Clinical and demographic characteristics of patients with ADRD and receipt of chronic opioid therapy (COT), overall and by continuation versus discontinuation of COT
| Characteristic . | N (%)a . | SDiffb . | |||
|---|---|---|---|---|---|
| Overall sample (n = 162,677) . | COT continuers (n = 180,916)c . | COT discontinuers (n = 37,124)c . | Before IPTW . | After IPTW . | |
| Age, years | |||||
| Mean (SD) | 83.2 (8.7) | 83.5 (8.7) | 82.6 (8.7) | 0.107 | 0.000 |
| 65–74 | 31,389 (19.3) | 33,186 (18.3) | 7,765 (20.9) | ||
| 75–84 | 52,656 (32.4) | 58,604 (32.4) | 12,685 (34.2) | ||
| ≥85 | 78,632 (48.3) | 89,126 (49.3) | 16,674 (44.9) | ||
| Female | 132,443 (81.1) | 149,648 (82.7) | 29,160 (78.5) | 0.106 | 0.009 |
| Race and ethnicity | 0.176 | 0.000 | |||
| White | 133,372 (82.0) | 150,110 (83.0) | 28,238 (76.1) | ||
| Black | 18,952 (11.7) | 20,390 (11.3) | 5,607 (15.1) | ||
| Otherd | 10,353 (6.4) | 10,416 (5.8) | 3,279 (8.8) | ||
| Receiving low-income subsidy | 143,967 (88.5) | 162,984 (90.1) | 33,378 (89.9) | 0.017 | 0.012 |
| US region | 0.116 | 0.000 | |||
| Northeast | 26,231 (16.1) | 28,505 (15.8) | 6,078 (16.4) | ||
| Midwest | 47,525 (29.2) | 54,288 (30.0) | 9,336 (25.1) | ||
| South | 71,307 (43.8) | 78,791 (43.6) | 17,657 (47.6) | ||
| West | 17,614 (10.8) | 19,332 (10.7) | 4,053 (10.9) | ||
| Body mass index | 0.050 | 0.025 | |||
| Underweight | 10,133 (6.2) | 11,132 (6.2) | 2,291 (6.2) | ||
| Normal weight | 51,558 (31.7) | 54,942 (30.4) | 11,932 (32.1) | ||
| Overweight | 47,238 (29.0) | 52,936 (29.3) | 10,630 (28.6) | ||
| Obese | 53,748 (33.0) | 61,606 (34.1) | 12,271 (33.1) | ||
| Clinical condition | |||||
| Tobacco or alcohol use disorder | 10,713 (6.6) | 10,497 (5.8) | 2,983 (8.0) | 0.088 | 0.010 |
| Mental health disorder | 124,528 (76.5) | 137,560 (76.0) | 29,657 (79.9) | 0.093 | 0.007 |
| Diabetes | 79,171 (48.7) | 85,911 (47.5) | 20,330 (54.8) | 0.146 | 0.006 |
| Cardiovascular disease | 140,529 (86.4) | 154,045 (85.1) | 33,201 (89.4) | 0.129 | 0.008 |
| Hypertension | 146,176 (89.9) | 161,108 (89.1) | 34,190 (92.1) | 0.103 | 0.006 |
| Pulmonary condition | 119,217 (73.3) | 127,906 (70.7) | 29,364 (79.1) | 0.195 | 0.012 |
| Kidney disease | 56,569 (34.8) | 58,336 (32.2) | 15,389 (41.5) | 0.192 | 0.013 |
| Liver disease | 12,741 (7.8) | 12,268 (6.8) | 3,815 (10.3) | 0.125 | 0.016 |
| Gastrointestinal tract disorder | 100,746 (61.9) | 108,011 (59.7) | 24,875 (67.0) | 0.152 | 0.016 |
| Injury | 82,544 (50.7) | 82,142 (45.4) | 21,486 (57.9) | 0.252 | 0.020 |
| Neurodegenerative disorder | 36,312 (22.3) | 38,099 (21.1) | 9,490 (25.6) | 0.107 | 0.002 |
| Drug use disorder | 2,666 (1.6) | 2,481 (1.4) | 729 (2.0) | 0.045 | 0.005 |
| BPSD | 36,887 (22.7) | 40,466 (22.4) | 8,821 (23.8) | 0.033 | 0.006 |
| Total number of comorbidities | 29.4 (12.8) | 27.5 (12.1) | 33.4 (13.4) | 0.461 | 0.020 |
| Health care use | |||||
| Any hospital stay | 59,405 (36.5) | 52,584 (29.1) | 18,576 (50.0) | 0.434 | 0.033 |
| Any ED visit | 48,069 (29.5) | 42,085 (23.3) | 15,399 (41.5) | 0.392 | 0.030 |
| Pain management | |||||
| Drug or non-drug pain intervention | 156,506 (96.2) | 176,562 (97.6) | 34,133 (91.9) | 0.256 | 0.007 |
| Any physical therapy | 112,969 (69.4) | 120,558 (66.6) | 27,476 (74.0) | 0.161 | 0.014 |
