TABLE 1.
Characteristics of Medicare beneficiaries with persistent musculoskeletal pain by treatment phase and county type
| Entire Cohort (N = 69 456) | Phase 1 | Phase 2 | Rural (N = 12 926) | Metropolitan (N = 56 530) | P‐value | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| No opioid prescription (N = 60 334) | Opioid prescription (N = 9122) | P‐value | No opioid prescription (N = 62 011) | Opioid prescription (N = 7445) | P‐value | |||||
| Mean (Standard Deviation)/Number (Percent) | Mean (Standard Deviation)/Number (Percent) | Mean (Standard Deviation)/Number (Percent) | Mean (Standard Deviation)/Number (Percent) | Mean (Standard Deviation)/Number (Percent) | Mean (Standard Deviation)/Number (Percent)) | Mean (Standard Deviation)/Number (Percent) | ||||
| Outcomes | ||||||||||
| Opioid Prescription in Phase 1 | 9122 (13.1) | — | 9122 (100.0) | 6530 (10.5) | 2592 (34.8) | <.001 | 1756 (13.6) | 7366 (13.0) | .09 | |
| Opioid Prescription in Phase 2 | 7445 (10.7) | 4853 (8.0) | 2592 (28.4) | <.001 | — | 7445 (100.0) | 1453 (11.2) | 5992 (10.6) | .03 | |
| Physical Therapy in Phase 1 | 9634 (13.9) | 7297 (12.1) | 2337 (25.6) | <.001 | 8472 (13.7) | 1162 (15.6) | <.001 | 1467 (11.3) | 8167 (14.4) | <.001 |
| Physical Therapy in Phase 2 | 7409 (10.7) | 5490 (9.1) | 1919 (21.0) | <.001 | 5787 (9.3) | 1622 (21.8) | <.001 | 1101 (8.5) | 6308 (11.2) | <.001 |
| Mental Health Services in Phase 1 | 1221 (1.8) | 1065 (1.8) | 156 (1.7) | .71 | 1061 (1.7) | 160 (2.1) | .007 | 97 (0.8) | 1124 (2.0) | <.001 |
| Mental Health Services in Phase 2 | 1105 (1.6) | 973 (1.6) | 132 (1.4) | .24 | 968 (1.6) | 137 (1.8) | .07 | 88 (0.7) | 1017 (1.8) | <.001 |
| Demographics | ||||||||||
| Age | ||||||||||
| 66‐69 y | 20 159 (29.0) | 17 317 (28.7) | 2842 (31.2) | <.001 | 17 858 (28.8) | 2301 (30.9) | <.001 | 3738 (28.9) | 16 421 (29.0) | .77 |
| 70‐74 y | 16 425 (23.6) | 14 184 (23.5) | 2241 (24.6) | .03 | 14 562 (23.5) | 1863 (25.0) | .003 | 3183 (24.6) | 13 242 (23.4) | .004 |
| 75‐79 y | 12 595 (18.1) | 10 970 (18.2) | 1625 (17.8) | .40 | 11 292 (18.2) | 1303 (17.5) | .13 | 2449 (18.9) | 10 146 (17.9) | .008 |
| 80‐84 y | 9911 (14.3) | 8712 (14.4) | 1199 (13.1) | <.001 | 8964 (14.5) | 947 (12.7) | <.001 | 1738 (13.4) | 8173 (14.5) | .003 |
| >85 y | 10 366 (14.9) | 9151 (15.2) | 1215 (13.3) | <.001 | 9335 (15.1) | 1031 (13.8) | .006 | 1818 (14.1) | 8548 (15.1) | .002 |
