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Table 3 Demographic and clinical characteristics of older patients with chronic pain with or without ADRD residing in a nursing home stratified by cohort

From: Quality of opioid prescribing in older adults with or without Alzheimer disease and related dementia

Baseline characteristica Patients with chronic pain, %   Opioid-naive patients, %   Patients with neuropathic pain   Patients with opioid prescription, %   Patients with moderate to severe pain, %b  
With ADRD Without ADRD P-valueg With ADRD Without ADRD P-valueg With ADRD Without ADRD P-valueg With ADRD Without ADRD P-valueg With ADRD Without ADRD P-valueg
Total no. 37,117 5128 23,205 2761 2602 686 17,570 3180 10,971 2329
Age, y
 Mean (SD) 82.2 (10.5) 73.1 (12.8) < .001 82.6 (10.4) 73.8 (13.0) < .001 77.3 (11.4) 69.2 (10.9) < .001 81.6 (10.5) 72.9 (12.5) < .001 80.9 (10.6) 72.7 (12.5) < .001
 50–64 7.1 28.2   6.8 26.8   15.2 34.5   7.6 27.8   8.5 28.7  
 65–74 14.6 27.4 13.7 26.1 23.0 34.7 15.7 28.8 17.2 28.3
 75–84 29.8 21.0 29.4 21.3 31.0 21.0 30.5 21.0 31.2 20.8
  ≥ 85 48.4 23.4 50.0 25.8 30.8 9.8 46.1 22.3 43.2 22.1
Female 75.4 64.3 < .001 73.0 61.1 < .001 70.6 61.3 < .001 78.3 67.5 < .001 78.9 69.3 < .001
Race/ethnicity
 White 80.4 81.4 .205 78.6 80.3 .114 77.6 81.8 .082 83.1 82.7 .128 84.8 84.3 .662
 Black 14.1 13.2 15.1 13.7 15.4 12.6 12.8 12.4 11.6 11.7
 Othersc 5.5 5.4 6.3 5.9 7.0 5.6 4.1 4.9 3.7 4.0
US region
 Northeast 23.2 18.8 < .001 27.6 22.2 < .001 23.1 19.8 < .001 17.2 16.3 < .001 19.3 17.5 < .001
 Midwest 26.2 34.4 25.1 34.7 25.4 33.1 27.7 34.3 29.9 36.0
 South 40.0 33.1 37.1 30.9 38.7 33.2 44.3 35.5 40.7 32.7
 West or other regions 10.5 13.6 10.3 12.2 12.8 13.9 10.8 13.9 10.1 13.8
Low-income subsidy 82.5 79.6 < .001 81.2 76.1 < .001 85.1 81.2 .018 82.5 79.9 < .001 83.9 81.5 .006
Tobacco or alcohol use 5.3 8.9 < .001 4.6 7.8 < .001 6.8 8.1 .259 6.5 9.6 < .001 7.3 9.4 < .001
Drug use disorder 1.7 3.0 < .001 1.1 1.5 .051 2.0 2.8 .217 2.5 3.9 < .001 2.8 4.0 .002
Index pain diagnosisd
 Musculoskeletal 92.5 86.4 < .001 93.6 88.1 < .001 13.1 10.1 .044 90.8 85.1 < .001 90.6 85.1 < .001
 Neuropathic 6.0 11.8 < .001 5.6 11.3 < .001 100 100 NA 6.6 12.4 < .001 6.9 11.6 < .001
 Idiopathic 3.0 3.7 .012 1.8 1.6 .551 0.7 0.7 .956 4.7 5.1 .281 4.6 5.7 .022
Comorbidity affecting pain treatment
 Cardiovascular disease 93.2 88.1 < .001 92.0 84.5 < .001 93.0 88.3 < .001 94.4 90.1 < .001 94.6 90.1 .025
 Pulmonary condition 57.6 58.0 .565 54.1 51.5 .009 59.0 55.5 .130 62.1 61.3 .391 64.3 61.8 < .001
 Diabetes 42.5 50.7 < .001 40.5 45.9 < .001 69.2 66.3 .169 44.8 53.2 < .001 46.0 53.6 < .001
 Mental disorder 60.1 46.3 < .001 56.3 40.1 < .001 62.9 45.8 < .001 63.9 48.1 < .001 67.0 49.5 < .001
 Gastrointestinal tract disorder 43.9 36.5 < .001 41.1 32.3 < .001 45.6 38.8 .003 46.3 38.3 < .001 47.0 38.9 < .001
 Urinary tract infection 41.3 27.9 < .001 37.9 22.6 < .001 41.5 31.9 < .001 45.2 30.8 < .001 46.0 31.3 < .001
