Associations Between Social Determinants of Health and Opioid-Use Disorder Among Chronic Pain Patients From a Multi-Institutional Dataset

BACKGROUND:

This study examined the association between opioid-use disorder (OUD)-related diagnoses (eg, opioid dependence) and social determinants of health (SDoH) among patients with chronic pain.

METHODS:

A cross-sectional study was performed using the All of Us dataset (including >70,000 patients) to measure associations between SDoH and OUD using population- and individual-level surveys. Mixed-effects multivariable regression models (random effect being zip code) were conducted for each of the key SDoH domains. The odds ratio (OR) and 95% confidence interval (CI) were reported.

RESULTS:

There were 71,727 participants identified to have chronic pain, of which 7272 (10.1%) had OUD. Using data from all participants with population-level survey data available (n = 71,684), the Area Deprivation Index was associated with increased odds of OUD (OR, 5.70, 95% CI, 2.34–13.83, P < .001). Being unemployed (OR, 1.91, 95% CI, 1.59–2.31, P < .001) was associated with OUD. Chronic pain patients with a college degree or greater had lower odds of having OUD (OR, 0.48, 95% CI, 0.39–0.59, P < .001). Responses to questions related to delayed medical care (OR, 1.42, 95% CI, 1.20–1.69, P < .001) and inability to afford medical care (OR, 1.37, 95% CI, 1.16–1.63, P < .001) were associated with an increased odds of OUD. Chronic pain patients who were never married or without a partner (OR, 1.49, 95% CI, 1.28–1.73, P < .001) had higher odds of OUD.

CONCLUSIONS:

The study revealed a significantly greater social disadvantage metric in chronic pain individuals with OUD.