Social Determinants of Health and Patient-Level Characteristics Associated with Opioid Use for Chronic Pain

Social determinants of health are gaining prominence in pain research. This study measured the association between residing in disadvantaged neighborhoods in the United States and using opioids for chronic low back pain.

This retrospective cohort study included patients from a national pain research registry from April 2016 through August 2024. Patients were classified using quintile rankings for disadvantaged neighborhoods based on the Area Deprivation Index (ADI). Frequency of opioid use was measured at quarterly intervals for 12 months. Multivariable analysis adjusted for patient-level demographic, behavioral, psychological, and clinical characteristics.

The mean (SD) age of 1757 patients was 53.1 (13.1) years, and 1298 (73.9%) were female. The 7738 patient encounters initially demonstrated a dose-response with higher ADI quintiles associated with more frequent opioid use. In multivariable analysis, ADI quintiles were no longer associated with frequency of opioid use. Non-White patients used opioids more often than White patients (OR, 1.38; 95% CI, 1.09-1.75), whereas Hispanic patients used opioids less often than non-Hispanic patients (OR, 0.66; 95% CI, 0.47-0.93). Similarly, when compared with non-Hispanic White referents, Black patients used opioids more often (OR, 1.53; 95% CI, 1.18-1.97) and Hispanic patients used opioids less often (OR, 0.68; 95% CI, 0.47-0.97).

The association of ADI quintile with frequency of opioid use was obviated after controlling for patient-level characteristics. Black and Hispanic patients reported divergent frequencies of opioid use. Policymakers, administrators, researchers, and clinicians should exercise caution when extrapolating results based on aggregate measures of social determinants of health to individual patients.