Investigating the association between asthma and opioid use disorder with interactions of anxiety and depression among a national sample of the US population

Abstract

Introduction

Previous studies have not examined the association between asthma and opioid use disorder (OUD) in a comprehensive national sample of the U.S. population. This study aims to investigate such an association.

Methods

This is a matched retrospective cohort study, with a follow-up period of two years, utilizing longitudinal electronic medical records of a comprehensive national healthcare database in the U.S.–Cerner-Real World Data^TM. Patients selected for analysis were ≥12 years old with a hospital encounter between January 2000 and June 2020. Adjusted risk ratios (aRRs) of incident OUD for those with asthma compared to those without asthma were calculated using a modified Poisson regressions with robust standard errors via the Huber-White sandwich estimator, and results were stratified by comorbid mental illnesses.

Results

Individuals with asthma had a greater risk of OUD compared to those without asthma (aRR = 2.12; 95% CI 2.03–2.23). When stratified by anxiety and depression status, individuals with asthma and no anxiety or depression had a greater risk of incident OUD compared to individuals with asthma and either anxiety, depression, or both. Additionally, individuals with asthma medication had 1.29 (95% CI: 1.24, 1.35) greater overall risk for incident OUD compared to those without medication. Independent of comorbid mental illnesses, individuals with asthma medication had greater risk for incident OUD compared to those without medication among individuals without severe/obstructive asthma.

Conclusions

Individuals with asthma face a higher OUD risk compared to those without asthma. Comorbid mental illnesses modulate this risk. Caution is advised in opioid prescribing for asthma patients.

Keywords:

• asthma
• opioid use disorder
• severe/obstructive asthma
• anxiety
• depression

Acknowledgments

The authors acknowledge Oracle Cerner for the national data access and computation capabilities. We also thank Mr. Steven Birch for completing data queries for the pilot study. We thank Rona Bern for her work on the initial literature review for the study.

Author disclosures

FQ is partially funded from NIH grants (1) 5R61DA049382: Leveraging CDC opioid overdose surveillance funding from the Albuquerque area southwest tribal epidemiology center to create tribal data and culturally center medications for opioid use disorder; and (2) R01DA057658: Weighting Longitudinal Data to Access Opioid Analgesia Tapering Outcomes among Patients with Co-occurring Chronic Pain and Substance Use Disorder.

Contributors

Each author contributed to the submission in the following manner. Study Concept: FQ Data Management: BT, Statistical Analysis: BT Interpretation of data: FQ, AM, BT Initial drafting of manuscript: AM Editing/revision of manuscript: FQ, AM, BT, RPJ, KLB, and AIS. All authors have made significant contributions to this manuscript and have approved this version for submission.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.