| Use of other pain medication | |||||
| Any adjuvant analgesic | 76,994 (47.3) | 88,045 (48.7) | 18,250(49.2) | 0.006 | 0.001 |
| Any prescription non-opioid | 23,797 (14.6) | 25,259 (14.0) | 5,759 (15.5) | 0.043 | 0.001 |
| Use of PRN pain medication | 64,370 (39.6) | 67,260 (37.2) | 15,742 (42.4) | 0.105 | 0.006 |
| Dosage of chronic opioid therapy | 0.305 | 0.025 | |||
| <20 MME/daily | 120,890 (74.3) | 127,332 (70.4) | 30,683 (82.7) | ||
| 20–50 MME/daily | 33,744 (20.7) | 42,864 (23.7) | 5,528 (14.9) | ||
| >50 MME/daily | 8,043 (4.9) | 10,720 (5.9) | 913 (2.5) | ||
| Use of long-acting opioid | 34,272 (21.1) | 43,477 (24.0) | 4,948 (13.3) | 0.279 | 0.021 |
| Medication use | |||||
| Use of other CNS medication | 128,226 (78.8) | 141,729 (78.3) | 29,559 (79.6) | 0.030 | 0.001 |
| Use of other ADRD medication | 56,002 (34.4) | 61,057 (33.7) | 13,587 (36.6) | 0.061 | 0.002 |
| Polypharmacy | 152,455 (93.7) | 168,657 (93.2) | 35,199 (94.8) | 0.066 | 0.002 |
| Any opioid-related side effect | 9,494 (5.8) | 11,448 (6.3) | 2,487 (6.7) | 0.015 | 0.003 |
| Dementia severity | 0.050 | 0.035 | |||
| Mild | 93,839 (57.7) | 104,659 (57.8) | 21,086 (56.8) | ||
| Moderate | 53,721 (33.0) | 58,574 (32.4) | 12,752 (34.3) | ||
| Severe | 15,117 (9.3) | 17,683 (9.8) | 3,286 (8.9) | ||
| Physical dependence | 0.094 | 0.025 | |||
| No (ADL ≤ 9) | 24,036 (14.8) | 27,310 (15.1) | 4,530 (12.2) | ||
| Mild (10 ≤ ADL ≤ 18) | 28,618 (17.6) | 31–64 (17.2) | 6,455 (17.4) | ||
| Moderate (19 ≤ ADL ≤ 27) | 66,308 (40.8) | 72,252 (39.9) | 15,879 (42.8) | ||
| Severe (ADL ≥ 28) | 43,715 (26.9) | 50,290 (27.8) | 10,260 (27.6) | ||
| Depression status | 0.076 | 0.000 | |||
| No (PHQ-9 ≤ 4) | 126,952 (78.0) | 142,093 (78.5) | 29,381 (79.1) | ||
| Mild (5 ≤ PHQ-9 ≤ 9) | 24,838 (15.3) | 27,358 (15.1) | 5,234 (14.1) | ||
| Moderate (10 ≤ PHQ-9 ≤ 14) | 8,254 (5.1) | 8,730 (4.8) | 1932 (5.2) | ||
| Severe (PHQ-9 ≥ 15) | 2,633 (1.6) | 2,735 (1.5) | 577 (1.6) | ||
| Pain statuse | 0.074 | 0.000 | |||
| No | 84,077 (51.7) | 95,137 (52.6) | 20,114 (54.2) | ||
| Mild | 25,481 (15.7) | 28,272 (15.6) | 5,733 (15.4) | ||
| Moderate | 35,658 (21.9) | 38,392 (21.2) | 7,808(21.0) | ||
| Severe | 15,634 (9.6) | 17,098 (9.4) | 3,026 (8.2) | ||
| Able to communicate | 138,106 (84.9) | 152,883 (84.5) | 31,587 (85.1) | 0.017 | 0.001 |
| Time since ADRD diagnosis, years | 0.081 | 0.007 | |||
| Mean (SD) | 4.6 (3.6) | 5.3 (3.8) | 5.0 (3.8) | ||
| Year of the index date | 0.109 | 0.000 | |||
| 2011 | 36,067 (22.2) | 30,558 (16.9) | 5,509 (14.8) | ||
| 2012 | 24,201 (14.9) | 22,636 (12.5) | 4,979 (13.4) | ||
| 2013 | 20,347 (12.5) | 24,452 (13.5) | 4,879 (13.1) | ||
| 2014 | 19,227 (11.8) | 22,702 (12.5) | 5,149 (13.8) | ||
| 2015 | 16,320 (10.0) | 21,153 (11.7) | 4,108 (11.1) | ||
| 2016 | 15,584 (9.6) | 19,896 (11.0) | 4,023 (10.8) | ||
| 2017 | 14,569 (9.0) | 18,314 (10.1) | 3,945 (10.6) | ||
| 2018 | 8,709 (5.4) | 11,130 (6.2) | 2,378 (6.4) | ||
| 2019 | 7,653 (4.7) | 10,075 (5.6) | 2,154 (5.8) | ||
| Characteristic . | N (%)a . | SDiffb . | |||
|---|---|---|---|---|---|
| Overall sample (n = 162,677) . | COT continuers (n = 180,916)c . | COT discontinuers (n = 37,124)c . | Before IPTW . | After IPTW . | |
| Age, years | |||||
