Do sex, age, and comorbidities modify the association of socioeconomic status and opioid use after total hip arthroplasty?: a population-based study from the Danish Hip Arthroplasty Register
DOI:
https://doi.org/10.2340/17453674.2024.40708Keywords:
Arthroplasty, cohort study, comorbidity, Relationship, opioids, Osteoarthrosis, social inequalityAbstract
Background and purpose: We aimed to examine the association between socioeconomic status (SES) markers and opioid use after primary total hip arthroplasty (THA) due to osteoarthritis, and whether sex, age, or comorbidities modify any association.
Methods: Using Danish databases, we included 80,038 patients undergoing primary THA (2001–2018). We calculated prevalences and prevalence ratios (PRs with 95% confidence intervals [CIs]) of immediate post-THA opioid use (≥ 1 prescription within 1 month) and continued opioid use (≥ 1 prescription in 1–12 months) among immediate opioid users. Exposures were individual-based education, cohabitation, and wealth.
Results: The prevalence of immediate opioid use was ~45% in preoperative non-users and ~60% in preoperative users (≥ 1 opioid 0–6 months before THA). Among non-users, the prevalences and PRs of continued opioid use were: 28% for low vs. 21% for high education (PR 1.28, CI 1.20–1.37), 27% for living alone vs. 23% for cohabiting (PR 1.09, CI 1.04–1.15), and 30% for low vs. 20% for high wealth (PR 1.43, CI 1.35–1.51). Among users, prevalences were 67% for low vs. 55% for high education (1.22, CI 1.17–1.27), 68% for living alone vs. 60% for cohabiting (PR 1.10, CI 1.07–1.12), and 73% for low wealth vs. 54% for high wealth (PR 1.32, CI 1.28–1.36). Based on testing for interaction, sex, age, and comorbidity did not statistically significant modify the associations. Nevertheless, associations were stronger in younger patients for all SES markers (mainly for non-users).
Conclusion: Markers of low SES were associated with a higher prevalence of continued post-THA opioid use. Age modified the magnitude of the associations, but it was not statistically significant.
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Thiels C A, Anderson S S, Ubl D S, Hanson K T, Bergquist W J, Gray R J, et al. Wide variation and overprescription of opioids after elective surgery. Ann Surg 2017; 266(4): 564-73. doi: 10.1097/sla.0000000000002365. DOI: https://doi.org/10.1097/SLA.0000000000002365
Shah R, Kuo Y F, Westra J, Lin Y L, Raji M A. Opioid use and pain control after total hip and knee arthroplasty in the US, 2014 to 2017. JAMA Netw Open 2020; 3(7): e2011972. doi:10.1001/jamanetworkopen.2020.11972. DOI: https://doi.org/10.1001/jamanetworkopen.2020.11972
Svendsen K, Fredheim O M, Romundstad P, Borchgrevink P C, Skurtveit S. Persistent opioid use and socio-economic factors: a population-based study in Norway. Acta Anaesthesiol Scand 2014; 58(4): 437-45. doi: 10.1111/aas.12281. DOI: https://doi.org/10.1111/aas.12281
Klenø A N, Stisen M B, Edwards N M, Mechlenburg I, Pedersen A B. Socioeconomic status and use of analgesic drugs before and after primary hip arthroplasty: a population-based cohort study of 103,209 patients during 1996–2018. Acta Orthop 2022; 93: 171-8. doi: 10.2340/17453674.2021.955. DOI: https://doi.org/10.2340/17453674.2021.955
