Association of Disability With Mortality From Opioid Overdose Among US Medicare Adults

Key Points

Question: What is the rate of opioid overdose deaths among Medicare enrollees younger than 65 years who qualified for Medicare because of disability?

Findings: In this cohort study, the 1 766 790 adult Medicare enrollees who qualified for disability—representing 14.9% of the Medicare population—accounted for 80.8% of all opioid overdose deaths among all Medicare enrollees. Among the 11.1% of the enrollees with disability who had 3 co-occurring conditions of substance abuse, psychiatric diseases, and chronic pain syndrome, the opioid overdose death rate was 23.4 times higher than that for enrollees without any of the conditions.

Meaning: Understanding the heterogeneity of medical and psychiatric conditions associated with opioid use and misuse is key to developing specific, data-driven interventions targeted for each subgroup of high-risk populations.

Abstract

Importance: Patients qualifying for Medicare disability have the highest rates of opioid use compared with older Medicare beneficiaries and commercial insurance beneficiaries. Research on opioid overdose deaths in this population can help identify appropriate interventions.

Objective: To assess the rate of opioid overdose death and to identify its associated risk factors.

Design, Setting, and Participants: This cohort study included a 20% national sample of Medicare enrollees aged 21 to 64 years whose initial Medicare entitlement was based on disability and who resided in 50 US states and Washington, DC, in 2012 to 2016. Data analyses were performed from March 15, 2019, through September 23, 2019.

Exposures: Fifty-five chronic or potentially disabling conditions were selected from the Centers for Medicare & Medicaid Services Chronic Disease Data Warehouse.

Main Outcomes and Measures: Opioid overdose death rate estimated from Medicare National Death Index linkage data.

Results: Among 1 766 790 Medicare enrollees younger than 65 years who qualified for Medicare because of disability, the mean (SD) age was 52.2 (10.2) years, and 866 914 (49.1%) were women. These enrollees represent 14.9% (95% CI, 14.9%-15.0%) of the entire Medicare population and accounted for 80.8% (95% CI, 78.9%-82.7%) of opioid overdose deaths among all Medicare enrollees. Opioid overdose mortality in this population increased from 57.4 per 100 000 (95% CI, 53.9-61.0 per 100 000) in 2012 to 77.6 per 100 000 (95% CI, 73.5-81.8 per 100 000) in 2016. Results from the stepwise logistic regression model revealed that 3 categories of conditions are associated with opioid overdose death: substance abuse, psychiatric diseases, and chronic pain. Among the 11.1% (95% CI, 11.0%-11.2%) of adults with disability who had all 3 conditions, the rate of opioid overdose death was 363.7 per 100 000 (95% CI, 326.7-402.6 per 100 000), which is 23.4 times higher than the rate for individuals with none of the conditions (15.5 per 100 000; 95% CI, 11.6-20.1 per 100 000).

Conclusions and Relevance: This study identifies differences in opioid overdose mortality among subgroups of Medicare enrollees younger than 65 years who qualify for Medicare because of disability. Understanding the heterogeneity of medical and psychiatric conditions associated with opioid use and misuse is key to developing specific, data-driven interventions targeted to each subgroup of high-risk populations.