| Mean (SD) | 83.2 (8.7) | 83.5 (8.7) | 82.6 (8.7) | 0.107 | 0.000 |
| 65–74 | 31,389 (19.3) | 33,186 (18.3) | 7,765 (20.9) | ||
| 75–84 | 52,656 (32.4) | 58,604 (32.4) | 12,685 (34.2) | ||
| ≥85 | 78,632 (48.3) | 89,126 (49.3) | 16,674 (44.9) | ||
| Female | 132,443 (81.1) | 149,648 (82.7) | 29,160 (78.5) | 0.106 | 0.009 |
| Race and ethnicity | 0.176 | 0.000 | |||
| White | 133,372 (82.0) | 150,110 (83.0) | 28,238 (76.1) | ||
| Black | 18,952 (11.7) | 20,390 (11.3) | 5,607 (15.1) | ||
| Otherd | 10,353 (6.4) | 10,416 (5.8) | 3,279 (8.8) | ||
| Receiving low-income subsidy | 143,967 (88.5) | 162,984 (90.1) | 33,378 (89.9) | 0.017 | 0.012 |
| US region | 0.116 | 0.000 | |||
| Northeast | 26,231 (16.1) | 28,505 (15.8) | 6,078 (16.4) | ||
| Midwest | 47,525 (29.2) | 54,288 (30.0) | 9,336 (25.1) | ||
| South | 71,307 (43.8) | 78,791 (43.6) | 17,657 (47.6) | ||
| West | 17,614 (10.8) | 19,332 (10.7) | 4,053 (10.9) | ||
| Body mass index | 0.050 | 0.025 | |||
| Underweight | 10,133 (6.2) | 11,132 (6.2) | 2,291 (6.2) | ||
| Normal weight | 51,558 (31.7) | 54,942 (30.4) | 11,932 (32.1) | ||
| Overweight | 47,238 (29.0) | 52,936 (29.3) | 10,630 (28.6) | ||
| Obese | 53,748 (33.0) | 61,606 (34.1) | 12,271 (33.1) | ||
| Clinical condition | |||||
| Tobacco or alcohol use disorder | 10,713 (6.6) | 10,497 (5.8) | 2,983 (8.0) | 0.088 | 0.010 |
| Mental health disorder | 124,528 (76.5) | 137,560 (76.0) | 29,657 (79.9) | 0.093 | 0.007 |
| Diabetes | 79,171 (48.7) | 85,911 (47.5) | 20,330 (54.8) | 0.146 | 0.006 |
| Cardiovascular disease | 140,529 (86.4) | 154,045 (85.1) | 33,201 (89.4) | 0.129 | 0.008 |
| Hypertension | 146,176 (89.9) | 161,108 (89.1) | 34,190 (92.1) | 0.103 | 0.006 |
| Pulmonary condition | 119,217 (73.3) | 127,906 (70.7) | 29,364 (79.1) | 0.195 | 0.012 |
| Kidney disease | 56,569 (34.8) | 58,336 (32.2) | 15,389 (41.5) | 0.192 | 0.013 |
| Liver disease | 12,741 (7.8) | 12,268 (6.8) | 3,815 (10.3) | 0.125 | 0.016 |
| Gastrointestinal tract disorder | 100,746 (61.9) | 108,011 (59.7) | 24,875 (67.0) | 0.152 | 0.016 |
| Injury | 82,544 (50.7) | 82,142 (45.4) | 21,486 (57.9) | 0.252 | 0.020 |
| Neurodegenerative disorder | 36,312 (22.3) | 38,099 (21.1) | 9,490 (25.6) | 0.107 | 0.002 |
| Drug use disorder | 2,666 (1.6) | 2,481 (1.4) | 729 (2.0) | 0.045 | 0.005 |
| BPSD | 36,887 (22.7) | 40,466 (22.4) | 8,821 (23.8) | 0.033 | 0.006 |
| Total number of comorbidities | 29.4 (12.8) | 27.5 (12.1) | 33.4 (13.4) | 0.461 | 0.020 |
| Health care use | |||||
| Any hospital stay | 59,405 (36.5) | 52,584 (29.1) | 18,576 (50.0) | 0.434 | 0.033 |
| Any ED visit | 48,069 (29.5) | 42,085 (23.3) | 15,399 (41.5) | 0.392 | 0.030 |
| Pain management | |||||
| Drug or non-drug pain intervention | 156,506 (96.2) | 176,562 (97.6) | 34,133 (91.9) | 0.256 | 0.007 |
| Any physical therapy | 112,969 (69.4) | 120,558 (66.6) | 27,476 (74.0) | 0.161 | 0.014 |
| Use of other pain medication | |||||
| Any adjuvant analgesic | 76,994 (47.3) | 88,045 (48.7) | 18,250(49.2) | 0.006 | 0.001 |
| Any prescription non-opioid | 23,797 (14.6) | 25,259 (14.0) | 5,759 (15.5) | 0.043 | 0.001 |
| Use of PRN pain medication | 64,370 (39.6) | 67,260 (37.2) | 15,742 (42.4) | 0.105 | 0.006 |
| Dosage of chronic opioid therapy | 0.305 | 0.025 | |||
| <20 MME/daily | 120,890 (74.3) | 127,332 (70.4) | 30,683 (82.7) | ||
