Table 1.
Baseline Demographic Characteristics of Dose Escalators and Maintainers before and after Matching
| Unmatched Sample (N=53,187) | Matched Sample (N=38,716) | |||||
|---|---|---|---|---|---|---|
| Dose Maintainer (N=32,420) | Dose Escalator (N=20,767) | Abs Std Diff | Dose Maintainer (N=19,358) | Dose Escalator (N=19,358) | Abs Std Diff | |
| N (Column %) | N (Column %) | (%) | N (Column %) | N (Column %) | (%) | |
| Race | ||||||
| White | 22715 (70.06) | 14824 (71.38) | 2.9 | 13751 (71.04) | 13729 (70.92) | 0.3 |
| Black | 5343 (16.48) | 3363 (16.19) | 0.8 | 3163 (16.34) | 3202 (16.54) | 0.5 |
| Multiracial | 1127 (3.48) | 636 (3.06) | 2.3 | 579 (2.99) | 607 (3.14) | 0.8 |
| Other | 2294 (7.08) | 1328 (6.39) | 2.7 | 1278 (6.60) | 1242 (6.42) | 0.8 |
| Unknown | 941 (2.90) | 616 (2.97) | 0.4 | 587 (3.03) | 578 (2.99) | 0.3 |
| Age | ||||||
| 58.2 ± 12.82 | 55.6 ± 13.22 | 56.21 ± 12.95 | 56.14 ± 13.06 | |||
| 18–30 | 1097 (3.38) | 1118 (5.38) | 9.8 | 905 (4.68) | 915 (4.73) | 0.2 |
| 31–49 | 5850 (18.04) | 4655 (22.42) | 10.9 | 4198 (21.69) | 4167 (21.53) | 0.4 |
| 50–64 | 16164 (49.86) | 10434 (50.24) | 0.8 | 9706 (50.14) | 9831 (50.79) | 1.3 |
| ≥65 | 9309 (28.71) | 4560 (21.96) | 15.6 | 4549 (23.50) | 4445 (22.96) | 1.3 |
| Sex | ||||||
| Male | 29342 (90.51) | 18715 (90.12) | 1.3 | 17463 (90.21) | 17458 (90.18) | 0.1 |
| Marital Status | ||||||
| Married | 16859 (52.00) | 10309 (49.64) | 4.7 | 9787 (50.56) | 9719 (50.21) | 0.7 |
| Rural-Urban Commuting Area | ||||||
| Urban | 22314 (68.83) | 14534 (69.99) | 2.5 | 13550 (70.00) | 13518 (69.83) | 0.4 |
| Large Rural | 4682 (14.44) | 2993 (14.41) | 0.1 | 2793 (14.43) | 2800 (14.46) | 0.1 |
| Isolated Small Rural | 4628 (14.28) | 2826 (13.61) | 1.9 | 2616 (13.51) | 2656 (13.72) | 0.6 |
| Missing | 796 (2.46) | 414 (1.99) | 3.1 | 399 (2.06) | 384 (1.98) | 0.6 |
| Enhanced Charlson Comorbidity Index | ||||||
| 2.6 ± 1.95 | 2.4 ± 1.95 | 2.45 ± 1.97 | 2.43 ± 1.95 | |||
| 0 | 3481 (10.74) | 2694 (12.97) | 6.9 | 2365 (12.22) | 2435 (12.58) | 1.1 |
| 1 | 7489 (23.10) | 5245 (25.26) | 5.0 | 4830 (24.95) | 4804 (24.82) | 0.3 |
| 2 | 7525 (23.21) | 4777 (23.00) | 0.5 | 4440 (22.94) | 4461 (23.04) | 0.3 |
| 3 | 5605 (17.29) | 3256 (15.68) | 4.3 | 3107 (16.05) | 3105 (16.04) | 0.0 |
| 4 | 3558 (10.97) | 2033 (9.79) | 3.9 | 1930 (9.97) | 1934 (9.99) | 0.1 |
| 5 | 2100 (6.48) | 1146 (5.52) | 4.0 | 1110 (5.73) | 1092 (5.64) | 0.4 |
| ≥6 | 2662 (8.21) | 1616 (7.78) | 1.6 | 1576 (8.14) | 1527 (7.89) | 0.9 |
| Pain Condition | ||||||
| Back and/or Neck Pain Only | 4384 (13.52) | 2929 (14.10) | 1.7 | 2597 (13.42) | 2704 (13.97) | 1.6 |
| Arthritis Only | 6094 (18.80) | 3464 (16.68) | 5.5 | 3260 (16.84) | 3332 (17.21) | 1.0 |
| Headaches Only | 276 (0.85) | 125 (0.60) | 2.9 | 149 (0.77) | 120 (0.62) | 1.8 |
