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Original research
Age, period and cohort-related trends in prescription opioid use in the USA, 1999–2018
  1. Kristin Y Shiue1,
  2. Anna E Austin2,3,
  3. Rebecca B Naumann1,2,
  4. Allison E Aiello4,
  5. Stephen W Marshall1,2,
  6. Yvonne M Golightly1,5
  1. 1 Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
  2. 2 Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
  3. 3 Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
  4. 4 Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
  5. 5 College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
  1. Correspondence to Dr Kristin Y Shiue, Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, 27599, USA; kshiue{at}live.unc.edu

Abstract

Background To provide insight into the longitudinal dynamics of opioid use throughout the overdose crisis, this study estimated the separate influences of age, period and cohort on prescription opioid use during 1999–2018 in the USA.

Methods Data from 10 cycles of the cross-sectional National Health and Nutrition Examination Survey were used to conduct an age–period–cohort analysis of the prevalence of prescription opioid use (n=63 500 across 1999–2018). Temporal trends were graphically visualised. The median polish approach was used to estimate age, period and cohort-related effects on prescription opioid use.

Results Prescription opioid use broadly increased across the lifespan, with steeper prevalence increases observed from young adulthood to mid-adulthood. Period-related variation was consistent with recognised nationwide declines in opioid prescribing. While there was no evidence of systematic cohort effects, compared with individuals born in 1951–1954, those born during 1963–1966 had greater prescription opioid use (prevalence ratio (PR)=1.23, 95% CI: 1.05 to 1.43), whereas the 1991–1994 and 1999–2002 cohorts had lower prescription opioid use (PR91-94=0.70, 95% CI: 0.50 to 0.98; PR99-02=0.72, 95% CI: 0.63 to 0.81).

Conclusion In the USA, longitudinal trends in prescription opioid use during 1999–2018 were predominantly driven by age and period influences. The cohort of youngest baby boomers experienced greater prescription opioid use, whereas recent-born cohorts have had lower use. As the overdose crisis continues evolving, such population-level characterisations of age, period and cohort dynamics are instrumental in understanding opioid use and can inform prevention and intervention approaches by identifying population groups more likely to use opioids who, thus, may also experience related outcomes.

  • DRUG PRESCRIPTIONS
  • EPIDEMIOLOGY
  • Life course epidemiology

Data availability statement

Data are available in a public, open access repository. Data are available for download from the CDC/National Center for Health Statistics NHANES website: https://www.cdc.gov/nchs/nhanes/index.htm.

https://doi.org/10.1136/jech-2023-220701

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    Data availability statement

    Data are available in a public, open access repository. Data are available for download from the CDC/National Center for Health Statistics NHANES website: https://www.cdc.gov/nchs/nhanes/index.htm.

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    Footnotes

    • Contributors KYS and YMG conceptualised and designed the study. KYS conducted all statistical analyses and prepared the first draft of the manuscript. All authors critically reviewed the manuscript and provided input. KYS completed manuscript revisions. All authors have reviewed and approved the final manuscript. KYS is responsible for the overall content as the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.