Evaluating chronic pain as a risk factor for COVID-19 complications among New York State Medicaid beneficiaries: a retrospective claims analysis

Abstract

Objective: To assess whether chronic pain increases the risk of COVID-19 complications and whether opioid use disorder (OUD) differentiates this risk among New York State Medicaid beneficiaries. Design, Setting, and Subjects: This was a retrospective cohort study of New York State Medicaid claims data. We evaluated Medicaid claims from March 2019 through December 2020 to determine whether chronic pain increased the risk of COVID-19 emergency department (ED) visits, hospitalizations, and complications and whether this relationship differed by OUD status. We included beneficiaries 18–64 years of age with 10 months of prior enrollment. Patients with chronic pain were propensity score-matched to those without chronic pain on demographics, utilization, and comorbidities to control for confounders and were stratified by OUD. Complementary log–log regressions estimated hazard ratios (HRs) of COVID-19 ED visits and hospitalizations; logistic regressions estimated odds ratios (ORs) of hospital complications and readmissions within 0–30, 31–60, and 61–90 days. Results: Among 773 880 adults, chronic pain was associated with greater hazards of COVID-related ED visits (HR ¼ 1.22 [95% CI: 1.16–1.29]) and hospitalizations (HR ¼ 1.19 [95% CI: 1.12–1.27]). Patients with chronic pain and OUD had even greater hazards of hospitalization (HR ¼ 1.25 [95% CI: 1.07–1.47]) and increased odds of hepatic- and cardiac-related events (OR ¼ 1.74 [95% CI: 1.10–2.74]). Conclusions: Chronic pain increased the risk of COVID-19 ED visits and hospitalizations. Presence of OUD further increased the risk of COVID-19 hospitalizations and the odds of hepatic- and cardiac-related events. Results highlight intersecting risks among a vulnerable population and can inform tailored COVID-19 management.