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Sex Differences in Comorbid Mental and Substance Use Disorders Among Primary Care Patients With Opioid Use Disorder
Jordan M Braciszewski1, Abisola E Idu1, Bobbi Jo H Yarborough1
1Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit (Braciszewski, Loree); Kaiser Permanente Washington Health Research Institute (KPWHRI), Seattle (Idu, Bobb, Bradley, Glass, Matson, Lapham, Madziwa); Kaiser Permanente Northwest Center for Health Research, Portland, Oregon (Yarborough, Stumbo); HealthPartners Institute and Department of Research, University of Minnesota, Minneapolis (Rossom); MultiCare Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington (Murphy, Pflugeisen, Silva); Kaiser Permanente Colorado Institute for Health Research, Colorado Permanente Medical Group, Department of Health System Science, Bernard J. Tyson Kaiser Permanente School of Medicine, University of Colorado School of Medicine, Aurora (Binswanger); Kaiser Permanente Northern California Division of Research, Oakland (Campbell); Department of Health Systems and Population Health, University of Washington, Seattle (Lapham, Hutcheson); Washington State University Health Sciences Spokane, Spokane (Barbosa-Leiker); Department of Psychiatry and Behavioral Sciences and Addictions, Drug and Alcohol Institute, University of Washington, Seattle (Hatch); Department of Medicine, University of Washington and Harborview Medical Center, Seattle (Tsui); Albert Einstein College of Medicine, Montefiore Medical Center, New York City (Arnsten); Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston (Stotts); Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami (Horigian, Usaga); Hennepin Healthcare and Department of Medicine, University of Minnesota Medical School, Minneapolis (Bart); Veterans Affairs Puget Sound Health Care System, Seattle (Saxon); Manning College of Nursing and Health Sciences, University of Massachusetts, Boston (Thakral); Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena (Ling Grant); Genentech, Inc., San Francisco (Boudreau).
Objective:
The authors sought to characterize the 3-year prevalence of mental disorders and nonnicotine substance use disorders among male and female primary care patients with documented opioid use disorder across large U.S. health systems.
Methods:
This retrospective study used 2014-2016 data from patients ages ≥16 years in six health systems. Diagnoses were obtained from electronic health records or claims data; opioid use disorder treatment with buprenorphine or injectable extended-release naltrexone was determined through prescription and procedure data. Adjusted prevalence of comorbid conditions among patients with opioid use disorder (with or without treatment), stratified by sex, was estimated by fitting logistic regression models for each condition and applying marginal standardization.
Results:
Females (53.2%, N=7,431) and males (46.8%, N=6,548) had a similar prevalence of opioid use disorder. Comorbid mental disorders among those with opioid use disorder were more prevalent among females (86.4% vs. 74.3%, respectively), whereas comorbid other substance use disorders (excluding nicotine) were more common among males (51.9% vs. 60.9%, respectively). These differences held for those receiving medication treatment for opioid use disorder, with mental disorders being more common among treated females (83% vs. 71%) and other substance use disorders more common among treated males (68% vs. 63%). Among patients with a single mental health condition comorbid with opioid use disorder, females were less likely than males to receive medication treatment for opioid use disorder (15% vs. 20%, respectively).
Conclusions:
The high rate of comorbid conditions among patients with opioid use disorder indicates a strong need to supply primary care providers with adequate resources for integrated opioid use disorder treatment.
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