Ten-year trends in opioid prescribing and vaso-occlusive crises in sickle cell disease: a population-based national cohort study (2011–2022)Research in context
Summary: Background: Patterns of opioid prescribing and vaso-occlusive crises (VOCs) are poorly characterized among individuals with sickle cell disease (SCD) across diverse insurance types and age groups. We aimed to evaluate opioid prescribing and VOC trends in publicly and commercially insured i...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-10-01
|
| Series: | The Lancet Regional Health. Americas |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667193X25002248 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849229261897990144 |
|---|---|
| author | Kevin Y. Xu Terri V. Newman Lakeya S. McGill Enrico M. Novelli Cheryl A. Hillery Joanna L. Buss Lisa Gong Ruizhi Huang Fanghong Dong Dustin Stwalley Joanne Salas Shiyuan A. Liu Jeffrey F. Scherrer Tashalee R. Brown Tae Woo Park Marc R. LaRochelle Richard A. Grucza Charles R. Jonassaint |
| author_facet | Kevin Y. Xu Terri V. Newman Lakeya S. McGill Enrico M. Novelli Cheryl A. Hillery Joanna L. Buss Lisa Gong Ruizhi Huang Fanghong Dong Dustin Stwalley Joanne Salas Shiyuan A. Liu Jeffrey F. Scherrer Tashalee R. Brown Tae Woo Park Marc R. LaRochelle Richard A. Grucza Charles R. Jonassaint |
| author_sort | Kevin Y. Xu |
| collection | DOAJ |
| description | Summary: Background: Patterns of opioid prescribing and vaso-occlusive crises (VOCs) are poorly characterized among individuals with sickle cell disease (SCD) across diverse insurance types and age groups. We aimed to evaluate opioid prescribing and VOC trends in publicly and commercially insured individuals with SCD over a 10-year time period in the United States (US). Methods: We conducted a retrospective cohort study of US administrative claims (2011–2022), analyzing 45,726 commercial and Medicaid beneficiaries with SCD. Primary outcomes were monthly rates of outpatient opioid prescriptions and VOC-related acute care encounters. We used joinpoint regression models to estimate trends without pre-specifying breakpoints, stratified by insurance type (Medicaid vs commercial) and age group (1–12, 13–17, 18–27, 28–45, 46–64 years). Primary outcomes were monthly rates of outpatient opioid prescriptions and VOC-related acute care encounters. We used joinpoint regression models to estimate trends without pre-specifying breakpoints, stratified by insurance type (Medicaid vs commercial) and age group. Findings: Among 45,726 individuals with SCD (mean age [SD] = 25.1 [16.2]; 39.7% female; 52.9% Medicaid, 47.1% commercial insurance), Medicaid beneficiaries had higher rates than commercial beneficiaries for monthly opioid prescribing (18.3 vs 14.0 per 100) and VOC encounters (16.6 vs 8.2 per 100). Monthly opioid prescribing per 100 people increased with age: 1–12 y = 5.1; 13–17 y = 11.3; 18–27 y = 22.5; 28–45 y = 24.6; 46–64 y = 20.6 per 100. Both Medicaid and commercial beneficiaries experienced declining opioid prescribing beginning in 2011 (commercial monthly percentage change [MPC] = −0.3% [95% CI: −0.3%, −0.2%]; Medicaid MPC = −0.5% [−0.6%, 0.5%]). Down-trending opioid prescribing was not consistently accompanied by up-trending VOCs until the COVID-19 pandemic's onset. Particularly among children and adolescents, VOC-related encounters increased significantly after 2020 across both commercial (MPC = 1.8% [1.5%, 2.2%]) and Medicaid (MPC = 0.6% [0.1%, 1.6%]) beneficiaries. Interpretation: Opioid prescribing and VOC admissions vary by insurance and age. Opioid prescribing declined from 2011 but was not consistently accompanied by increased VOCs until after COVID-19. Funding: Analyses of Merative MarketScan Commercial and Multi-State Medicaid Database were funded by grants NIH K12 DA041449 (PI: KYX; data analysts: JLB, DS). Effort for some personnel was supported by P50 MH122351 (KYX, PI: Eric Lenze MD, Michael Avidan MBBCh), K08 K08 DA061258 (KYX), the American Psychiatric Association (APA) Psychiatric Research Fellowship (with funding by NIDA and the APA, KYX), NIH K12NS130673 (LSM), NIH L60HL170453 (LSM), and the St. Louis University Research Institute Fellowship (RAG, JS, JFS, RH); these grants did not fund Merative MarketScan Commercial and Multi-State Medicaid Database data pull. |
| format | Article |
| id | doaj-art-bf34b96e38f24c6aad9ca501d348e45b |
| institution | Kabale University |
| issn | 2667-193X |
