Race and Gender Differences in Opioid Use Disorder in Massachusetts from 2014 through 2019, a Capture-Recapture Analysis

Abstract

Background: The opioid overdose epidemic has disproportionately impacted different groups. While overdoses continue to increase, accurate estimates of the prevalence of opioid use disorder (OUD) are needed to understand the size of the population at risk for overdose. Though overdoses are more common in males, the sex breakdown in OUD prevalence is unknown.

Objectives: To estimate the prevalence of OUD in Massachusetts from 2014 to 2018, stratified by sex.

Methods: We performed a capture-recapture analysis in Massachusetts from 2014-2018 among persons aged 18-64 years. We stratified our analysis by sex and used seven statewide datasets that were individually linked within the state’s Public Health Data Warehouse. We developed log linear models to estimate people previously unknown to have OUD. We estimated counts and prevalence of OUD among the adult population by sex.

Results: The estimated OUD prevalence increased from 4.74% (95% CI = 4.73%, 4.76%) in 2014 to 6.68% (95% CI = 6.66%, 6.70%) in 2018. Over that time, the proportion of the total prevalence attributable to females was 37% in 2014, 46% in 2015, 38% in 2016, 35% in 2017, and 44% in 2018. The proportion of estimated OUD cases known by the system remained stable (between 33%-43%), as well as the ratio of the proportion of females who were known to the unknown.

Conclusion: Overall prevalence estimates are significantly higher than those from NSDUH. Females account for nearly half of OUD prevalence in Massachusetts with no increase in the number who were previously unknown to the healthcare system.