| Sex | ||||||||||
| Female | 45625 (65.7) | 39 697 (65.8) | 5928 (65.0) | .13 | 40 822 (65.8) | 4803 (64.5) | .02 | 8470 (65.5) | 37 155 (65.7) | .67 |
| Male | 23 831 (34.3) | 20 637 (34.2) | 3 194 (35.0) | .13 | 21 189 (34.2) | 2642 (35.5) | .02 | 4456 (34.5) | 19 375 (34.3) | .67 |
| Race | ||||||||||
| White | 58 871 (84.8) | 51 094 (84.7) | 7777 (85.3) | .16 | 52 553 (84.7) | 6318 (84.9) | .8 | 11 851 (91.7) | 47 020 (83.2) | <.001 |
| Black | 4751 (6.8) | 4093 (6.8) | 658 (7.2) | .13 | 4176 (6.7) | 575 (7.7) | .001 | 727 (5.6) | 4024 (7.1) | <.001 |
| Other race | 5834 (8.4) | 5147 (8.5) | 687 (7.5) | .001 | 5282 (8.5) | 552 (7.4) | .001 | 348 (2.7) | 5486 (9.7) | <.001 |
| Medicaid dual eligible | 13 662 (19.7) | 11 690 (19.4) | 1972 (21.6) | <.001 | 11 953 (19.3) | 1709 (23.0) | <.001 | 2336 (18.1) | 11 326 (20.0) | <.001 |
| Metropolitan county | 56 530 (81.4) | 49 164 (81.5) | 7366 (80.7) | .09 | 50 538 (81.5) | 5992 (80.5) | .03 | — | 56 530 (100.0) | |
| Comorbidities | ||||||||||
| Deyo‐Charlson Comorbidity Score (mean,) | 1.1 (1.4) | 1.1 (1.4) | 1.1 (1.5) | .18 | 1.1 (1.4) | 1.1 (1.5) | .62 | 0.9 (1.3) | 1.1 (1.5) | <.001 |
| 0 | 32 774 (47.2) | 28 415 (47.1) | 4359 (47.8) | .22 | 29 300 (47.2) | 3474 (46.7) | .34 | 6813 (52.7) | 25 961 (45.9) | <.001 |
| 1 | 17 877 (25.7) | 15 532 (25.7) | 2 345 (25.7) | .94 | 15 900 (25.6) | 1 977 (26.6) | .09 | 3 300 (25.5) | 14 577 (25.8) | .55 |
| 2 | 9108 (13.1) | 7925 (13.1) | 1183 (13.0) | .66 | 8145 (13.1) | 963 (12.9) | .63 | 1447 (11.2) | 7661 (13.6) | <.001 |
| >3 | 9697 (14.0) | 8462 (14.0) | 1235 (13.5) | .21 | 8666 (14.0) | 1031 (13.8) | .77 | 1366 (10.6) | 8331 (14.7) | <.001 |
| Anxiety | 1475 (2.1) | 1274 (2.1) | 201 (2.2) | .57 | 1304 (2.1) | 171 (2.3) | .27 | 239 (1.8) | 1236 (2.2) | .02 |
| Depression | 4069 (5.9) | 3519 (5.8) | 550 (6.0) | .46 | 3624 (5.8) | 445 (6.0) | .64 | 625 (4.8) | 3444 (6.1) | <.001 |
| Pain type | ||||||||||
| Arthritis | 68 193 (98.2) | 59 259 (98.2) | 8934 (97.9) | .06 | 60 866 (98.2) | 7327 (98.4) | .11 | 12 719 (98.4) | 55 474 (98.1) | .04 |
| Back pain | 45 664 (65.7) | 39 140 (64.9) | 6524 (71.5) | <.001 | 40 196 (64.8) | 5468 (73.4) | <.001 | 8510 (65.8) | 37 154 (65.7) | .81 |
| Chronic pain | 10 743 (15.5) | 8466 (14.0) | 2277 (25.0) | <.001 | 8798 (14.2) | 1945 (26.1) | <.001 | 2076 (16.1) | 8667 (15.3) | .04 |
