Cross-sectional analysis of associations with long-term and stronger opioid prescribing
| Four or more opioids prescriptions within year (long term) | Stronger opioid prescription at any point within year | |||
|---|---|---|---|---|
| Unadjusted OR (95% CI) | Adjusted OR (95% CI) | Unadjusted OR (95% CI) | Adjusted OR (95% CI) | |
| Patient demographics | ||||
| Female 18–49 years | 1 | 1 | 1 | 1 |
| Female 50–64 years | 2.77 (2.65 to 2.90) | 1.93 (1.83 to 2.02) | 1.79 (1.64 to 1.96) | 1.17 (1.06 to 1.29) |
| Female 65–100 years | 4.22 (4.05 to 4.39) | 2.39 (2.28 to 2.51) | 3.02 (2.79 to 3.26) | 1.46 (1.33 to 1.59) |
| Male 18–49 years | 0.99 (0.94 to 1.04) | 1.25 (1.18 to 1.32) | 1.34 (1.21 to 1.47) | 1.82 (1.64 to 2.02) |
| Male 50–64 years | 2.43 (2.32 to 2.55) | 1.75 (1.65 to 1.84) | 1.58 (1.43 to 1.75) | 1.07 (0.96 to 1.19) |
| Male 65–100 years | 3.11 (2.97 to 3.26) | 1.76 (1.67 to 1.86) | 1.95 (1.77 to 2.14) | 0.86 (0.78 to 0.96) |
| British | 1 | Random effect | 1 | Random effect |
| Pakistani | 0.47 (0.45 to 0.49) | Random effect | 0.26 (0.23 to 0.30) | Random effect |
| Other | 0.55 (0.52 to 0.57) | Random effect | 0.57 (0.51 to 0.62) | Random effect |
| Unknown | 0.79 (0.77 to 0.82) | Random effect | 1.06 (1.00 to 1.19) | Random effect |
| Patient morbidity, behaviour and healthcare use | ||||
| Mental health problem | 1.19 (1.10 to 1.28) | 1.12 (1.03 to 1.23) | 1.32 (1.15 to 1.51) | 1.23 (1.06 to 1.43) |
| Definitively diagnosed disease | 1.47 (1.42 to 1.53) | 1.09 (1.05 to 1.14) | 1.43 (1.34 to 1.54) | 1.12 (1.04 to 1.20) |
| Clinical presentation without a definite diagnosis | 0.87 (0.85 to 0.89) | 0.83 (0.81 to 0.86) | 0.99 (0.94 to 1.04) | – |
| Pain-associated syndrome | 1.10 (0.92 to 1.31) | – | 1.49 (1.11 to 2.00) | – |
| Body mass index | ||||
| Overweight or obese | 1.01 (0.96 to 1.05) | – | 0.79 (0.73 to 0.87) | 0.87 (0.79 to 0.95) |
| Underweight | 0.99 (0.81 to 1.21) | – | 1.71 (1.24 to 2.34) | 1.89 (1.34 to 2.67) |
| Number of repeat prescriptions | ||||
| 1–4 | 2.21 (2.12 to 2.29) | 2.05 (1.96 to 2.14) | 2.45 (2.20 to 2.72) | 2.06 (1.85 to 2.30) |
| 5–9 | 4.12 (3.94 to 4.31) | 3.65 (3.47 to 3.84) | 4.31 (3.87 to 4.79) | 3.51 (3.13 to 3.95) |
| 10–56 | 6.68 (6.36 to 7.03) | 5.68 (5.35 to 6.03) | 8.44 (7.59 to 9.38) | 6.55 (5.81 to 7.38) |
| Number of consultations | ||||
| 0–6 | 1 | 1 | 1 | 1 |
| 7–12 | 1.39 (1.34 to 1.44) | 0.9 (0.86 to 0.93) | 1.51 (1.38 to 1.65) | 1.1 (1.00 to 1.20) |
| 13–366 | 1.37 (1.35 to 1.38) | 1.07 (1.03 to 1.12) | 4.02 (3.73 to 4.34) | 2.03 (1.86 to 2.21) |
