Neighborhood Socioeconomic Status and Receipt of Opioid Medication for New Back Pain Diagnosis

Abstract

Background: Although treatment for new back pain is heavily guideline driven, deviations occur frequently. Neighborhood socioeconomic status (nSES) may contribute to these deviations.

Objective: Determine whether nSES is associated with type of treatment provided for patients seeking treatment for new back pain in primary care clinics.

Methods: This retrospective cohort was conducted in academic internal and family medicine practices. Data were examined from the Primary Care Patient Data Registry. Eligibility criteria included age ≥18 years, free of HIV and cancer, and presenting to primary care with a new diagnosis of back pain, resulting in1646 patients included. Patients' nSES was determined using ZIP code and calculating a validated index of 7 census-tract variables. Multinomial logistic regression was used to measure the association between nSES and 3 treatment outcomes compared with no pharmacologic management. Outcomes included opioid prescription, nonsteroidal anti-inflammatory (NSAID)/muscle relaxant prescription, or combined opioid/nonopioid treatment within 90 days of initial presentation. Covariates included age, sex, race, high clinic utilization (HCU), depression, anxiety, substance use, obesity, comorbidities, smoking, number of pain conditions, and physical therapy (PT) referral.

Results: The cohort was 67.9% female with an average age of 55.72 years (Standard Error [SE] = 0.387). Compared with no pharmacologic treatment, individuals in the low nSES group had 63% higher odds of receiving an opioid only compared with the high nSES group (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.01 to 2.62). There was no significant association between nSES and odds of nonopioid or combined treatment compared with no pharmacotherapy (OR, 1.17; 95% CI, 0.97 to 1.50), (OR, 1.09; 95% CI, 0.67 to 1.78), respectively. Covariates associated with increased odds of opioid only included HCU, ever smoker, and increasing comorbidity index. PT referral was associated with NSAID/muscle relaxant only, and increasing age and comorbidity index were inversely associated with odds of NSAID/muscle relaxant only. Finally, covariates associated with increased odds of receiving both therapies included high clinic utilizusation, ever smoking, and PT referral.

Conclusions: These data characterize a possible association between low nSES and increased risk of receiving an opioid only when being treated for new back pain. This may be evidence that patients of low nSES are at increased risk of receiving guideline-noncompliant treatment for new back pain.

Keywords: Back Pain; Opioid Analgesics; Social Determinants of Health; Socioeconomic Status.