| Neck pain | 8201 (11.8) | 6919 (11.5) | 1282 (14.1) | <.001 | 7124 (11.5) | 1077 (14.5) | <.001 | 1326 (10.3) | 6875 (12.2) | <.001 |
| Psychogenic pain | 852 (1.2) | 731 (1.2) | 121 (1.3) | .35 | 741 (1.2) | 111 (1.5) | .03 | 126 (1.0) | 726 (1.3) | .004 |
| Sprain or strain | 19 796 (28.5) | 16 741 (27.7) | 3055 (33.5) | <.001 | 17 406 (28.1) | 2390 (32.1) | <.001 | 3647 (28.2) | 16 149 (28.6) | .42 |
| Fibromyalgia | 47 425 (68.3) | 41 043 (68.0) | 6382 (70.0) | <.001 | 42 066 (67.8) | 5359 (72.0) | <.001 | 8611 (66.6) | 38 814 (68.7) | <.001 |
| Other musculoskeletal pain | 21 269 (30.6) | 17 805 (29.5) | 3 464 (38.0) | <.001 | 18 589 (30.0) | 2680 (36.0) | <.001 | 3812 (29.5) | 17 457 (30.9) | .002 |
| County demographics | ||||||||||
| Mental Health Providers, (Median, interquartile range) a | 3.3 (1.6, 5.7) | 3.3 (1.6, 5.8) | 3.0 (1.4, 5.5) | <.001 | 3.3 (1.6, 5.8) | 2.9 (1.4, 5.4) | <.001 | 1.0 (0.3, 2.1) | 3.9 (2.1, 6.1) | <.001 |
| Physical Therapists, (Median, interquartile range) a | 5.9 (4.0, 7.6) | 6.0 (4.0, 7.7) | 5.6 (3.8, 7.4) | <.001 | 6.0 (4.0, 7.7) | 5.6 (3.8, 7.4) | <.001 | 3.6 (2.2, 5.4) | 6.4 (4.4, 7.9) | <.001 |
| Primary care providers, (Median, interquartile range) a | 6.8 (5.0, 8.9) | 6.9 (5.1, 8.9) | 6.6 (4.9, 8.5) | <.001 | 6.9 (5.1, 8.9) | 6.6 (4.8, 8.5) | <.001 | 5.0 (3.8, 6.6) | 7.2 (5.5, 9.3) | <.001 |
| Surgeons, (Median, interquartile range) a | 5.7 (3.5, 8.0) | 5.7 (3.5, 8.1) | 5.5 (3.3, 7.9) | <.001 | 5.7 (3.5, 8.1) | 5.5 (3.3, 7.9) | <.001 | 2.8 (1.1, 4.5) | 6.4 (4.2, 8.3) | <.001 |
| Pain specialist, (Median, interquartile range) a | 0.3 (0.1, 0.5) | 0.3 (0.1, 0.5) | 0.2 (0.1, 0.4) | <.001 | 0.3 (0.1, 0.5) | 0.2 (0.1, 0.4) | <.001 | 0.0 (0.0, 0.1) | 0.3 (0.2, 0.5) | <.001 |
| Pharmacists, (Median, interquartile range ) a | 8.9 (7.2, 11.2) | 8.9 (7.2, 11.2) | 8.7 (7.2, 11.1) | <.001 | 8.9 (7.2, 11.3) | 8.7 (7.1, 11.0) | <.001 | 7.4 (5.7, 9.3) | 9.3 (7.5, 11.7) | <.001 |
| Midlevel providers, (Median, interquartile range) a | 4.9 (3.3, 7.2) | 4.9 (3.3, 7.2) | 4.9 (3.3, 7.2) | .03 | 4.9 (3.3, 7.2) | 4.8 (3.3, 7.1) | .005 | 4.1 (2.5, 6.1) | 5.1 (3.5, 7.5) | <.001 |
| Proportion of population over 65 | 0.1 (0.0) | 0.1 (0.0) | 0.1 (0.0) | .03 | 0.1 (0.0) | 0.1 (0.0) | .004 | 0.2 (0.0) | 0.1 (0.0) | <.001 |
| Proportion of population in poverty | 0.1 (0.1) | 0.1 (0.1) | 0.1 (0.1) | <.001 | 0.1 (0.1) | 0.1 (0.1) | <.001 | 0.2 (0.1) | 0.1 (0.0) | <.001 |
a
Providers per 10 000 people.