State- and County-Level Geographic Variation in Opioid Use Disorder, Medication Treatment, and Opioid-Related Overdose Among Medicaid Enrollees.
State- and County-Level Geographic Variation in Opioid Use Disorder, Medication Treatment, and Opioid-Related Overdose Among Medicaid Enrollees.
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DOI：
10.1001/jamahealthforum.2023.1574
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发表时间：
2023-06-02
期刊：
影响因子：
--
通讯作者：
McConnell, John
中科院分区：
文献类型：
--
作者：
Lindner, Stephan R.;Hart, Kyle;Manibusan, Brynna;McCarty, Dennis;McConnell, John
本横断面研究分析了2016年至2018年美国各州和县医疗补助计划参保者中阿片类药物使用障碍（OUD）的患病率以及药物治疗和非致命性用药过量的比例。2016年至2018年，在医疗补助计划登记的个体中，基于索赔的阿片类药物使用障碍（OUD）患病率、OUD药物治疗率和与OUD相关的非致命性过量用药率的地理差异是什么？在这项对76 390817个入组年观察的横断面研究中，跨州的OUD患病率从0.6%到9.7%不等，OUD药物治疗率从17.7%到82.8%不等，与OUD相关的过量用药率从0.3%到10.5%不等。各县之间的差异也很大。研究结果表明，需要进一步的研究来确定影响基于索赔的OUD患病率和OUD药物治疗和过量用药率的因素。阿片类药物危机对医疗补助计划参会者的影响不成比例，但关于阿片类药物使用障碍（OUD）的患病率和医疗保健利用在不同地理区域的差异，几乎没有系统的证据存在。在医疗补助计划参保者中，以索赔为基础的OUD患病率、OUD药物治疗率和与OUD相关的非致命性过量用药率的变化特征。这项横断面研究使用了2016年1月1日至2018年12月31日转换医疗补助统计信息系统分析文件的数据。参与者是46个州的医疗补助计划参保者，有或没有OUD；华盛顿特区;年龄在18到64岁之间的波多黎各人，他们没有双重参加医疗保险。该分析是在2022年9月至2023年4月期间进行的。日历年OUD患病率。主要结果是基于索赔的OUD患病率和OUD药物治疗率以及阿片类药物相关非致命性过量的测量。个人记录在州和县一级汇总，并评估州内和州间的差异。在我们的研究中纳入的7639817例医疗补助入组年的观察中（平均[SD]入组年龄36.5[1.6]岁，女性59.0%），2280272例（3.0%）有基于索赔的OUD（平均[SD]年龄38.9[3.6]岁，女性51.4%）。在OUD患者中，41.2%的人由于医疗补助扩张而符合条件，46.4%的人有其他物质使用障碍，55.8%的人有精神健康状况，55.2%的人声称有某种形式的OUD药物，5.8%的人声称在一个日历年内过量服用。基于索赔的结果显示各州之间存在很大差异：OUD患病率从阿肯色州和波多黎各的0.6%到马里兰州的9.7%不等，OUD药物治疗率从堪萨斯州的17.7%到缅因州的82.8%不等，过量用药率从密西西比州的0.3%到伊利诺伊州的10.5%不等。各州之间也发现了明显的差异（例如，马里兰州的OUD患病率从乔治王子县的2.2%到塞西尔县的21.6%不等）。在这项2016年至2018年医疗补助计划参保者的横断面研究中，基于索赔的OUD患病率、OUD药物治疗率和阿片类药物相关过量在各州之间和各州之间存在很大差异。似乎需要进一步的研究来确定影响这种变化的重要因素。
This cross-sectional study analyzes the prevalence of opioid use disorder (OUD) and rates of medication treatment and nonfatal overdose among Medicaid enrollees in the US by state and county from 2016 to 2018. What is the geographic variation in claims-based prevalence of opioid use disorder (OUD) and rates of OUD medication treatment and OUD-related nonfatal overdose among individuals enrolled in Medicaid from 2016 to 2018? In this cross-sectional study of 76 390 817 enrollee-year observations, cross-state OUD prevalence ranged from 0.6% to 9.7%, rates of OUD medication treatment from 17.7% to 82.8%, and rates of OUD-related overdoses from 0.3% to 10.5% across states. Variation was also substantial across counties. The findings suggest that further research is needed to identify factors influencing claims-based OUD prevalence and rates of OUD medication treatment and overdose. The opioid crisis disproportionately affects Medicaid enrollees, yet little systematic evidence exists regarding how prevalence of and health care utilization for opioid use disorder (OUD) vary across geographical areas. To characterize state- and county-level variation in claims-based prevalence of OUD and rates of medication treatment for OUD and OUD-related nonfatal overdose among Medicaid enrollees. This cross-sectional study used data from the Transformed Medicaid Statistical Information System Analytic Files from January 1, 2016, to December 31, 2018. Participants were Medicaid enrollees with or without OUD in 46 states; Washington, DC; and Puerto Rico who were aged 18 to 64 years and not dually enrolled in Medicare. The analysis was conducted between September 2022 and April 2023. Calendar-year OUD prevalence. The main outcomes were claims-based measures of OUD prevalence and rates of medication treatment for OUD and opioid-related nonfatal overdose. Individual records were aggregated at the state and county level, and variation was assessed within and across states. Of the 76 390 817 Medicaid enrollee-year observations included in our study (mean [SD] enrollee age, 36.5 [1.6] years; 59.0% female), 2 280 272 (3.0%) had a claims-based OUD (mean [SD] age, 38.9 [3.6] years; 51.4% female). Of enrollees with OUD, 41.2% were eligible due to Medicaid expansion, 46.4% had other substance use disorders, 55.8% had mental health conditions, 55.2% had claims indicating some form of OUD medication, and 5.8% had claims indicating an overdose during a calendar year. Claims-based outcomes exhibited substantial variation across states: OUD prevalence ranged from 0.6% in Arkansas and Puerto Rico to 9.7% in Maryland, rates of OUD medication treatment ranged from 17.7% in Kansas to 82.8% in Maine, and rates of overdose ranged from 0.3% in Mississippi to 10.5% in Illinois. Pronounced variation was also found within states (eg, OUD prevalence in Maryland ranged from 2.2% in Prince George’s County to 21.6% in Cecil County). In this cross-sectional study of Medicaid enrollees from 2016 to 2018, claims-based prevalence of OUD and rates of OUD medication treatment and opioid-related overdose varied substantially across and within states. Further research appears to be needed to identify important factors influencing this variation.
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