| language | English |
| publishDate | 2025-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Americas |
| spelling | doaj-art-bf34b96e38f24c6aad9ca501d348e45b2025-08-22T04:58:38ZengElsevierThe Lancet Regional Health. Americas2667-193X2025-10-015010121410.1016/j.lana.2025.101214Ten-year trends in opioid prescribing and vaso-occlusive crises in sickle cell disease: a population-based national cohort study (2011–2022)Research in contextKevin Y. Xu0Terri V. Newman1Lakeya S. McGill2Enrico M. Novelli3Cheryl A. Hillery4Joanna L. Buss5Lisa Gong6Ruizhi Huang7Fanghong Dong8Dustin Stwalley9Joanne Salas10Shiyuan A. Liu11Jeffrey F. Scherrer12Tashalee R. Brown13Tae Woo Park14Marc R. LaRochelle15Richard A. Grucza16Charles R. Jonassaint17Washington University School of Public Health, St. Louis, MO, USA; Corresponding author. Department of Psychiatry, School of Medicine and School of Public Health, Washington University in St. Louis, USA.Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USADivision of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USADivision of Classical Hematology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA, USADivision of Hematology-Oncology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USAInstitute for Informatics, Data Science and Biostatistics, Washington University School of Medicine, St. Louis, MO, USADepartment of Psychiatry, Washington University School of Medicine, St. Louis, MO, USAThe Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, USADepartment of Psychiatry, Washington University School of Medicine, St. Louis, MO, USAInstitute for Informatics, Data Science and Biostatistics, Washington University School of Medicine, St. Louis, MO, USADepartment of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA; The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, USADivision of Hematology and Oncology, UCSF School of Medicine, San Francisco, CA, USADepartment of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA; The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, USA; Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, USAJane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USADepartment of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USAClinical Addiction Research and Education Unit at Boston University School of Medicine, Boston Medical Center, Boston, MA, USADepartment of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA; The Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, St. Louis, MO, USADivision of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USASummary: Background: Patterns of opioid prescribing and vaso-occlusive crises (VOCs) are poorly characterized among individuals with sickle cell disease (SCD) across diverse insurance types and age groups. We aimed to evaluate opioid prescribing and VOC trends in publicly and commercially insured individuals with SCD over a 10-year time period in the United States (US). Methods: We conducted a retrospective cohort study of US administrative claims (2011–2022), analyzing 45,726 commercial and Medicaid beneficiaries with SCD. Primary outcomes were monthly rates of outpatient opioid prescriptions and VOC-related acute care encounters. We used joinpoint regression models to estimate trends without pre-specifying breakpoints, stratified by insurance type (Medicaid vs commercial) and age group (1–12, 13–17, 18–27, 28–45, 46–64 years). Primary outcomes were monthly rates of outpatient opioid prescriptions and VOC-related acute care encounters. We used joinpoint regression models to estimate trends without pre-specifying breakpoints, stratified by insurance type (Medicaid vs commercial) and age group. Findings: Among 45,726 individuals with SCD (mean age [SD] = 25.1 [16.2]; 39.7% female; 52.9% Medicaid, 47.1% commercial insurance), Medicaid beneficiaries had higher rates than commercial beneficiaries for monthly opioid prescribing (18.3 vs 14.0 per 100) and VOC encounters (16.6 vs 8.2 per 100). Monthly opioid prescribing per 100 people increased with age: 1–12 y = 5.1; 13–17 y = 11.3; 18–27 y = 22.5; 28–45 y = 24.6; 46–64 y = 20.6 per 100. Both Medicaid and commercial beneficiaries experienced declining opioid prescribing beginning in 2011 (commercial monthly percentage change [MPC] = −0.3% [95% CI: −0.3%, −0.2%]; Medicaid MPC = −0.5% [−0.6%, 0.5%]). Down-trending opioid prescribing was not consistently accompanied by up-trending VOCs until the COVID-19 