Features of Residential Counties and Individual Health Conditions for Opioid Use Disorder Among Older Medicare Beneficiaries

ObjectivesLittle is known about how individual health conditions and residential characteristics jointly shape the risk of opioid use disorder (OUD) among older adults. This study examines hypotheses drawn from the collective resources and relative deprivation models to fill this gap.MethodsApplying the cases/controls matching technique to the 2018–2021 Medicare Fee-for-Service Part A and Part B claims data, this study constructs a case-control data set containing 92,244 older (65+) beneficiaries with OUD and 372,310 older beneficiaries without OUD. The beneficiary-level information is merged with characteristics of residential counties drawn from the 2016–2020 American Community Survey. Interaction terms between the beneficiary’s health conditions and county features, namely concentrated disadvantage and residential instability, are used to test the hypotheses.ResultsThe multilevel logistic regression results support the relative deprivation hypothesis as gaps in the predicted probability of having OUD for older adults with more versus fewer health conditions narrow in areas with more concentrated disadvantage. Older beneficiaries with poor health have a lower risk of OUD when living in socioeconomically disadvantaged counties than in affluent counties. Results also show that poor mental health and physical conditions are positively associated with the risk of OUD, and including county-level characteristics does not alter the relationships found at the beneficiary level.DiscussionOlder adults’ residential environment not only contributes to the risk of OUD but also moderates the relationships between health conditions and the risk of OUD. It is critical to consider the residential environment when developing interventions to reduce OUD among older adults.