| Neuropathic Pain Only | 550 (1.70) | 296 (1.43) | 2.2 | 310 (1.60) | 281 (1.45) | 1.2 |
| Arthritis and Back and/or Neck Pain Only | 9372 (28.91) | 6077 (29.26) | 0.8 | 5693 (29.41) | 5636 (29.11) | 0.7 |
| Arthritis, Back and/or Neck Pain, and Headaches Only | 1932 (5.96) | 1369 (6.59) | 2.6 | 1264 (6.53) | 1247 (6.44) | 0.4 |
| Neuropathic Pain and One or More Others | 7919 (24.43) | 5202 (25.05) | 1.4 | 4864 (25.13) | 4830 (24.95) | 0.4 |
| All Tracer Pain Conditions | 453 (1.40) | 394 (1.90) | 3.9 | 317 (1.64) | 361 (1.86) | 1.7 |
| Other Multiple Pain Conditions | 1440 (4.44) | 911 (4.39) | 0.3 | 904 (4.67) | 847 (4.38) | 1.4 |
| Other Medication Use | ||||||
| Antidepressant Use | 17322 (53.43) | 11735 (56.51) | 6.2 | 10794 (55.76) | 10809 (55.84) | 0.2 |
| Skeletal Muscle Relaxant Use | 11690 (36.06) | 8614 (41.48) | 11.1 | 7768 (40.13) | 7822 (40.41) | 0.6 |
| Benzodiazepine Use | 8768 (27.05) | 5846 (28.15) | 2.5 | 5369 (27.74) | 5408 (27.94) | 0.5 |
| Other Non-Opioid Analgesic Use | 22688 (69.98) | 15254 (73.45) | 7.7 | 14100 (72.84) | 14176 (73.23) | 0.9 |
| Hypnotics and Non-Benzodiazepine Sedative Use | 4871 (15.02) | 3405 (16.40) | 3.8 | 3052 (15.77) | 3123 (16.13) | 1.0 |
| Mental Health Conditions | ||||||
| No Mental Health Conditions | 15876 (48.97) | 9697 (46.69) | 4.6 | 9027 (46.63) | 9149 (47.26) | 1.3 |
| Schizophrenia | 271 (0.84) | 142 (0.68) | 1.8 | 133 (0.69) | 138 (0.71) | 0.3 |
| Major Depressive Disorder | 4332 (13.36) | 3066 (14.76) | 4.0 | 2751 (14.21) | 2803 (14.48) | 0.8 |
| Post-Traumatic Stress Disorder | 1854 (5.72) | 1139 (5.48) | 1.0 | 1105 (5.71) | 1068 (5.52) | 0.8 |
| Bipolar Disorder | 320 (0.99) | 244 (1.17) | 1.8 | 184 (0.95) | 229 (1.18) | 2.3 |
| 1717 (5.30) | 1069 (5.25) | 0.7 | 1045 (5.40) | 1004 (5.19) | 1.0 | |
| Multiple Mental Health Conditions | 8050 (24.83) | 5410 (26.05) | 2.8 | 5113 (26.41) | 4967 (25.66) | 1.7 |
| Percent with Each of the Following Visit Types in the 12 Months before Dosage Change Index Date | ||||||
| Physical Therapy | 10715 (33.05) | 7757 (37.35) | 9.0 | 6865 (35.46) | 7130 (36.83) | 2.9 |
| Pain Clinic | 4697 (14.49) | 3767 (18.14) | 9.9 | 3173 (16.39) | 3328 (17.19) | 2.1 |
| Chiropractic Care | 485 (1.50) | 363 (1.75) | 2.0 | 316 (1.63) | 333 (1.72) | 0.7 |
| Medicine and Primary Care | 32392 (99.91) | 20747 (99.90) | 0.3 | 19343 (99.92) | 19339 (99.90) | 0.7 |
| Mental Health Care | 15801 (48.74) | 10840 (52.20) | 6.9 | 9959 (51.45) | 9957 (51.44) | 0.0 |
| Duration of Action of Opioid Use in First 180 Days | ||||||
| Long-Acting Only | 715 (2.21) | 299 (1.44) | 5.7 | 332 (1.72) | 297 (1.53) | 1.4 |
| Short-Acting Only | 29365 (90.58) | 17792 (85.67) | 15.2 | 17219 (88.95) | 17183 (88.76) | 0.6 |
| Combination of Long and Short-Acting | 2340 (7.22) | 2676 (12.89) | 18.9 | 1807 (9.33) | 1878 (9.70) | 1.3 |
