Socioeconomic Differences in Opioid Use By People with Inflammatory Arthritis

Ashley Fletcher^1,2, Marissa Lassere³, Rachel Black^4,5, Claire Barrett⁶, Graeme Carroll⁷, Susan Lester^8,9, Bethan Richards³, Lyn March¹⁰, Rachelle Buchbinder^11,12 and Catherine Hill^5,13,14, ¹Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Australia, ²Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, ³University of New South Wales, Sydney, Australia, ⁴Rheumatology, Royal Adelaide Hospital, Adelaide, Australia, ⁵Medicine, The University of Adelaide, Adelaide, Australia, ⁶Redcliffe Hospital, University of Queensland, Redcliffe, Australia, ⁷Adult Rheumatology and Osteoarthritis, University of Notre Dame, Mount Lawley WA, Australia, ⁸Rheumatology Unit, The Queen Elizabeth Hospital, Adelaide, Australia, ⁹Discipline of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia, ¹⁰Department of Rheumatology, Northern Clinical School, Institute of Bone and Joint Research, Kolling Institute, University of Sydney & Department of Rheumatology, Royal North Shore Hospital, St Leonards, Sydney, Australia, ¹¹Cabrini Institute, Victoria, Australia, ¹²Monash University, Melbourne, Australia, ¹³The Queen Elizabeth Hospital, Adelaide, Australia, ¹⁴Rheumatology Unit, Royal Adelaide Hospital, Adelaide, Australia

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: inflammatory arthritis, opioids and registry

Session Information

Date: Wednesday, October 24, 2018

Title: 6W018 ACR Abstract: Epidemiology & Pub Health IV: Determinants & Consequences of Tx (2952–2957)

Session Type: ACR Concurrent Abstract Session

Session Time: 11:00AM-12:30PM

Background/Purpose:

Internationally, prescription opioid use is often higher among patients of lower socioeconomic status (SES). In addition, despite improved treatments for inflammatory arthritis, opioid use remains high among patients with inflammatory rheumatic diseases. The aim of this study was to determine the effect of lower SES on opioid use in people with inflammatory arthritis.

Methods:

The Australian Rheumatology Association Database (ARAD) is an observational database that collects outcome data for people with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA) and juvenile idiopathic arthritis (JIA). Participants complete semi-annual then annual questionnaires, which includes demographic and social details, self-reported medical history and medication use, and quality of life scales. We used the baseline questionnaire to examine opioid use between 2006 and 2016. Opioids classified were aspirin/codeine, paracetamol/codeine, dextropropoxyphene, oxycodone, oxycontin, morphine and tramadol. As a measure of SES, participants were assigned an Australian Bureau of Statistics (ABS) Socio-Economic Indexes for Areas (SEIFA) score (Index of Advantage/Disadvantage) based on their postcode (SEIFA 1= lowest quintile, SEIFA 5= highest quintile).

Results:

34.0% of 4,429 ARAD participants were taking opioids at baseline. Use was significantly more prevalent in lower SES participants (SEIFA 1: 47.4%, SEIFA 5: 36.6% (OR 1.56; 95%CI 1.22-2.00)). When other significant factors were considered in a multivariable model (including HAQ score (OR 1.85; 95%CI 1.64-2.09), currently smoking (OR 1.35; 95%CI 1.08-1.68) and being permanently unable to work (OR 1.66; 95%CI 1.26-2.19)), lower SES was still more prevalent but not significantly (OR 1.08; 95%CI 0.83-1.42). The prevalence of baseline opioid use between 2006 and 2016 did not change significantly. The prevalence of use in the SEIFA 1 participants remained higher than SEIFA 5 throughout this time period (p<0.05). Although the most commonly used opioid was paracetamol/codeine, the more potent opioids (oxycodone and morphine) were associated with higher use in lower SES.

Conclusion:

Although opioid use was more prevalent in the lower SES group, the strongest predictor of use was a high HAQ score, indicating more disability. Current smokers and those permanently unable to work were also more likely to take opioids. Higher use in lower SES groups has been evident over time and has not altered. Future research into the reasons for this difference may include further exploration of factors predictive of cessation and prescriber characteristics.

Disclosure: A. Fletcher, None; M. Lassere, None; R. Black, None; C. Barrett, None; G. Carroll, None; S. Lester, None; B. Richards, None; L. March, None; R. Buchbinder, None; C. Hill, None.

To cite this abstract in AMA style:

Fletcher A, Lassere M, Black R, Barrett C, Carroll G, Lester S, Richards B, March L, Buchbinder R, Hill C. Socioeconomic Differences in Opioid Use By People with Inflammatory Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/socioeconomic-differences-in-opioid-use-by-people-with-inflammatory-arthritis/. Accessed .

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