pandemic's onset. Particularly among children and adolescents, VOC-related encounters increased significantly after 2020 across both commercial (MPC = 1.8% [1.5%, 2.2%]) and Medicaid (MPC = 0.6% [0.1%, 1.6%]) beneficiaries. Interpretation: Opioid prescribing and VOC admissions vary by insurance and age. Opioid prescribing declined from 2011 but was not consistently accompanied by increased VOCs until after COVID-19. Funding: Analyses of Merative MarketScan Commercial and Multi-State Medicaid Database were funded by grants NIH K12 DA041449 (PI: KYX; data analysts: JLB, DS). Effort for some personnel was supported by P50 MH122351 (KYX, PI: Eric Lenze MD, Michael Avidan MBBCh), K08 K08 DA061258 (KYX), the American Psychiatric Association (APA) Psychiatric Research Fellowship (with funding by NIDA and the APA, KYX), NIH K12NS130673 (LSM), NIH L60HL170453 (LSM), and the St. Louis University Research Institute Fellowship (RAG, JS, JFS, RH); these grants did not fund Merative MarketScan Commercial and Multi-State Medicaid Database data pull.http://www.sciencedirect.com/science/article/pii/S2667193X25002248Opioid prescribingVaso-occlusive crisesSickle cell diseaseAge disparitiesInsuranceAdministrative claims |
| spellingShingle | Kevin Y. Xu Terri V. Newman Lakeya S. McGill Enrico M. Novelli Cheryl A. Hillery Joanna L. Buss Lisa Gong Ruizhi Huang Fanghong Dong Dustin Stwalley Joanne Salas Shiyuan A. Liu Jeffrey F. Scherrer Tashalee R. Brown Tae Woo Park Marc R. LaRochelle Richard A. Grucza Charles R. Jonassaint Ten-year trends in opioid prescribing and vaso-occlusive crises in sickle cell disease: a population-based national cohort study (2011–2022)Research in context The Lancet Regional Health. Americas Opioid prescribing Vaso-occlusive crises Sickle cell disease Age disparities Insurance Administrative claims |
| title | Ten-year trends in opioid prescribing and vaso-occlusive crises in sickle cell disease: a population-based national cohort study (2011–2022)Research in context |
| title_full | Ten-year trends in opioid prescribing and vaso-occlusive crises in sickle cell disease: a population-based national cohort study (2011–2022)Research in context |
| title_fullStr | Ten-year trends in opioid prescribing and vaso-occlusive crises in sickle cell disease: a population-based national cohort study (2011–2022)Research in context |
| title_full_unstemmed | Ten-year trends in opioid prescribing and vaso-occlusive crises in sickle cell disease: a population-based national cohort study (2011–2022)Research in context |
| title_short | Ten-year trends in opioid prescribing and vaso-occlusive crises in sickle cell disease: a population-based national cohort study (2011–2022)Research in context |
| title_sort | ten year trends in opioid prescribing and vaso occlusive crises in sickle cell disease a population based national cohort study 2011 2022 research in context |
| topic | Opioid prescribing Vaso-occlusive crises Sickle cell disease Age disparities Insurance Administrative claims |
| url | http://www.sciencedirect.com/science/article/pii/S2667193X25002248 |
| work_keys_str_mv | AT kevinyxu tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT terrivnewman tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT lakeyasmcgill tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT enricomnovelli tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT cherylahillery tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT joannalbuss tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT lisagong tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT ruizhihuang tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT fanghongdong tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT dustinstwalley tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT joannesalas tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT shiyuanaliu tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT jeffreyfscherrer tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT tashaleerbrown tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT taewoopark tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT marcrlarochelle tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT richardagrucza tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext AT charlesrjonassaint tenyeartrendsinopioidprescribingandvasoocclusivecrisesinsicklecelldiseaseapopulationbasednationalcohortstudy20112022researchincontext |