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Research ArticleOriginal Research

Cancer Screening Among Women Prescribed Opioids: A National Study

Alicia Agnoli, Anthony Jerant and Peter Franks
The Annals of Family Medicine January 2020, 18 (1) 59-65; DOI: https://doi.org/10.1370/afm.2489
Alicia Agnoli
Department of Family and Community Medicine, University of California, Davis, School of Medicine, Sacramento, California
MD, MPH, MHS
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  • For correspondence: aagnoli@ucdavis.edu
Anthony Jerant
Department of Family and Community Medicine, University of California, Davis, School of Medicine, Sacramento, California
MD
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Peter Franks
Department of Family and Community Medicine, University of California, Davis, School of Medicine, Sacramento, California
MD
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Tables

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    Table 1

    Patient Characteristics, by Opioid Prescription (None vs Any)

    CharacteristicTotalNo OpioidsAny OpioidsP Value
    No. (%)53,982 (100)45,449 (84.2)8,533 (15.8)
    Age, y, mean (SD)45.6 (17.5)45.2 (17.5)47.4 (17.2)<.001
    Race, no. (%)
     White24,732 (45.8)20,102 (44.2)4,630 (54.3)<.001
     Hispanic13,779 (25.5)12,297 (27.1)1,482 (17.4)
     Black10,774 (20.0)8,824 (19.4)1,950 (22.9)
     Other4,697 (8.7)4,226 (9.3)471 (5.5)
    Education, no. (%)
     Less than high school4,717 (8.7)4,102 (9.0)615 (7.2)<.001
     Some high school7,015 (13.0)5,744 (12.6)1,271 (14.9)
     High school graduate16,349 (30.3)13,577 (29.9)2,772 (32.5)
     Some college13,721 (25.4)11,337 (24.9)2,384 (27.9)
    College graduate12,180 (22.6)10,689 (23.5)1,491 (17.5)
     Household income, % federal poverty level, no. (%)
     <100%11,274 (20.9)9,059 (19.9)2,215 (26.0)<.001
     100%-124%3,505 (6.5)2,895 (6.4)610 (7.1)
     125%-199%9,102 (16.9)7,643 (16.8)1,459 (17.1)
     200%-399%15,494 (28.7)13,175 (29.0)2,319 (27.2)
     ≥400%14,607 (27.1)12,677 (27.9)1,930 (22.6)
    Census region, no. (%)
     Northeast8,390 (15.5)7,346 (16.2)1,044 (12.2)<.001
     Midwest10,646 (19.7)8,695 (19.1)1,951 (22.9)
     South20,811 (38.6)17,288 (38.0)3,523 (41.3)
     West14,135 (26.2)12,120 (26.7)2,015 (23.6)
    Insurance status, no. (%)
     Private31,131 (57.7)26,440 (58.2)4,691 (55.0)<.001
     Public13,695 (25.4)10,624 (23.4)3,071 (36.0)
     None9,156 (17.0)8,385 (18.4)771 (9.0)
    12-Item Short-Form Health Survey component, mean (SD)
     Physical Component Summary score48.7 (11.1)50.0 (10.0)41.6 (13.4)<.001
     Mental Component Summary score49.9 (10.4)50.4 (10.0)46.7 (11.9)<.001
    Self-rated health, no. (%)
     Excellent11,481 (21.3)10,508 (23.1)973 (11.4)<.001
     Very good17,285 (32.0)15,265 (33.6)2,020 (23.7)
     Good16,309 (30.2)13,541 (29.8)2,768 (32.4)
     Fair6,948 (12.9)5,079 (11.2)1,869 (21.9)
     Poor1,959 (3.6)1,056 (2.3)903 (10.6)
    Current smoker, no. (%)
     No45,543 (84.4)39,127 (86.1)6,416 (75.2)<.001
     Yes8,439 (15.6)6,322 (13.9)2,117 (24.8)
    Count of chronic diseases,001.0<.001
    median (IQR)(0-1.0)(0-1.0)(0-2.0)
    Usual source of care, no. (%)
     No12,534 (23.2)11,337 (24.9)1,197 (14.0)<.001
     Yes41,448 (76.8)34,112 (75.1)7,336 (86.0)
    Number of office visits,2.01.05.0<.001
    median (IQR)(0-5.0)(0-4.0)(2.0-10.0)
    Opioid category, no. (%)
     0 prescriptions45,449 (84.2)45,449 (100.0)<.001
     1 prescription4,505 (8.3)4,505 (52.8)
     2-3 prescriptions1,779 (3.3)1,779 (20.8)
     4-11 prescriptions1,622 (3.0)1,622 (19.0)
     >12 prescriptions627 (1.2)627 (7.3)
    Cervical cancer screening, no. (%)
     Yes39,229 (84.2)32,914 (84.1)6,315 (84.8).13
    Breast cancer screening, no. (%)
     Yes23,449 (70.7)19,220 (70.2)4,229 (73.2)<.001
    Colorectal cancer screening, no. (%)
     Yes11,622 (49.2)9,276 (47.8)2,346 (55.8)<.001
    • IQR = interquartile range.