 Kidney disease 26.7 28.6 .006 24.2 23.9 .732 32.9 33.4 .809 30.2 30.8 < .001 30.8 30.7 .943
 Fall or fracture 24.0 16.7 < .001 19.8 12.3 < .001 18.9 10.6 < .001 28.5 19.4 < .001 28.5 18.7 < .001
 Neurodegenerative disease 16.4 10.6 < .001 15.5 8.7 < .001 20.6 12.1 < .001 17.2 11.5 < .001 18.5 11.8 < .001
 Liver disease 5.5 6.7 < .001 4.9 5.2 .548 6.8 7.3 .666 6.3 7.4 < .001 6.8 7.3 .423
Health care utilization
 Any hospitalization stay 31.7 29.9 .009 29.1 25.7 < .001 33.9 27.4 .003 35.9 32.5 < .001 37.7 32.4 < .001
 Any ED visit 26.5 24.8 .009 22.3 19.2 < .001 26.6 25.5 .559 30.9 28.2 .003 31.5 27.9 < .001
 Any hospital surgical procedure 7.6 9.7 < .001 6.2 7.2 .053 8.2 8.8 .642 10.0 11.4 .017 10.1 11.1 .174
ADL dependencee
 None 22.7 29.7 < .001 22.2 31.2 < .001 24.0 24.3 .207 23.3 26.8 < .001 26.5 28.5 .006
 Mild 31.6 27.8 31.8 28.1 27.7 26.1 31.7 28.1 32.0 29.2
 Moderate 29.2 29.5 28.9 27.2 30.5 34.4 29.5 32.5 28.0 30.0
 Severe 16.5 13.0 17.0 13.5 17.8 15.2 15.5 12.7 13.5 12.3
PHQ-9 depression symptomse
 None 78.7 79.8 .247 80.2 81.3 .292 78.8 83.8 .027 76.4 77.7 .233 74.0 76.6 .017
 Mild 14.7 14.2 13.8 13.5 15.1 11.4 16.3 15.6 17.7 16.4
 Moderate 4.9 4.6 4.6 4.1 4.2 4.0 5.2 5.1 5.8 5.5
 Severe 1.7 1.4 1.4 1.1 1.9 0.8 2.1 1.6 2.4 1.5
BMIe
 Underweight 7.9 7.5 < .001 7.9 7.2 < .001 5.2 6.4 < .001 8.2 7.9 < .001 7.4 7.3 < .001
 Normal weight 36.5 23.4 37.9 26.6 28.1 19.0 34.7 21.0 32.2 18.9
 Overweight 29.6 24.1 30.5 25.9 31.1 21.7 28.1 22.9 27.9 22.1
 Obese 25.9 45.0 23.6 40.2 35.6 52.9 28.9 48.1 32.4 51.7
Nursing home stay duration, mean (SD), df 326.3 (65.6) 263.8 (100.5) < .001 325.0 (66.4) 261.7 (101.0) < .001 316.0 (77.5) 254.9 (102.9) < .001 323.3 (69.7) 256.3 (102.5) < .001 331.6 (59.5) 268.0 (98.2) < .001
  1. Abbreviations: ADRD Alzheimer disease and related dementias, ADL activities of daily living, BMI body mass index (calculated as weight in kilograms divided by height in meters squared), ED emergency department, MDS 3.0 Minimum Data Set, version 3.0, PHQ-9 Patient Health Questionnaire-9
  2. aDefined as the 6 months prior to the date of a randomly selected chronic pain diagnosis for each patient
  3. bDefined as having ≥ 1 quarterly MDS 3.0 pain assessment with a numeric rating scale score of ≥ 4 or moderate or severe pain based on the verbal descriptor scale
  4. cIncluded Hispanic, Asian, Pacific Islander, and Native American individuals
  5. dMeasured as primary or secondary diagnosis as the index diagnosis
  6. eMeasured based on the first observe quarterly MDS 3.0 assessment during 12 months after diagnosis of chronic pain, which was randomly selected per patient
  7. fMeasured during the entire 12 months after diagnosis of chronic pain, which was randomly selected per patient
  8. gStatistical comparisons and P-values were calculated using t-tests for continuous variables and chi-square tests for categorical variables