Table 3-.
Association of healthcare access and geographic region with long-term pre-operative opioid use rates in in a cohort of severe osteoarthritis patients, Medicare data 2010–2014
| Independent variables of interest | N (%) of PCSAs (total N= 4,080) | Unadjusted mean (SD) of % long-term opioid users | Adjusted*mean difference in proportion (percentage points) of long term opioid users (95% confidence interval) |
|---|---|---|---|
| State† | |||
| New York | 181 (4.4) | 12.3 (6.1) | Reference |
| West Virginia | 26 (0.6) | 24.9 (8.6) | 10.3 (7.9–12.6) |
| Alabama | 69 (1.7) | 26.4 (7) | 10.2 (7.3–13.2) |
| Georgia | 111 (2.7) | 22.9 (8.2) | 9.4 (6.8–12) |
| Kentucky | 81 (2) | 24 (9.6) | 8.8 (7.2–10.4) |
| Lousiana | 53 (1.3) | 25 (8.6) | 8.3 (6.5–10.1) |
| Oklohama | 77 (1.9) | 22.3 (6.1) | 8.2 (6.6–9.8) |
| North Carolina | 135 (3.3) | 22.6 (8.1) | 7.9 (5.5–10.3) |
| Virginia | 123 (3) | 17 (6.3) | 7.2 (5.8–8.7) |
| Inidiana | 128 (3.1) | 19.1 (6.1) | 7.2 (5.8–8.6) |
| Mississipi | 67 (1.6) | 25 (7.7) | 7.1 (4.5–9.7) |
| Number of primary care providers/1000 Medicare beneficiaries in the primary care service area | |||
| >8.6 (Q4) | 1020 (25) | 16 (7.2) | Reference |
| 5.5–8.6 (Q3) | 1020 (25) | 16.4 (7.2) | 0.9 (0.4–1.4) |
| 3.6–5.5 (Q2) | 1020 (25) | 18.3 (8.0) | 1.7 (1.1–2.2) |
| <3.6 (Q1) | 1020 (25) | 18.3 (8.5) | 1.4 (0.8–2) |
| Number of rheumatologists/1000 Medicare beneficiaries in the primary care service area | |||
| >0.29 (T3) | 381 (9.4) | 15.4 (7.2) | Reference |
| 0.15–0.29 (T2) | 381 (9.4) | 16.3 (6.4) | 0.4 (−0.4–1.2) |
| <0.15 (T1) | 381 (9.3) | 17.5 (6.0) | 0.1 (−0.8–0.9) |
| None | 2938 (72) | 17.6 (8.2) | 0.6 (−0.1–1.3) |
Adjusted for case-mix including age, race, gender, dual Medicare-Medicaid enrollment, pain related diagnoses, co-morbid conditions, type of joint replacement surgery, and socioeconomic characteristics in each primary care service area as well as state level policies including rigor of prescription drug monitoring programs and legal availability of medical marijuana.
Based on the highest adjusted estimates, top 10 states presented in descending order of the magnitude of the effect. New York was selected as the reference based on low proportion of long term opioid users and a large sample size. Estimates for rest of the states are provided in Appendix Table 1.