Abstract
The prevalence of older adults with pain and comorbid cardiovascular conditions is increasing in the United States (U.S.). This retrospective, cross-sectional database study used 2017 Medical Expenditure Panel Survey data and hierarchical logistic regression models to identify predictive characteristics of opioid use among a nationally representative sample of older U.S. adults (aged ≥50 years) with pain in the past four weeks and comorbid hypertension (pain–hypertension group) or hypercholesterolemia (pain–hypercholesterolemia group). The pain–hypertension group included 2733 subjects (n = 803 opioid users) and the pain–hypercholesterolemia group included 2796 subjects (n = 795 opioid users). In both groups, predictors of opioid use included: White race versus others, Hispanic versus non-Hispanic ethnicity, 1 versus ≥5 chronic conditions, little/moderate versus quite a bit/extreme pain, good versus fair/poor perceived mental health, functional limitation versus no functional limitation, smoker versus non-smoker, and Northeast versus West census region. In addition, Midwest versus West census region was a predictor in the pain–hypertension group, and 4 versus ≥5 chronic conditions was a predictor in the pain–hypercholesterolemia group. In conclusion, several characteristics of older U.S. adults with pain and comorbid hypertension or hypercholesterolemia were predictive of opioid use. These characteristics could be addressed to optimize individuals’ pain management and help address the opioid overdose epidemic.
Highlights
Pain is prevalent among United States (U.S.) adults, with estimates ranging from 8.0% to 20.4%in high-impact chronic pain and higher prevalence reported among older adults [1]
The prevalence of opioid use among those with pain and hypercholesterolemia was 28.5% from a weighted population of 31,014,839
Need factors were significant predictors of opioid use in both groups; 1 versus ≥5 chronic conditions was a predictor in the pain–hypertension group, (AOR = 0.522, 95% CI = 0.315, 0.866) and in the pain–hypercholesterolemia group (AOR = 0.587, 95% CI = 0.349, 0.986), but 4 versus ≥5 chronic conditions was a predictor in the pain–hypercholesterolemia group (AOR = 1.425, 95% CI = 1.042, 1.949)
Summary
Pain is prevalent among United States (U.S.) adults, with estimates ranging from 8.0% to 20.4%. In high-impact chronic pain (pain that limited at least one major life activity) and higher prevalence reported among older adults [1]. Appropriate pain management is often challenging for older adults as it is associated with comorbid conditions, such as cardiovascular conditions [4]. A report from the Global Burden of Disease Study 2016 shows that high prevalence of pain and pain-related diseases is the leading cause of disability and disease burden globally [5]. A variety of pain management strategies exist [7], opioids have increasingly been used by older adults to manage both acute and chronic pain in recent years [8]. Evidence for the short-term efficacy of opioid use (≤12 weeks) among older adults has been established [10], Healthcare 2020, 8, 341; doi:10.3390/healthcare8030341 www.mdpi.com/journal/healthcare
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