| 20–50 MME/daily | 33,744 (20.7) | 42,864 (23.7) | 5,528 (14.9) | ||
| >50 MME/daily | 8,043 (4.9) | 10,720 (5.9) | 913 (2.5) | ||
| Use of long-acting opioid | 34,272 (21.1) | 43,477 (24.0) | 4,948 (13.3) | 0.279 | 0.021 |
| Medication use | |||||
| Use of other CNS medication | 128,226 (78.8) | 141,729 (78.3) | 29,559 (79.6) | 0.030 | 0.001 |
| Use of other ADRD medication | 56,002 (34.4) | 61,057 (33.7) | 13,587 (36.6) | 0.061 | 0.002 |
| Polypharmacy | 152,455 (93.7) | 168,657 (93.2) | 35,199 (94.8) | 0.066 | 0.002 |
| Any opioid-related side effect | 9,494 (5.8) | 11,448 (6.3) | 2,487 (6.7) | 0.015 | 0.003 |
| Dementia severity | 0.050 | 0.035 | |||
| Mild | 93,839 (57.7) | 104,659 (57.8) | 21,086 (56.8) | ||
| Moderate | 53,721 (33.0) | 58,574 (32.4) | 12,752 (34.3) | ||
| Severe | 15,117 (9.3) | 17,683 (9.8) | 3,286 (8.9) | ||
| Physical dependence | 0.094 | 0.025 | |||
| No (ADL ≤ 9) | 24,036 (14.8) | 27,310 (15.1) | 4,530 (12.2) | ||
| Mild (10 ≤ ADL ≤ 18) | 28,618 (17.6) | 31–64 (17.2) | 6,455 (17.4) | ||
| Moderate (19 ≤ ADL ≤ 27) | 66,308 (40.8) | 72,252 (39.9) | 15,879 (42.8) | ||
| Severe (ADL ≥ 28) | 43,715 (26.9) | 50,290 (27.8) | 10,260 (27.6) | ||
| Depression status | 0.076 | 0.000 | |||
| No (PHQ-9 ≤ 4) | 126,952 (78.0) | 142,093 (78.5) | 29,381 (79.1) | ||
| Mild (5 ≤ PHQ-9 ≤ 9) | 24,838 (15.3) | 27,358 (15.1) | 5,234 (14.1) | ||
| Moderate (10 ≤ PHQ-9 ≤ 14) | 8,254 (5.1) | 8,730 (4.8) | 1932 (5.2) | ||
| Severe (PHQ-9 ≥ 15) | 2,633 (1.6) | 2,735 (1.5) | 577 (1.6) | ||
| Pain statuse | 0.074 | 0.000 | |||
| No | 84,077 (51.7) | 95,137 (52.6) | 20,114 (54.2) | ||
| Mild | 25,481 (15.7) | 28,272 (15.6) | 5,733 (15.4) | ||
| Moderate | 35,658 (21.9) | 38,392 (21.2) | 7,808(21.0) | ||
| Severe | 15,634 (9.6) | 17,098 (9.4) | 3,026 (8.2) | ||
| Able to communicate | 138,106 (84.9) | 152,883 (84.5) | 31,587 (85.1) | 0.017 | 0.001 |
| Time since ADRD diagnosis, years | 0.081 | 0.007 | |||
| Mean (SD) | 4.6 (3.6) | 5.3 (3.8) | 5.0 (3.8) | ||
| Year of the index date | 0.109 | 0.000 | |||
| 2011 | 36,067 (22.2) | 30,558 (16.9) | 5,509 (14.8) | ||
| 2012 | 24,201 (14.9) | 22,636 (12.5) | 4,979 (13.4) | ||
| 2013 | 20,347 (12.5) | 24,452 (13.5) | 4,879 (13.1) | ||
| 2014 | 19,227 (11.8) | 22,702 (12.5) | 5,149 (13.8) | ||
| 2015 | 16,320 (10.0) | 21,153 (11.7) | 4,108 (11.1) | ||
| 2016 | 15,584 (9.6) | 19,896 (11.0) | 4,023 (10.8) | ||
| 2017 | 14,569 (9.0) | 18,314 (10.1) | 3,945 (10.6) | ||
| 2018 | 8,709 (5.4) | 11,130 (6.2) | 2,378 (6.4) | ||
| 2019 | 7,653 (4.7) | 10,075 (5.6) | 2,154 (5.8) | ||
Abbreviations: SDiff, standardised difference; BPSD, behavioural and psychological symptoms of dementia; PRN, pro re nata (as needed); ADL, activities of daily living; PHQ-9, Patient Health Questionnaire-9.
aClinical conditions and health care use were measured in the year and other characteristics were measured in the 6 months before index date index date (i.e. opioid discontinuation for discontinuers and frequency-matched date for continuers)
bCovariates with SDiff >0.100 represent meaningful differences between groups.
cA patient can contribute to more than one COT episode.
dIncluded Asian, Hispanic, Native American and Pacific Islander individuals.
eHad <1.2% of missing values.