    • Notes: Data not adjusted for survey characteristics. P values based on sample and not survey adjusted.

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    Table 2

    Adjusted Odds of Reporting Opioid Prescriptions, by Patient Characteristic

    CharacteristicAOR (95% CI)P Value
    Age0.98 (0.98-0.98)<.001
    Race/ethnicity (ref = white)
     Hispanic0.67 (0.61-0.73)<.001
     Black0.91 (0.84-0.99).023
     Other0.6 (0.52-0.69)<.001
    Education (ref = less than high school)
     Some high school1.18 (1.02-1.36).028
     High school graduate1.21 (1.05-1.39).008
     Some college1.29 (1.12-1.47)<.001
     College graduate1.08 (0.93-1.25).299
    Household income, % federal poverty level (ref = <100%)
     100%-124%0.97 (0.84-1.11).643
     125%-199%0.96 (0.87-1.05).332
     200%-399%0.88 (0.8-0.97).014
     ≥400%0.84 (0.75-0.94).003
    Census region (ref = Northeast)
     Midwest1.59 (1.43-1.77)<.001
     South1.58 (1.42-1.76)<.001
     West1.7 (1.52-1.9)<.001
    Insurance status (ref = private)
     Public0.95 (0.87-1.03).206
     None0.59 (0.53-0.67)<.001
    12-Item Short-Form Health Survey component
     Physical Component Summary score0.95 (0.95-0.96)<.001
     Mental Component Summary score0.99 (0.98-0.99)<.001
    Self-rated health1.07 (1.03-1.11).001
    Current smoker (vs nonsmoker)1.56 (1.45-1.67)<.001
    Count of chronic diseases1.05 (1.02-1.09).001
    Usual source of care, Yes (vs No)1.43 (1.31-1.56)<.001
    Number of office visits1.08 (1.07-1.08)<.001
    • AOR = adjusted odds ratio.

    • Note: Data adjusted for survey characteristics and panel year.

    • View popup
    Table 3

    Adjusted Odds of Cancer Screening, Without and With Health Care Utilization Adjustment

    Screening TestModel 1: Without Utilization Adjustment, AOR (95% CI)Model 2: With Utilization Adjustment, AOR (95% CI)Statistical Significance of Difference Between Models (P Value)a
    Breast cancer (n = 33,166)1.26 (1.16-1.38) P<.0011.07 (0.98-1.18) P = .09<.001
    Cervical cancer (n = 46,598)1.22 (1.13-1.33) P<.0011.01 (0.93-1.09) P = .8<.001
    Colorectal cancer (n = 23,613)1.22 (1.12-1.33) P<.0011.04 (0.95-1.14) P = .35<.001
    • AOR = adjusted odds ratio for women reporting opioid prescriptions vs women reporting none.

    • Notes: Model 1 includes adjustment for age, race/ethnicity, US Census region, education level, income, health insurance status, health status, comorbidities, smoking status, usual source of care, and panel year. Model 2 includes all covariates in Model 1, as well as count of doctor’s office visits.

    • ↵a Adjusted Wald test comparing parameter estimates for opioids in Model 1 and Model 2.

Additional Files

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  • The Article in Brief

    Cancer Screening Among Women Prescribed Opioids: A National Study

    Alicia Agnoli , and colleagues

    Background Concerns have been raised that in the primary care setting, treating chronic pain and managing opioid prescriptions may be associated with negative preventive care outcomes. Managing patient pain and prescription opioids takes considerable time, and these competing demands may strain and impair the delivery of evidence-based preventive health needs, such as recommended cancer screenings.

    What This Study Found Researchers at the University of California, Davis analyzed data from a nationally representative sample of 53,982 women in the United States. Findings revealed that women who are prescribed opioids were more likely to receive breast, cervical, and colorectal cancer screenings for the simple fact that they are frequent users of the health care system. They had a median number of doctor visits that was five times higher than their non-prescribed counterparts. When this factor was controlled for, analysis showed no association between prescription opioid use and cancer screening. Authors conclude that U.S. women who take prescription opioids are no less likely to receive key cancer screenings when compared to women who are not prescribed opioids.

    Implications

    • This study is one of the first to examine access to key preventive health services for opioid versus non-opioid users. Authors suggest that "the key driver of whether women receive recommended cancer screening is simply how often they see the doctor."
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The Annals of Family Medicine: 18 (1)
The Annals of Family Medicine: 18 (1)
Vol. 18, Issue 1
January/February 2020
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Cancer Screening Among Women Prescribed Opioids: A National Study
Alicia Agnoli, Anthony Jerant, Peter Franks
The Annals of Family Medicine Jan 2020, 18 (1) 59-65; DOI: 10.1370/afm.2489

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Cancer Screening Among Women Prescribed Opioids: A National Study
Alicia Agnoli, Anthony Jerant, Peter Franks
The Annals of Family Medicine Jan 2020, 18 (1) 59-65; DOI: 10.1370/afm.2489
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