Department of Sociology, University at Buffalo, State University of New York.
J Gerontol B Psychol Sci Soc Sci. 2019 Aug 21;74(6):1009-1019. doi: 10.1093/geronb/gby093.
This study identifies sociodemographic predictors of prescription opioid use among older adults (age 65+) during the peak decade of U.S. opioid prescription, and tests whether pain level and Medicaid coverage mediate the association between low wealth and opioid use. Predictors of prescription nonsteroidal anti-inflammatory drug (NSAID) use, and of opinions of both drug classes, are also examined.
Regressions of opioid and NSAID use on sociodemographic characteristics, pain level, and insurance type were conducted using Health and Retirement Study 2004 core and 2005 Prescription Drug Study data (n = 3,721). Mediation analyses were conducted, and user opinions of drug importance, quality, and side effects were assessed.
Low wealth was a strong, consistent predictor of opioid use. Both pain level and Medicaid coverage significantly, but only partially, mediated this association. Net of wealth, there were no significant associations between education and use of, or opinions of, either class of drugs.
Among older American adults, the poorest are disproportionately likely to have been exposed to prescription opioid analgesics. Wealth, rather than education, drove social class differences in mid-2000s opioid use. Opioid-related policies should take into account socioeconomic contributors to opioid use, and the needs and treatment histories of chronic pain patients.
本研究旨在确定美国阿片类药物处方高峰期（65 岁以上老年人）期间，社会人口统计学因素与老年患者处方类阿片类药物使用的相关性，并检验低财富与阿片类药物使用之间的关联是否可通过疼痛程度和医疗补助（Medicaid）覆盖来解释。同时还检验了处方非甾体抗炎药（NSAID）使用的预测因素，以及对这两类药物的看法。
使用健康与退休研究（Health and Retirement Study）2004 年核心数据和 2005 年处方药研究数据（n = 3721），对阿片类药物和 NSAID 使用情况与社会人口统计学特征、疼痛程度和保险类型进行回归分析。进行了中介分析，并评估了药物重要性、质量和副作用的使用意见。
低财富是阿片类药物使用的一个强有力且一致的预测因素。疼痛程度和医疗补助覆盖均显著（但仅部分）中介了这种关联。在财富因素之外，教育程度与这两类药物的使用或意见之间不存在显著关联。
在美国老年成年人中，最贫困的人群最有可能接触到处方类阿片类镇痛药。在 21 世纪中期，财富而不是教育程度，导致了社会阶层之间在阿片类药物使用上的差异。阿片类药物相关政策应考虑到社会经济因素对阿片类药物使用的影响，以及慢性疼痛患者的需求和治疗史。