Clinical and demographic characteristics of patients with ADRD and receipt of chronic opioid therapy (COT), overall and by continuation versus discontinuation of COT
| Characteristic . | N (%)a . | SDiffb . | |||
|---|---|---|---|---|---|
| Overall sample (n = 162,677) . | COT continuers (n = 180,916)c . | COT discontinuers (n = 37,124)c . | Before IPTW . | After IPTW . | |
| Age, years | |||||
| Mean (SD) | 83.2 (8.7) | 83.5 (8.7) | 82.6 (8.7) | 0.107 | 0.000 |
| 65–74 | 31,389 (19.3) | 33,186 (18.3) | 7,765 (20.9) | ||
| 75–84 | 52,656 (32.4) | 58,604 (32.4) | 12,685 (34.2) | ||
| ≥85 | 78,632 (48.3) | 89,126 (49.3) | 16,674 (44.9) | ||
| Female | 132,443 (81.1) | 149,648 (82.7) | 29,160 (78.5) | 0.106 | 0.009 |
| Race and ethnicity | 0.176 | 0.000 | |||
| White | 133,372 (82.0) | 150,110 (83.0) | 28,238 (76.1) | ||
| Black | 18,952 (11.7) | 20,390 (11.3) | 5,607 (15.1) | ||
| Otherd | 10,353 (6.4) | 10,416 (5.8) | 3,279 (8.8) | ||
| Receiving low-income subsidy | 143,967 (88.5) | 162,984 (90.1) | 33,378 (89.9) | 0.017 | 0.012 |
| US region | 0.116 | 0.000 | |||
| Northeast | 26,231 (16.1) | 28,505 (15.8) | 6,078 (16.4) | ||
| Midwest | 47,525 (29.2) | 54,288 (30.0) | 9,336 (25.1) | ||
| South | 71,307 (43.8) | 78,791 (43.6) | 17,657 (47.6) | ||
| West | 17,614 (10.8) | 19,332 (10.7) | 4,053 (10.9) | ||
| Body mass index | 0.050 | 0.025 | |||
| Underweight | 10,133 (6.2) | 11,132 (6.2) | 2,291 (6.2) | ||
| Normal weight | 51,558 (31.7) | 54,942 (30.4) | 11,932 (32.1) | ||
| Overweight | 47,238 (29.0) | 52,936 (29.3) | 10,630 (28.6) | ||
| Obese | 53,748 (33.0) | 61,606 (34.1) | 12,271 (33.1) | ||
| Clinical condition | |||||
| Tobacco or alcohol use disorder | 10,713 (6.6) | 10,497 (5.8) | 2,983 (8.0) | 0.088 | 0.010 |
| Mental health disorder | 124,528 (76.5) | 137,560 (76.0) | 29,657 (79.9) | 0.093 | 0.007 |
| Diabetes | 79,171 (48.7) | 85,911 (47.5) | 20,330 (54.8) | 0.146 | 0.006 |
| Cardiovascular disease | 140,529 (86.4) | 154,045 (85.1) | 33,201 (89.4) | 0.129 | 0.008 |
| Hypertension | 146,176 (89.9) | 161,108 (89.1) | 34,190 (92.1) | 0.103 | 0.006 |
| Pulmonary condition | 119,217 (73.3) | 127,906 (70.7) | 29,364 (79.1) | 0.195 | 0.012 |
| Kidney disease | 56,569 (34.8) | 58,336 (32.2) | 15,389 (41.5) | 0.192 | 0.013 |
| Liver disease | 12,741 (7.8) | 12,268 (6.8) | 3,815 (10.3) | 0.125 | 0.016 |
| Gastrointestinal tract disorder | 100,746 (61.9) | 108,011 (59.7) | 24,875 (67.0) | 0.152 | 0.016 |
| Injury | 82,544 (50.7) | 82,142 (45.4) | 21,486 (57.9) | 0.252 | 0.020 |
| Neurodegenerative disorder | 36,312 (22.3) | 38,099 (21.1) | 9,490 (25.6) | 0.107 | 0.002 |
| Drug use disorder | 2,666 (1.6) | 2,481 (1.4) | 729 (2.0) | 0.045 | 0.005 |
| BPSD | 36,887 (22.7) | 40,466 (22.4) | 8,821 (23.8) | 0.033 | 0.006 |
| Total number of comorbidities | 29.4 (12.8) | 27.5 (12.1) | 33.4 (13.4) | 0.461 | 0.020 |
| Health care use | |||||
| Any hospital stay | 59,405 (36.5) | 52,584 (29.1) | 18,576 (50.0) | 0.434 | 0.033 |
| Any ED visit | 48,069 (29.5) | 42,085 (23.3) | 15,399 (41.5) | 0.392 | 0.030 |
| Pain management | |||||
| Drug or non-drug pain intervention | 156,506 (96.2) | 176,562 (97.6) | 34,133 (91.9) | 0.256 | 0.007 |
| Any physical therapy | 112,969 (69.4) | 120,558 (66.6) | 27,476 (74.0) | 0.161 | 0.014 |
