Characterizing the demographics of chronic pain patients in the state of Maine using the Maine all payer claims database

Abstract

Background: Chronic pain is currently a significant health problem in the United States. A comprehensive strategy is needed to increase prevention of chronic pain and to improve care for chronic pain patients. However, development of a successful strategy relies, in part, on a better understanding of the demographics and socioeconomics of patients living with chronic pain conditions. The current study was designed to understand the burden of chronic pain in the state of Maine by identifying the prevalence of chronic pain and its relationship with selected demographic and socioeconomic factors in Maine.

Methods: The Maine All Payer Claims Database (MEAPCD) (2006-2011) was used in the secondary data analysis to assess the demographic characteristics (such as age, sex, insurance type, and county of residence) of chronic pain patients in Maine. Chronic pain patients were identified based on the presence of pre-identified chronic pain-associated ICD-9 code(s) and opioid prescription information. Potential associations between the prevalence of chronic pain and a number of socioeconomic factors were determined by comparisons to Maine Census data.

Results: More women in the state were identified as having chronic pain across all counties and all age groups (> 10 years old). Surprisingly, the majority of chronic pain patients were identified based on the diagnostic code criteria and not the opioid prescription criteria. A greater utilization of public health insurance was seen within the chronic pain patients. At the county level, although neither education level nor income were associated with the prevalence of chronic pain, these factors significantly correlated with the usage of public health insurance.

Conclusions: Further detailed characterization of the chronic pain patient population in the state of Maine, using multiple data sources, can help design population-targeted strategies to prevent and manage chronic pain.

Keywords: Chronic pain; ICD-9 code; Maine; Maine all payer claims database (MEAPCD); Opioid.

Fig. 1

Demographics of identified chronic pain population. The chronic pain cohort was identified within the total Maine All Payer Claims Database for the years 2006, 2007, 2009, and 2010, respectively using the pre-determined ICD-9 codes and opioid prescription criteria (see text for detail). Data from each year were broken down into age, gender, insurance type, and residing county of chronic pain patient, and then analyzed. The chart shows the average of the four years for each of the indicated demographic factors

Fig. 2

Distribution of cohort identification criteria. Pie charts represent the total number and percent (within parentheses) of patients who met the ICD-9 code parameters, opioid parameters, or ICD-9 code plus opioid parameters, as described in the Methods section. Parameters are reported for years 2006 (a), 2007 (b), 2009 (c), and 2010 (d)

Fig. 3

Age and gender distribution of the chronic pain cohort. Distribution of male and female chronic pain patients by age are graphed for each calendar year: 2006 (a), 2007 (b), 2009 (c), and 2010 (d). Genders and ages, as reported in five-year increments, of the chronic pain cohort were compared to the total Maine population, as reported by the 2010 Maine Census: females (e) and males (f). The percent of chronic pain patients for each gender and age group within the perspective Maine population were used to indicate the prevalence of chronic pain in Maine: female (g) and male (h)

Fig. 4

Chronic pain cases by county. The total numbers of male and female chronic pain patients per Maine county are shown for the following calendar years: 2006 (a), 2007 (b), 2009 (c), and 2010 (d). County of residence are classified as county of residence during the calendar year of reporting. The numbers of female (e) and male (f) chronic pain patients per county were compared to the total numbers of females and males living in that county in 2010, as reported by the 2010 Maine Census. The percent of chronic pain patients within the perspective Maine population were used to indicate the prevalence of chronic pain in each of the Maine county: female (g) and male (h). These same percentages of the female (i) and male (j) chronic pain cohort within the population of each Maine county are also shown on the state map. Percentages are presented in a density scale and the same scale is used in Figs. i and j

Fig. 5

Estimates of healthcare insurance types in the perspective chronic pain population across the state. Distribution of chronic pain patients who receive public (a, c, e, and g) versus private (b, d, f, and h) primary insurances are shown for each Maine county. County of residence is classified as county of residence during the calendar year of reporting. Graph is displayed as follows: 2006 public healthcare recipients versus (a) 2006 private healthcare users (b), 2007 public healthcare recipients versus (c) 2007 public healthcare users (d), 2009 public healthcare recipients versus (e), 2009 public healthcare users (f), 2010 public healthcare users versus (g) 2010 public healthcare users (h)

Fig. 6

Association between socioeconomic factors and the usage of public health insurance. The percentages of individuals who used primarily public (a, c and e) and private (b, d, and f) insurances were compared to the median household income (a and b), percent population below poverty level (c and d), and percent with bachelor’s degree or higher (e and f) using the data from the 2010 chronic pain cohort and 2010 Maine Census