Hofstede S N, Gademan M G J, Stijnen T, Nelissen R, Marang-van de Mheen P J. The influence of preoperative determinants on quality of life, functioning and pain after total knee and hip replacement: a pooled analysis of Dutch cohorts. BMC Musculoskelet Disord 2018; 19(1): 68. doi: 10.1186/s12891-018-1991-0. DOI: https://doi.org/10.1186/s12891-018-1991-0
Wiesenfeld-Hallin Z. Sex differences in pain perception. Gend Med 2005; 2(3): 137-45. doi: 10.1016/s1550-8579(05)80042-7. DOI: https://doi.org/10.1016/S1550-8579(05)80042-7
Gibson S J, Helme R D. Age-related differences in pain perception and report. Clin Geriatr Med 2001; 17(3): 433-56, v-vi. doi: 10.1016/s0749-0690(05)70079-3. DOI: https://doi.org/10.1016/S0749-0690(05)70079-3
Jones C M, McCance-Katz E F. Co-occurring substance use and mental disorders among adults with opioid use disorder. Drug Alcohol Depend 2019; 197: 78-82. doi: 10.1016/j.drugalcdep.2018.12.030. DOI: https://doi.org/10.1016/j.drugalcdep.2018.12.030
Moffat A K, Pratt N L, Kalisch Ellett L M, Ramsay E N, Roughead E E. Comorbidities in an Australian sample of chronic and new opioid users. J Opioid Manag 2020; 16(2): 103-10. doi: 10.5055/jom.2020.0556. DOI: https://doi.org/10.5055/jom.2020.0556
Schmidt M, Pedersen L, Sørensen H T. The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol 2014; 29(8): 541-9. doi: 10.1007/s10654-014-9930-3. DOI: https://doi.org/10.1007/s10654-014-9930-3
Gundtoft P H, Varnum C, Pedersen A B, Overgaard S. The Danish Hip Arthroplasty Register. Clin Epidemiol 2016; 8: 509-14. doi: /10.2147%2FCLEP.S99498. DOI: https://doi.org/10.2147/CLEP.S99498
Pedersen A, Johnsen S, Overgaard S, Søballe K, Sørensen H T, Lucht U. Registration in the Danish Hip Arthroplasty Registry: completeness of total hip arthroplasties and positive predictive value of registered diagnosis and postoperative complications. Acta Orthop Scand 2004; 75(4): 434-41. doi: 10.1080/00016470410001213-1. DOI: https://doi.org/10.1080/00016470410001213-1
Pottegård A, Schmidt S A J, Wallach-Kildemoes H, Sørensen H T, Hallas J, Schmidt M. Data resource profile: the Danish National Prescription Registry. Int J Epidemiol 2017; 46(3): 798-f. doi: 10.1093/ije/dyw213. DOI: https://doi.org/10.1093/ije/dyw213
Schmidt M, Schmidt S A, Sandegaard J L, Ehrenstein V, Pedersen L, Sørensen H T. The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 2015; 7:449-90. doi: 10.2147/clep.s91125. DOI: https://doi.org/10.2147/CLEP.S91125
Goesling J, Moser S E, Zaidi B, Hassett A L, Hilliard P, Hallstrom B, et al. Trends and predictors of opioid use after total knee and total hip arthroplasty. Pain 2016; 157(6): 1259-65. doi: 10.1097/j.pain.0000000000000516. DOI: https://doi.org/10.1097/j.pain.0000000000000516
Rajamäki T J, Puolakka P A, Hietaharju A, Moilanen T, Jämsen E. Predictors of the use of analgesic drugs 1 year after joint replacement: a single-center analysis of 13,000 hip and knee replacements. Arthritis Res Ther 2020; 22(1): 89. doi: 10.1186%2Fs13075-020-02184-1. DOI: https://doi.org/10.1186/s13075-020-02184-1
Klenø A N, Sørensen H T, Pedersen A B. Time trends in use of non-steroidal anti-inflammatory drugs and opioids one year after total hip arthroplasty due to osteoarthritis during 1996–2018: a population-based cohort study of 103,209 patients. Osteoarthritis Cartilage 2022; 30(10): 1376-84. doi: 10.1016/j.joca.2022.07.006. DOI: https://doi.org/10.1016/j.joca.2022.07.006
Ruddell J H, Reid D B C, Shah K N, Shapiro B H, Akelman E, Cohen E M, et al. Larger initial opioid prescriptions following total joint arthroplasty are associated with greater risk of prolonged use. J Bone Joint Surg Am 2021; 103(2): 106-14. doi: 10.2106/jbjs.20.00732. DOI: https://doi.org/10.2106/JBJS.20.00732