| Use of other pain medication | |||||
| Any adjuvant analgesic | 76,994 (47.3) | 88,045 (48.7) | 18,250(49.2) | 0.006 | 0.001 |
| Any prescription non-opioid | 23,797 (14.6) | 25,259 (14.0) | 5,759 (15.5) | 0.043 | 0.001 |
| Use of PRN pain medication | 64,370 (39.6) | 67,260 (37.2) | 15,742 (42.4) | 0.105 | 0.006 |
| Dosage of chronic opioid therapy | 0.305 | 0.025 | |||
| <20 MME/daily | 120,890 (74.3) | 127,332 (70.4) | 30,683 (82.7) | ||
| 20–50 MME/daily | 33,744 (20.7) | 42,864 (23.7) | 5,528 (14.9) | ||
| >50 MME/daily | 8,043 (4.9) | 10,720 (5.9) | 913 (2.5) | ||
| Use of long-acting opioid | 34,272 (21.1) | 43,477 (24.0) | 4,948 (13.3) | 0.279 | 0.021 |
| Medication use | |||||
| Use of other CNS medication | 128,226 (78.8) | 141,729 (78.3) | 29,559 (79.6) | 0.030 | 0.001 |
| Use of other ADRD medication | 56,002 (34.4) | 61,057 (33.7) | 13,587 (36.6) | 0.061 | 0.002 |
| Polypharmacy | 152,455 (93.7) | 168,657 (93.2) | 35,199 (94.8) | 0.066 | 0.002 |
| Any opioid-related side effect | 9,494 (5.8) | 11,448 (6.3) | 2,487 (6.7) | 0.015 | 0.003 |
| Dementia severity | 0.050 | 0.035 | |||
| Mild | 93,839 (57.7) | 104,659 (57.8) | 21,086 (56.8) | ||
| Moderate | 53,721 (33.0) | 58,574 (32.4) | 12,752 (34.3) | ||
| Severe | 15,117 (9.3) | 17,683 (9.8) | 3,286 (8.9) | ||
| Physical dependence | 0.094 | 0.025 | |||
| No (ADL ≤ 9) | 24,036 (14.8) | 27,310 (15.1) | 4,530 (12.2) | ||
| Mild (10 ≤ ADL ≤ 18) | 28,618 (17.6) | 31–64 (17.2) | 6,455 (17.4) | ||
| Moderate (19 ≤ ADL ≤ 27) | 66,308 (40.8) | 72,252 (39.9) | 15,879 (42.8) | ||
| Severe (ADL ≥ 28) | 43,715 (26.9) | 50,290 (27.8) | 10,260 (27.6) | ||
| Depression status | 0.076 | 0.000 | |||
| No (PHQ-9 ≤ 4) | 126,952 (78.0) | 142,093 (78.5) | 29,381 (79.1) | ||
| Mild (5 ≤ PHQ-9 ≤ 9) | 24,838 (15.3) | 27,358 (15.1) | 5,234 (14.1) | ||
| Moderate (10 ≤ PHQ-9 ≤ 14) | 8,254 (5.1) | 8,730 (4.8) | 1932 (5.2) | ||
| Severe (PHQ-9 ≥ 15) | 2,633 (1.6) | 2,735 (1.5) | 577 (1.6) | ||
| Pain statuse | 0.074 | 0.000 | |||
| No | 84,077 (51.7) | 95,137 (52.6) | 20,114 (54.2) | ||
| Mild | 25,481 (15.7) | 28,272 (15.6) | 5,733 (15.4) | ||
| Moderate | 35,658 (21.9) | 38,392 (21.2) | 7,808(21.0) | ||
| Severe | 15,634 (9.6) | 17,098 (9.4) | 3,026 (8.2) | ||
| Able to communicate | 138,106 (84.9) | 152,883 (84.5) | 31,587 (85.1) | 0.017 | 0.001 |
| Time since ADRD diagnosis, years | 0.081 | 0.007 | |||
| Mean (SD) | 4.6 (3.6) | 5.3 (3.8) | 5.0 (3.8) | ||
| Year of the index date | 0.109 | 0.000 | |||
| 2011 | 36,067 (22.2) | 30,558 (16.9) | 5,509 (14.8) | ||
| 2012 | 24,201 (14.9) | 22,636 (12.5) | 4,979 (13.4) | ||
| 2013 | 20,347 (12.5) | 24,452 (13.5) | 4,879 (13.1) | ||
| 2014 | 19,227 (11.8) | 22,702 (12.5) | 5,149 (13.8) | ||
| 2015 | 16,320 (10.0) | 21,153 (11.7) | 4,108 (11.1) | ||
| 2016 | 15,584 (9.6) | 19,896 (11.0) | 4,023 (10.8) | ||
| 2017 | 14,569 (9.0) | 18,314 (10.1) | 3,945 (10.6) | ||
| 2018 | 8,709 (5.4) | 11,130 (6.2) | 2,378 (6.4) | ||
| 2019 | 7,653 (4.7) | 10,075 (5.6) | 2,154 (5.8) | ||
| Characteristic . | N (%)a . | SDiffb . | |||
|---|---|---|---|---|---|
| Overall sample (n = 162,677) . | COT continuers (n = 180,916)c . | COT discontinuers (n = 37,124)c . | Before IPTW . | After IPTW . | |
| Age, years | |||||
| Mean (SD) | 83.2 (8.7) | 83.5 (8.7) | 82.6 (8.7) | 0.107 | 0.000 |