| Number of missed appointments | ||||
| 0 | 1 | 1 | 1 | 1 |
| 1–2 | 1.19 (1.06 to 1.12) | 1.08 (1.04 to 1.12) | 1.28 (1.21 to 1.36) | 1.12 (1.06 to 1.20) |
| 3–29 | 1.29 (1.23 to 1.35) | 1.31 (1.24 to 1.39) | 2.08 (1.92 to 2.25) | 1.68 (1.53 to 1.84) |
| Referrals | ||||
| Diagnostic testing | 1.19 (1.14 to 1.24) | 0.95 (0.90 to 0.99) | 1.14 (1.06 to 1.24) | – |
| Medical specialty | 1.36 (1.30 to 1.42) | 0.87 (0.83 to 0.92) | 1.52 (1.41 to 1.63) | – |
| Musculoskeletal specialty | 1.28 (1.24 to 1.33) | 1.19 (1.14 to 1.24) | 1.26 (1.18 to 1.34) | – |
| Neurology | 1.56 (1.43 to 1.70) | 1.27 (1.15 to 1.40) | 2.16 (1.90 to 2.45) | 1.52 (1.32 to 1.75) |
| Specialist pain management | 4.2 (3.76 to 4.68) | 3.7 (3.28 to 4.18) | 7.44 (6.68 to 8.28) | 5.74 (5.09 to 6.47) |
| Surgical specialty | 1.14 (1.08 to 1.20) | – | 1.34 (1.22 to 1.47) | – |
| Practice characteristics | ||||
| List size | ||||
| 1500–6999 | 1 | – | 1 | – |
| 7000–10 999 | 1.18 (1.13 to 1.21 | – | 1.05 (0.99 to 1.12) | – |
| 11 000–25 112 | 1.15 (1.12 to 1.19) | – | 1.16 (1.09 to 1.23) | – |
| Practice Index of Multiple Deprivation | ||||
| 7–26.7 | 1 | 1 | 1 | – |
| 26.7–39.5 | 1.01 (0.98 to 1.05) | 1.17 (1.04 to 1.31) | 1.02 (0.97 to 1.09) | – |
| 39.5–57.5 | 0.92 (0.89 to 0.95) | 1.21 (1.09 to 1.35) | 0.7 (0.66 to 0.75) | – |
| Number of GPs | ||||
| 0–4 | 1 | – | 1 | – |
| 5–9 | 1.16 (1.12 to 1.19) | – | 1.07 (1.01 to 1.14) | – |
| 9–20 | 1.14 (1.11 to 1.18) | – | 1.14 (1.07 to 1.21) | – |
| Proportion of salaried GPs | ||||
| Lower third | 1 | – | 1 | – |
| Middle third | 1.02 (0.99 to 1.06) | 0.88 (0.83 to 0.93) | – | |
| Upper third | 1 (0.97 to 1.03) | 0.86 (0.81 to 0.92) | – | |
| Patients per GP | ||||
| 707–1278 | 1 | – | 1 | – |
| 1279–1558 | 1.01 (0.98 to 1.04) | 1.23 (1.16 to 1.3) | – | |
| 1559–4447 | 0.86 (0.83 to 0.88) | 0.9 (0.84 to 0.96) | – | |
| Proportion of ‘first five’ GPs | ||||
| Lower third | 1 | – | 1 | – |
| Middle third | 1.04 (1.01 to 1.08) | – | 0.85 (0.79 to 0.91) | – |
| Upper third | 1.01 (0.98 to 1.04) | – | 0.83 (0.8 to 0.9) | – |
| Teaching status | 1.03 (1.01 to 1.06) | 1.23 (1.17 to 1.29) | – | |
| Total QOF clinical domain points | ||||
| 243–647 | 1 | – | 1 | – |
| 648–657 | 1.01 (0.99 to 1.04) | 1.09 (1.02 to 1.15) | – | |
| 658–661 | 1.02 (0.99 to 1.02) | 1.09 (1.03 to 1.16) | – | |
Bold typeface represent odds ratios for which the 95% confidence intervals did not cross 1.
GP, general practitioner; QOF, Quality and Outcomes Framework.