County Social Isolation and Opioid Use Disorder among Older Adults: A Longitudinal Analysis of Medicare Data, 2013–2018

Authors

Tse-Chuan Yang, University of Texas Medical BranchFollow
Carla Shoff, Centers for Medicare & Medicaid Services, Baltimore, MDFollow
Seulki Kim, University at Albany, State University of New YorkFollow
Benjamin A. Shaw, University of Illinois ChicagoFollow

Date of this Version

5-2022

Citation

Social Science & Medicine 301 (May 2022), 114971.

doi: 10.1016/j.socscimed.2022.114971

Comments

Copyright © 2022 Elsevier Ltd. Used by permission.

Abstract

This study aims to fill three knowledge gaps: (1) unclear role of ecological factors in shaping older adults’ risk of opioid use disorder (OUD), (2) a lack of longitudinal perspective in OUD research among older adults, and (3) underexplored racial/ethnic differences in the determinants of OUD in older populations. This study estimates the effects of county-level social isolation, concentrated disadvantage, and income inequality on older adults’ risk of OUD using longitudinal data analysis. We merged the 2013–2018 Medicare population (aged 65+) data to the American Community Survey 5-year county-level estimates to create a person-year dataset (N = 47,291,217 person-years) and used conditional logit fixed-effects modeling to test whether changes in individual- and county-level covariates alter older adults’ risk of OUD. Moreover, we conducted race/ethnicity-specific models to compare how these associations vary across racial/ethnic groups. At the county level, a one-unit increase in social isolation (mean = –0.197, SD = 0.511) increased the risk of OUD by 5.5 percent (OR = 1.055; 95% CI = [1.018, 1.094]) and a one-percentage-point increase in the working population employed in primary industry decreases the risk of OUD by 1 percent (OR = 0.990; 95% CI = [0.985, 0.996]). At the individual-level, increases in the Medicare Hierarchical Condition Categories risk score, physical comorbidity, and mental comorbidity all elevate the risk of OUD. The relationship between county-level social isolation and OUD is driven by non-Hispanic whites, while Hispanic beneficiaries are less sensitive to the changes in county-level factors than any other racial ethnic groups. Between 2013 and 2018, US older adults’ risk of OUD was associated with both ecological and individual factors, which carries implications for intervention. Further research is needed to understand why associations of individual factors with OUD are comparable across racial/ethnic groups, but county-level social isolation is associated only with OUD among non-Hispanic white beneficiaries.