Table 6.
Adjusted hazard ratios of death and graft loss associated with ≥ 90 days opioid prescription after transplant in transplant recipients who had their first transplant in 2007–2009 (n=13,925)
| Characteristics | Outcome = death | Outcome = graft loss | ||||
|---|---|---|---|---|---|---|
|
|
|
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| HR | (95% CI) | P value | HR | (95% CI) | P value | |
| Opioid prescription, after transplant * | ||||||
| None and short-term | 1.00 | 1.00 | ||||
| Chronic, <50 MME/day | 1.24 | (1.05, 1.46) | 0.01 | 1.06 | (0.92, 1.22) | 0.44 |
| Chronic, 50–89 MME/day | 1.45 | (1.15, 1.84) | 0.002 | 1.27 | (1.03, 1.56) | 0.02 |
| Chronic, 90+ MME/day | 1.61 | (1.24, 2.10) | <0.001 | 1.33 | (1.05, 1.67) | 0.02 |
| Age at transplant | ||||||
| 20–44 | 1.00 | 1.00 | ||||
| 45–64 | 1.69 | (1.51, 1.89) | <0.001 | 0.95 | (0.88, 1.02) | 0.19 |
| 65+ | 2.85 | (2.51, 3.25) | <0.001 | 1.25 | (1.14, 1.38) | <0.001 |
| Gender | ||||||
| Male | 1.12 | (1.03, 1.21) | 0.01 | 1.05 | (0.98, 1.12) | 0.15 |
| Female | 1.00 | 1.00 | ||||
| Race | ||||||
| White | 1.00 | 1.00 | ||||
| Non-White | 1.05 | (0.96, 1.14) | 0.26 | 1.26 | (1.18, 1.35) | <0.001 |
| Education | ||||||
| High school or less | 1.00 | 1.00 | ||||
| Some college or higher | 1.03 | (0.94, 1.13) | 0.56 | 1.04 | (0.97, 1.11) | 0.33 |
| Unknown/Missing | 1.05 | (0.93, 1.18) | 0.45 | 0.97 | (0.89, 1.07) | 0.58 |
| Employment status | ||||||
| Working | 1.00 | 1.00 | ||||
| Not working | 1.39 | (1.20, 1.61) | <0.001 | 1.21 | (1.09, 1.34) | <0.001 |
| Unknown/Missing | 1.31 | (1.09, 1.58) | 0.004 | 1.14 | (1.00, 1.30) | 0.05 |
| ZIP code median income | ||||||
| < $45,000 | 1.08 | (0.94, 1.24) | 0.26 | 1.15 | (1.03, 1.28) | 0.02 |
| $45,000 – $74,999 | 1.03 | (0.90, 1.18) | 0.68 | 1.08 | (0.96, 1.20) | 0.19 |
| ≥$75,000 | 1.00 | 1.00 | ||||
| Dual status† | ||||||
| No | 1.00 | 1.00 | ||||
| Yes | 0.96 | (0.87, 1.06) | 0.46 | 1.06 | (0.98, 1.14) | 0.18 |
| Residential area | ||||||
| Rural | 1.08 | (0.97, 1.20) | 0.17 | 1.02 | (0.94, 1.11) | 0.66 |
| Non-rural | 1.00 | 1.00 | ||||
| Nursing home residence‡ | ||||||
| No | 1.00 | 1.00 | ||||
| Yes | 1.77 | (1.50, 2.08) | <0.001 | 1.53 | (1.32, 1.78) | <0.001 |
| ESRD vintage | ||||||
| 0 years | 1.00 | 1.00 | ||||
| 1–3 years | 1.13 | (0.94, 1.35) | 0.19 | 1.27 | (1.10, 1.48) | 0.001 |
| 4+ years | 1.42 | (1.17, 1.71) | <0.001 | 1.48 | (1.27, 1.74) | <0.001 |
| Opioid prescription, before transplant | ||||||
| None and short-term | 1.00 | 1.00 | ||||
| Chronic | 1.35 | (1.18, 1.55) | <0.001 | 1.22 | (1.10, 1.36) | <0.001 |
| No data | 0.93 | (0.82, 1.05) | 0.22 | 0.95 | (0.87, 1.05) | 0.32 |
| Cancer, after transplant*§ | ||||||
| No | 1.00 | 1.00 | ||||
| Yes | 6.23 | (5.46, 7.10) | <0.001 | 4.75 | (4.19, 5.39) | <0.001 |
| Cancer, before transplant¶ | ||||||
| No | 1.00 | 1.00 | ||||
| Yes | 1.48 | (1.25, 1.74) | <0.001 | 1.29 | (1.12, 1.49) | <0.001 |
| Congestive heart failure | ||||||
| No | 1.00 | 1.00 | ||||
| Yes | 1.28 | (1.15, 1.42) | <0.001 | 1.13 | (1.04, 1.24) | 0.006 |
| Peripheral vascular disease | ||||||
| No | 1.00 | 1.00 | ||||
| Yes | 1.14 | (0.98, 1.33) | 0.10 | 1.09 | (0.95, 1.25) | 0.22 |
| Cerebrovascular disease | ||||||
| No | 1.00 | 1.00 | ||||
| Yes | 1.30 | (1.09, 1.55) | 0.004 | 1.18 | (1.01, 1.37) | 0.03 |
| Chronic obstructive pulmonary disease | ||||||
| No | 1.00 | 1.00 | ||||
| Yes | 1.30 | (1.02, 1.66) | 0.03 | 1.37 | (1.11, 1.69) | 0.003 |
| Atherosclerotic heart disease | ||||||
| No | 1.00 | 1.00 | ||||
| Yes | 1.35 | (1.20, 1.52) | <0.001 | 1.24 | (1.11, 1.38) | <0.001 |
| Diabetes | ||||||
| No | 1.00 | 1.00 | ||||
| Yes | 1.51 | (1.39, 1.64) | <0.001 | 1.22 | (1.14, 1.30) | <0.001 |
| AIDS | ||||||
| No | 1.00 | 1.00 | ||||
| Yes | 1.31 | (0.62, 2.75) | 0.48 | 1.40 | (0.89, 2.21) | 0.14 |
HR, hazard ratio; CI, confidence interval; MME, morphine milligram equivalent.
All variables presented in the table were adjusted in the Cox regression model.
None opioid prescription: 0 days filled opioid prescription; short-term opioid prescription: 1–89 days filled opioid prescription; chronic opioid prescription: 90 days or more filled opioid prescription
As a time-dependent variable in the Cox regression model
Dual status in Medicare and Medicaid before transplant
On the basis of one or more claims before transplant in physician/carrier files
On the basis of one or more inpatient stays with a cancer diagnosis after transplant; the date of the first inpatient stay with a cancer diagnosis defined as the date of cancer occurrence after transplant
On the basis of one or more inpatient stays with a cancer diagnosis before transplant and Form 2728