| 65–74 | 31,389 (19.3) | 33,186 (18.3) | 7,765 (20.9) | ||
| 75–84 | 52,656 (32.4) | 58,604 (32.4) | 12,685 (34.2) | ||
| ≥85 | 78,632 (48.3) | 89,126 (49.3) | 16,674 (44.9) | ||
| Female | 132,443 (81.1) | 149,648 (82.7) | 29,160 (78.5) | 0.106 | 0.009 |
| Race and ethnicity | 0.176 | 0.000 | |||
| White | 133,372 (82.0) | 150,110 (83.0) | 28,238 (76.1) | ||
| Black | 18,952 (11.7) | 20,390 (11.3) | 5,607 (15.1) | ||
| Otherd | 10,353 (6.4) | 10,416 (5.8) | 3,279 (8.8) | ||
| Receiving low-income subsidy | 143,967 (88.5) | 162,984 (90.1) | 33,378 (89.9) | 0.017 | 0.012 |
| US region | 0.116 | 0.000 | |||
| Northeast | 26,231 (16.1) | 28,505 (15.8) | 6,078 (16.4) | ||
| Midwest | 47,525 (29.2) | 54,288 (30.0) | 9,336 (25.1) | ||
| South | 71,307 (43.8) | 78,791 (43.6) | 17,657 (47.6) | ||
| West | 17,614 (10.8) | 19,332 (10.7) | 4,053 (10.9) | ||
| Body mass index | 0.050 | 0.025 | |||
| Underweight | 10,133 (6.2) | 11,132 (6.2) | 2,291 (6.2) | ||
| Normal weight | 51,558 (31.7) | 54,942 (30.4) | 11,932 (32.1) | ||
| Overweight | 47,238 (29.0) | 52,936 (29.3) | 10,630 (28.6) | ||
| Obese | 53,748 (33.0) | 61,606 (34.1) | 12,271 (33.1) | ||
| Clinical condition | |||||
| Tobacco or alcohol use disorder | 10,713 (6.6) | 10,497 (5.8) | 2,983 (8.0) | 0.088 | 0.010 |
| Mental health disorder | 124,528 (76.5) | 137,560 (76.0) | 29,657 (79.9) | 0.093 | 0.007 |
| Diabetes | 79,171 (48.7) | 85,911 (47.5) | 20,330 (54.8) | 0.146 | 0.006 |
| Cardiovascular disease | 140,529 (86.4) | 154,045 (85.1) | 33,201 (89.4) | 0.129 | 0.008 |
| Hypertension | 146,176 (89.9) | 161,108 (89.1) | 34,190 (92.1) | 0.103 | 0.006 |
| Pulmonary condition | 119,217 (73.3) | 127,906 (70.7) | 29,364 (79.1) | 0.195 | 0.012 |
| Kidney disease | 56,569 (34.8) | 58,336 (32.2) | 15,389 (41.5) | 0.192 | 0.013 |
| Liver disease | 12,741 (7.8) | 12,268 (6.8) | 3,815 (10.3) | 0.125 | 0.016 |
| Gastrointestinal tract disorder | 100,746 (61.9) | 108,011 (59.7) | 24,875 (67.0) | 0.152 | 0.016 |
| Injury | 82,544 (50.7) | 82,142 (45.4) | 21,486 (57.9) | 0.252 | 0.020 |
| Neurodegenerative disorder | 36,312 (22.3) | 38,099 (21.1) | 9,490 (25.6) | 0.107 | 0.002 |
| Drug use disorder | 2,666 (1.6) | 2,481 (1.4) | 729 (2.0) | 0.045 | 0.005 |
| BPSD | 36,887 (22.7) | 40,466 (22.4) | 8,821 (23.8) | 0.033 | 0.006 |
| Total number of comorbidities | 29.4 (12.8) | 27.5 (12.1) | 33.4 (13.4) | 0.461 | 0.020 |
| Health care use | |||||
| Any hospital stay | 59,405 (36.5) | 52,584 (29.1) | 18,576 (50.0) | 0.434 | 0.033 |
| Any ED visit | 48,069 (29.5) | 42,085 (23.3) | 15,399 (41.5) | 0.392 | 0.030 |
| Pain management | |||||
| Drug or non-drug pain intervention | 156,506 (96.2) | 176,562 (97.6) | 34,133 (91.9) | 0.256 | 0.007 |
| Any physical therapy | 112,969 (69.4) | 120,558 (66.6) | 27,476 (74.0) | 0.161 | 0.014 |
| Use of other pain medication | |||||
| Any adjuvant analgesic | 76,994 (47.3) | 88,045 (48.7) | 18,250(49.2) | 0.006 | 0.001 |
| Any prescription non-opioid | 23,797 (14.6) | 25,259 (14.0) | 5,759 (15.5) | 0.043 | 0.001 |
| Use of PRN pain medication | 64,370 (39.6) | 67,260 (37.2) | 15,742 (42.4) | 0.105 | 0.006 |
| Dosage of chronic opioid therapy | 0.305 | 0.025 | |||
| <20 MME/daily | 120,890 (74.3) | 127,332 (70.4) | 30,683 (82.7) | ||