Chalmers B P, Lebowitz J, Chiu Y F, Joseph A D, Padgett D E, Bostrom M P G, et al. Changes in opioid discharge prescriptions after primary total hip and total knee arthroplasty affect opioid refill rates and morphine milligram equivalents: an institutional experience of 20,000 patients. Bone Joint J 2021; 103-b(7 Supple B): 103-10. doi: 10.1302/0301-620X.103B7.BJJ-2020-2392.R1. DOI: https://doi.org/10.1302/0301-620X.103B7.BJJ-2020-2392.R1
Feldman C H, Dong Y, Katz J N, Donnell-Fink L A, Losina E. Association between socioeconomic status and pain, function and pain catastrophizing at presentation for total knee arthroplasty. BMC Musculoskelet Disord 2015; 16: 18. doi: 10.1186/s12891-015-0475-8. DOI: https://doi.org/10.1186/s12891-015-0475-8
Mesterton J, Willers C, Dahlström T, Rolfson O. Comparison of individual and neighbourhood socioeconomic status in case mix adjustment of hospital performance in primary total hip replacement in Sweden: a register-based study. BMC Health Serv Res 2020; 20(1): 645. doi: 10.1186/s12913-020-05510-0. DOI: https://doi.org/10.1186/s12913-020-05510-0
Inacio M C, Hansen C, Pratt N L, Graves S E, Roughead E E. Risk factors for persistent and new chronic opioid use in patients undergoing total hip arthroplasty: a retrospective cohort study. BMJ Open 2016; 6(4): e010664. doi: 10.1136%2Fbmjopen-2015-010664. DOI: https://doi.org/10.1136/bmjopen-2015-010664
Petre B M, Roxbury C R, McCallum J R, Defontes K W 3rd, Belkoff S M, Mears S C. Pain reporting, opiate dosing, and the adverse effects of opiates after hip or knee replacement in patients 60 years old or older. Geriatr Orthop Surg Rehabil 2012; 3(1): 3-7. doi: 10.23736%2FS1973-9087.23.07650-5. DOI: https://doi.org/10.1177/2151458511432758
Edwards N M, Varnum C, Overgaard S, Pedersen A B. Impact of socioeconomic status on the 90- and 365-day rate of revision and mortality after primary total hip arthroplasty: a cohort study based on 103,901 patients with osteoarthritis from national databases in Denmark. Acta Orthop 2021; 92(5): 581-8. doi: 10.1080%2F17453674.2021.1935487. DOI: https://doi.org/10.1080/17453674.2021.1935487
Brembo E A, Kapstad H, Van Dulmen S, Eide H. Role of self-efficacy and social support in short-term recovery after total hip replacement: a prospective cohort study. Health Qual Life Outcomes 2017; 15(1): 68. https://doi.org/10.1186/s12955-017-0649-1. DOI: https://doi.org/10.1186/s12955-017-0649-1
Svendsen M T, Bak CK, Sørensen K, Pelikan J, Riddersholm S J, Skals R K, et al. Associations of health literacy with socioeconomic position, health risk behavior, and health status: a large national population-based survey among Danish adults. BMC Public Health 2020; 20(1): 565. doi: 10.1186/s12889-020-08498-8. DOI: https://doi.org/10.1186/s12889-020-08498-8
Weyers S, Dragano N, Möbus S, Beck E M, Stang A, Möhlenkamp S, et al. Low socio-economic position is associated with poor social networks and social support: results from the Heinz Nixdorf Recall Study. Int J Equity Health 2008; 7: 13. doi: 10.1186/1475-9276-7-13. DOI: https://doi.org/10.1186/1475-9276-7-13
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Copyright (c) 2024 André S Klenø, Inger Mechlenburg, Maaike G J Gademan, Henrik T S��rensen, Alma B Pedersen
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