Session Type: ACR Concurrent Abstract Session
Session Time: 11:00AM-12:30PM
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.
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).
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.
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.
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 10). https://acrabstracts.org/abstract/socioeconomic-differences-in-opioid-use-by-people-with-inflammatory-arthritis/. Accessed June 28, 2022.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/socioeconomic-differences-in-opioid-use-by-people-with-inflammatory-arthritis/