# Area Deprivation Index and Coprescription of Opioids and Sedative Hypnotics

## TL;DR

This study found that patients in more socioeconomically disadvantaged areas are more likely to be prescribed both opioids and sedatives, highlighting a link between socioeconomic status and risky medication combinations.

## Contribution

The study introduces the Area Deprivation Index as a tool to assess socioeconomic disadvantage in relation to opioid and sedative coprescription patterns.

## Key findings

- Higher socioeconomic disadvantage (as measured by ADI) correlates with increased coprescription of opioids and sedatives.
- Patients with higher ADI scores had a 1.004% increased risk of coprescription for every unit increase in ADI.
- Significant differences in ADI were observed across insurance types, suggesting socioeconomic disparities in prescribing patterns.

## Abstract

Background and objectives

The coprescription of an opioid and a sedative-hypnotic (i.e., benzodiazepine or Z-drug) is associated with negative patient outcomes. Although multiple guidelines recommend minimizing this combination, studies demonstrate high coprescribing patterns. The Area Deprivation Index (ADI), a validated surrogate measure of socioeconomic status, was used to assess socioeconomic disadvantage. The objective of this study was to evaluate the current prevalence and the relationship between coprescriptions and ADI scores of patients.

Methods

A single-center retrospective observational study from 2019 to 2022 of adult patients in outpatient clinics with a coprescription (i.e., ≥ 7 days overlap between an opioid prescription and a benzodiazepine or Z-drug prescription) was conducted. A negative binomial model analyzed the percentage change in the incidence of coprescription for every unit increase in national ADI.

Results

A total of 6,846 patients had ≥ 7 days overlap of opioid and sedative-hypnotic prescriptions, comprising a total of 83,560 coprescriptions over the four-year period. A negative binomial regression found a 1.004% increased risk of coprescription for every unit increase in national ADI (p < 0.01), indicating higher socioeconomic disadvantage. The average patient was 57 years old with an ADI of 64.1, a coprescription overlap duration of 23.8 days, and ts (MME) of 47.3. Secondary observations included a significant difference in patient ADI across insurance types (p-value < 0.001). Higher MMEs were observed in white, black, and younger patients.

Conclusions

This study highlights the continued prevalence of coprescriptions and their relationship to social determinants of health. A stronger association between coprescriptions among patients with greater socioeconomic disadvantage (i.e., higher ADI) was observed and underscores the importance of incorporating ADI into prescribing risk assessments.