| Schedule of Opioid Use in First 180 Days | ||||||
| Schedule II Only | 18908 (58.32) | 12076 (58.15) | 0.4 | 11601 (59.93) | 11429 (59.04) | 1.8 |
| Schedule III Only | 1070 (3.30) | 457 (2.20) | 6.7 | 448 (2.31) | 457 (2.36) | 0.3 |
| Schedule IV Only | 7087 (21.86) | 2953 (14.22) | 20.0 | 2974 (15.36) | 2946 (15.22) | 0.4 |
| Schedule V Only | 0 (0.00) | 0 (0.00) | 0.0 | 0 (0.00) | 0 (0.00) | 0.0 |
| Use of Multiple Schedules | 5355 (16.52) | 5281 (25.43) | 22.0 | 4335 (22.39) | 4526 (23.38) | 2.4 |
| Duration of Action of Opioid Use in Second 180 Days | ||||||
| Long-Acting Only | 848 (2.62) | 538 (2.59) | -- | 504 (2.60) | 449 (2.32) | -- |
| Short-Acting Only | 29291 (90.35) | 16031 (77.19) | -- | 17310 (89.42) | 15424 (79.68) | -- |
| Combination of Long and Short-Acting | 2281 (7.04) | 4198 (20.21) | -- | 1544 (7.98) | 3485 (18.00) | -- |
| Schedule of Opioid Use in Second 180 Days | ||||||
| Schedule II Only | 20259 (62.49) | 13687 (65.91) | -- | 12810 (66.17) | 12701 (65.61) | -- |
| Schedule III Only | 1040 (3.21) | 248 (1.19) | -- | 485 (2.51) | 245 (1.27) | -- |
| Schedule IV Only | 6771 (20.89) | 2086 (10.04) | -- | 3199 (16.53) | 2050 (10.59) | -- |
| Schedule V Only | 0 (0.00) | 0 (0.00) | -- | 0 (0.00) | 0 (0.00) | -- |
| Use of Multiple Schedules | 4350 (13.42) | 4746 (22.85) | -- | 2864 (14.79) | 4362 (22.53) | -- |
| Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | |||
| Average Morphine Equivalent Dose | ||||||
| First 180 Days | 30.33 (41.44) | 27.16 (29.52) | 8.8 | 27.75 (29.29) | 26.84 (29.95) | 3.1 |
| Second 180 Days | 30.61 (41.62) | 45.76 (48.41) | -- | 28.04 (29.53) | 44.82 (48.57) | -- |
| Percent Change in Average Morphine Equivalent Dose | 1.13% | 77.29% | -- | 1.20% | 75.98% | -- |
| Pain Characteristics in 180 Days before Dosage Change Index Date | ||||||
| First Pain Score | 4.73 (3.30) | 5.26 (3.20) | 16.1 | 5.16 (3.22) | 5.17 (3.22) | 0.2 |
| Last Pain Score | 3.96 (3.28) | 4.71 (3.26) | 23.1 | 4.54 (3.24) | 4.58 (3.26) | 1.2 |
| Pain Score Average | 4.23 (2.38) | 4.88 (2.30) | 27.8 | 4.76 (2.31) | 4.76 (2.29) | 0.3 |
| Change in Pain Score | −0.77 (3.84) | −0.54 (3.83) | 6.1 | −0.62 (3.84) | −0.59 (3.86) | 0.9 |
| Service Visits in the 12 Months before Dosage Change Index Date Conditional on Use of the Visit Type | ||||||
| Physical Therapy | 3.96 (5.76) | 3.94 (5.87) | -- | 4.05 (6.08) | 3.94 (5.93) | -- |
| Pain Clinic | 3.27 (3.17) | 3.46 (3.64) | -- | 3.28 (3.21) | 3.45 (3.64) | -- |
| Chiropractic Care | 4.25 (4.62) | 4.36 (4.95) | -- | 4.18 (4.79) | 4.30 (5.05) | -- |
| Medicine and Primary Care | 10.66 (7.49) | 10.97 (7.51) | -- | 10.79 (7.51) | 10.90 (7.50) | -- |
| Mental Health Care | 8.40 (11.79) | (10.54) | -- | 8.49 (11.44) | 8.12 (10.59) | -- |