Oklahoma American Indian 45–54-year-old Population Mortality and Medicaid Opioid Spending: Comparing 1999–2008 Trends

Abstract

Oklahoma is a leading state in population exposure to prescription opioids, and substance abuse-related death in the 45–54-year-old age group. A recent Oklahoma study of routine surveillance data (1999 to 2016) discovered marked increases in all-cause, medical-cause, and external/behavioral-cause mortality rates in 45–54-year-old American Indian/Alaska Natives (AI/AN45-54). This study hypothesis was that annual AI/AN45-54 mortality rate time trend period effects in Oklahoma align with fluctuations in Medicaid opioid spending. Oklahoma AI/AN45-54 annual mortality data were collected from the Centers for Disease Control & Prevention Wonder Detailed Mortality database, and restricted to gender groups. Three broad categories of mortality were examined: all-cause, medical-cause, and external/behavioral-cause. Annual Medicaid opioid spending (1999-2008) data were obtained from the Medicaid Analytic eXtract MAX Rx database. Mortality rate time trend graphs were generated, and compared to annual Oklahoma Medicaid opioid spending. Annual AI/AN45-54 population mortality rates from 1999 to 2008 are shown, and compared to Oklahoma Medicaid opioid spending, using dual-Y-axis graphs. From 2003 to 2006, time trend period effects in Medicaid opioid spending strongly resemble those seen with AI/AN45-54 female (medical-cause) and male (external-cause) mortality trends. In Oklahoma, Medicaid opioid spending is temporally-associated with AI/AN45-54 mortality, and is therefore now a suspected risk factor for the increasing all-cause mortality in this population.