(87) Sex, Socioeconomic Status, and Self-Perceived Risk of Opioid Overdose

Background &

Introduction: With the rising incidence of opioid overdoses in the United States, there is an urgent call for more effective interventions. A known risk factor for opioid overdose is male sex. Sex also plays a role in shaping individual perceptions of overdose risk, given that in other contexts, like contagious diseases, female participants demonstrated higher risk perceptions. Additionally, socioeconomic status (SES) impacts risk perception, with lower SES correlating with lower risk perception. Understanding self-perceived risk of overdose is crucial as it is known to influence the utilization of interventions that could potentially prevent fatalities. Current data on illicit opioid use shows no difference in risk perception between male and female participants, yet further investigation is warranted regarding prescription opioid use and in the context of SES.

Methods: This study is a secondary analysis on survey data collected from patients from Kaiser Permanente Colorado (KPCO) prescribed long-term opioid therapy (LTOT). The survey asked participants to specify demographic information and asked them to rank their level of risk of overdose, which we categorized into “risk” and “no risk”. We then used bivariate followed by multivariable analysis to examine the relationship between sex and self-risk perception of opioid overdose, in the context of other demographic/socioeconomic information that may affect risk perception independently, such as age, income, education level, race and ethnicity.

Results: Of the 985 participants, 355 were male (36%) and 630 were female (64%) based on the data from the EMR. Males in this study were significantly older than females, with mean age of male and female participants being 62.7 years (SD = 11.1) and 58.8 years (SD = 13.1), respectively. Most of the participants were White (78.5%), with Hispanic and Black participants making up 10% and 4% of the sample. Male participants were more likely to have completed a college degree (49.6%) than their female counterparts (38.1%). A higher percentage of females reported family incomes under $40,000 (37%) compared to males (24.5%). Only 1.6% of participants reported previous overdoses.
There was no significant difference in risk perception between male and female participants, with the majority and male and female participants reporting no risk when asked about risk of opioid overdose. However, there was an association between risk perception with age, education and income. Education was positively association with risk perception, while family income appeared to be negatively associated with risk perception. Prior opioid overdose was associated with increased risk perception, though the number of participants who reports prior overdose was small. There was no association between race/ethnicity and overdose risk perception.
Multivariable logistic regression was used to examine the association of sex with risk perception, while adjusting for sociodemographic and health characteristics. Similar to the results from the bivariate analysis where 61.1% of males and 63.8% of females responded with no risk, there was no statistically significant association between risk perception and sex. Older age was associated with a reduced odds of overdose risk perception (OR, 0.99; 95% CI, 0.97-1.00) after adjusting for prior overdose and sociodemographics. Compared to those with college degrees, participants with some college (OR, 0.70; 95% CI, 0.52-0.95) or a high school degree or less (OR, 0.49; 95% CI, 0.32-0.73) were less likely to believe they were at risk of an opioid overdose. Participants with higher incomes were more likely to perceive risk of overdose compared to those in the lowest income bracket ( < $20,000): $20,000 - $39,999 (OR, 2.42; 95% CI, 1.49-3.97); $45,000 - $74,999 (OR, 1.89; 95% CI, 1.21-2.99); ≥ $75,000 (OR, 1.65; 95% CI, 1.04-2.65). Prior opioid overdose was also associated with an increased likelihood of overdose risk perception (OR, 4.17; 95% CI, 1.45-13.8) There was no association between overdose risk perception and race/ethnicity.

Conclusion &

Discussion: Sex does not appear to be associated with self-perceived risk of opioid overdose in patients prescribed LTOT. However, higher socioeconomic status is positively correlated with risk perception, regardless of sex. This possibly suggests patients with lower SES may require more teaching on risk and modes of harm reduction in the clinic than patients of higher SES, though future research regarding concordance of a patient's true risk vs perceived risk of opioid overdose should be conducted.
This study examines sex as opposed to gender, as the former was available to us in the electronic medical record. Therefore, the results of this study cannot be generalized to intersex, transgender people, or anyone whose gender identity falls outside of the binary.

References: [1] Stoové MA, Dietze PM, Jolley D. Overdose deaths following previous non-fatal heroin overdose: record linkage of ambulance attendance and death registry data. Drug Alcohol Rev. 2009;28(4):347-352. doi:10.1111/j.1465-3362.2009.00057.x
[2] Foglia, R., Kline, A. & Cooperman, N.A. New and Emerging Opioid Overdose Risk Factors. Curr Addict Rep 8, 319–329 (2021). https://doi.org/10.1007/s40429-021-00368-6
[3] Alsharawy A, Spoon R, Smith A, Ball S. Gender differences in fear and risk perception during the COVID-19 pandemic. Frontiers.
[4] Powis B, Griffiths P, Gossop M, Strang J. The differences between male and female drug users: community samples of heroin and cocaine users compared. Subst Use Misuse. 1996;31(5):529-543. From https://nida.nih.gov/publications/research-reports/substance-use-in-women/sex-gender-differences-in-substance-use
[5] Christopher Rowe, Glenn-Milo Santos, Emily Behar, Philip O. Coffin, Correlates of overdose risk perception among illicit opioid users, Drug and Alcohol Dependence, Volume 159, 2016, ISSN 0376-8716,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734628/pdf/nihms748808.pdf