| 20–50 MME/daily | 33,744 (20.7) | 42,864 (23.7) | 5,528 (14.9) | ||
| >50 MME/daily | 8,043 (4.9) | 10,720 (5.9) | 913 (2.5) | ||
| Use of long-acting opioid | 34,272 (21.1) | 43,477 (24.0) | 4,948 (13.3) | 0.279 | 0.021 |
| Medication use | |||||
| Use of other CNS medication | 128,226 (78.8) | 141,729 (78.3) | 29,559 (79.6) | 0.030 | 0.001 |
| Use of other ADRD medication | 56,002 (34.4) | 61,057 (33.7) | 13,587 (36.6) | 0.061 | 0.002 |
| Polypharmacy | 152,455 (93.7) | 168,657 (93.2) | 35,199 (94.8) | 0.066 | 0.002 |
| Any opioid-related side effect | 9,494 (5.8) | 11,448 (6.3) | 2,487 (6.7) | 0.015 | 0.003 |
| Dementia severity | 0.050 | 0.035 | |||
| Mild | 93,839 (57.7) | 104,659 (57.8) | 21,086 (56.8) | ||
| Moderate | 53,721 (33.0) | 58,574 (32.4) | 12,752 (34.3) | ||
| Severe | 15,117 (9.3) | 17,683 (9.8) | 3,286 (8.9) | ||
| Physical dependence | 0.094 | 0.025 | |||
| No (ADL ≤ 9) | 24,036 (14.8) | 27,310 (15.1) | 4,530 (12.2) | ||
| Mild (10 ≤ ADL ≤ 18) | 28,618 (17.6) | 31–64 (17.2) | 6,455 (17.4) | ||
| Moderate (19 ≤ ADL ≤ 27) | 66,308 (40.8) | 72,252 (39.9) | 15,879 (42.8) | ||
| Severe (ADL ≥ 28) | 43,715 (26.9) | 50,290 (27.8) | 10,260 (27.6) | ||
| Depression status | 0.076 | 0.000 | |||
| No (PHQ-9 ≤ 4) | 126,952 (78.0) | 142,093 (78.5) | 29,381 (79.1) | ||
| Mild (5 ≤ PHQ-9 ≤ 9) | 24,838 (15.3) | 27,358 (15.1) | 5,234 (14.1) | ||
| Moderate (10 ≤ PHQ-9 ≤ 14) | 8,254 (5.1) | 8,730 (4.8) | 1932 (5.2) | ||
| Severe (PHQ-9 ≥ 15) | 2,633 (1.6) | 2,735 (1.5) | 577 (1.6) | ||
| Pain statuse | 0.074 | 0.000 | |||
| No | 84,077 (51.7) | 95,137 (52.6) | 20,114 (54.2) | ||
| Mild | 25,481 (15.7) | 28,272 (15.6) | 5,733 (15.4) | ||
| Moderate | 35,658 (21.9) | 38,392 (21.2) | 7,808(21.0) | ||
| Severe | 15,634 (9.6) | 17,098 (9.4) | 3,026 (8.2) | ||
| Able to communicate | 138,106 (84.9) | 152,883 (84.5) | 31,587 (85.1) | 0.017 | 0.001 |
| Time since ADRD diagnosis, years | 0.081 | 0.007 | |||
| Mean (SD) | 4.6 (3.6) | 5.3 (3.8) | 5.0 (3.8) | ||
| Year of the index date | 0.109 | 0.000 | |||
| 2011 | 36,067 (22.2) | 30,558 (16.9) | 5,509 (14.8) | ||
| 2012 | 24,201 (14.9) | 22,636 (12.5) | 4,979 (13.4) | ||
| 2013 | 20,347 (12.5) | 24,452 (13.5) | 4,879 (13.1) | ||
| 2014 | 19,227 (11.8) | 22,702 (12.5) | 5,149 (13.8) | ||
| 2015 | 16,320 (10.0) | 21,153 (11.7) | 4,108 (11.1) | ||
| 2016 | 15,584 (9.6) | 19,896 (11.0) | 4,023 (10.8) | ||
| 2017 | 14,569 (9.0) | 18,314 (10.1) | 3,945 (10.6) | ||
| 2018 | 8,709 (5.4) | 11,130 (6.2) | 2,378 (6.4) | ||
| 2019 | 7,653 (4.7) | 10,075 (5.6) | 2,154 (5.8) | ||
Abbreviations: SDiff, standardised difference; BPSD, behavioural and psychological symptoms of dementia; PRN, pro re nata (as needed); ADL, activities of daily living; PHQ-9, Patient Health Questionnaire-9.
aClinical conditions and health care use were measured in the year and other characteristics were measured in the 6 months before index date index date (i.e. opioid discontinuation for discontinuers and frequency-matched date for continuers)
bCovariates with SDiff >0.100 represent meaningful differences between groups.
cA patient can contribute to more than one COT episode.
dIncluded Asian, Hispanic, Native American and Pacific Islander individuals.
eHad <1.2% of missing values.
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