr | |||||||||
| 1–2 | 1.00 | 1.00 | 1.00 | ||||||
| 3–4 | 1.14 | 1.11 to 1,18 | <0.001 | 1.01 | 0.93 to 1.10 | 0.80 | 1.07 | 1.05 to 1.09 | <0.001 |
| 5+ | 1.29 | 1.26 to 1.33 | <0.001 | 1.02 | 0.93 to 1.10 | 0.72 | 1.09 | 1.08 to 1.11 | <0.001 |
| Dialysis modality | |||||||||
| HD | 1.00 | 1.00 | 1.00 | ||||||
| PD | 1.29 | 1.23 to 1.35 | <0.001 | 1.21 | 1.06 to 1.40 | 0.01 | 1.16 | 1.13 to 1.19 | <0.001 |
| History of kidney transplantation | |||||||||
| No | 1.00 | 1.00 | 1.00 | ||||||
| Yes | 0.88 | 0.84 to 0.93 | <0.001 | 0.66 | 0.54 to 0.81 | <0.001 | 0.99 | 0.97 to 1.01 | 0.37 |
| Dual statusb | |||||||||
| No | 1.00 | 1.00 | 1.00 | ||||||
| Yes | 0.91 | 0.89 to 0.93 | <0.001 | 0.75 | 0.70 to 0.81 | <0.001 | 1.01 | 1.00 to 1.03 | 0.04 |
| Residential area | |||||||||
| Large | 1.00 | 1.00 | 1.00 | ||||||
| Medium/small | 1.01 | 0.99 to 1.04 | 0.27 | 1.58 | 1.47 to 1.70 | <0.001 | 0.96 | 0.95 to 0.98 | <0.001 |
| Nonmetropolitan | 1.11 | 1.08 to 1.13 | <0.001 | 1.73 | 1.59 to 1.87 | <0.001 | 0.92 | 0.91 to 0.93 | <0.001 |
| Nursing home residencec | |||||||||
| No | 1.00 | 1.00 | 1.00 | ||||||
| Yes | 1.56 | 1.52 to 1.60 | <0.001 | 2.24 | 2.07 to 2.42 | <0.001 | 1.08 | 1.06 to 1.10 | <0.001 |
| Cancerd | |||||||||
| No | 1.00 | 1.00 | 1.00 | ||||||
| Yes | 1.26 | 1.21 to 1.30 | <0.001 | 1.40 | 1.26 to 1.55 | <0.001 | 1.04 | 1.01 to 1.07 | 0.003 |
| Prior pain-related hospitalization in 2010 | |||||||||
| No | 1.00 | 1.00 | 1.00 | ||||||
| Yes | 0.95 | 0.92 to 0.99 | 0.01 | 0.97 | 0.86 to 1.10 | 0.66 | 1.16 | 1.13 to 1.18 | <0.001 |
| No. of prior hospitalizations in 2010 | |||||||||
| 0 | 1.00 | 1.00 | 1.00 | ||||||
| 1–2 | 1.55 | 1.52 to 1.59 | <0.001 | 1.42 | 1.31 to 1.54 | <0.001 | 1.56 | 1.54 to 1.58 | <0.001 |
| 3–4 | 2.17 | 2.11 to 2.24 | <0.001 | 1.85 | 1.67 to 2.04 | <0.001 | 2.34 | 2.30 to 2.39 | <0.001 |
| 5 or more | 3.05 | 2.95 to 3.15 | <0.001 | 2.58 | 2.32 to 2.87 | <0.001 | 3.63 | 3.55 to 3.71 | <0.001 |
| Smoker | |||||||||
| No | 1.00 | 1.00 | 1.00 | ||||||
| Yes | 1.13 | 1.09 to 1.18 | <0.001 | 1.26 | 1.11 to 1.42 | <0.001 | 1.07 | 1.05 to 1.10 | <0.001 |
| Congestive heart failure | |||||||||
| No | 1.00 | 1.00 | 1.00 | ||||||
| Yes | 1.20 | 1.17 to 1.23 | <0.001 | 1.07 | 1.00 to 1.15 | 0.05 | 1.06 | 1.04 to 1.07 | <0.001 |
| Peripheral vascular disease | |||||||||
| No | 1.00 | 1.00 | 1.00 | ||||||
| Yes | 1.08 | 1.05 to 1.11 | <0.001 | 1.14 | 1.04 to 1.25 | <0.01 | 1.03 | 1.00 to 1.05 | 0.02 |
| Cerebrovascular disease | |||||||||
| No | 1.00 | 1.00 | 1.00 | ||||||
| Yes | 1.03 | 0.99 to 1.07 | 0.10 | 1.29 | 1.17 to 1.43 | <0.001 | 1.03 | 1.01 to 1.05 | 0.01 |
| Chronic obstructive pulmonary disease | |||||||||
| No | 1.00 | 1.00 | 1.00 | ||||||
| Yes | 1.12 | 1.08 to 1.17 | <0.001 | 1.11 | 0.99 to 1.24 | 0.08 | 1.13 | 1.10 to 1.15 | <0.001 |
| Atherosclerotic heart disease | |||||||||
| No | 1.00 | 1.00 | 1.00 | ||||||
| Yes | 1.14 | 1.11 to 1.17 | <0.001 | 1.06 | 0.98 to 1.15 | 0.14 | 1.07 | 1.05 to 1.09 | <0.001 |
| Diabetes | |||||||||
| No | 1.00 | 1.00 | 1.00 | ||||||
| Yes | 1.18 | 1.15 to 1.20 | <0.001 | 0.88 | 0.82 to 0.94 | <0.001 | 1.13 | 1.12 to 1.14 | <0.001 |
| AIDS | |||||||||
| No | 1.00 | 1.00 | 1.00 | ||||||
| Yes | 1.19 | 1.06 to 1.34 | 0.003 | 1.24 | 0.76 to 2.00 | 0.39 | 1.12 | 1.06 to 1.19 | <0.001 |
a
Short term: 1- to 89-day filled prescription supply within the study year; chronic: 90-day or more filled prescription supply within the study year.
b
Dual status in Medicare and Medicaid.
c
On the basis of one or more claims in physician/carrier files.
d
On the basis of one or more inpatient stays with a cancer diagnosis and CMS Form 2728.