The opioid epidemic, involving both prescription pain relievers and heroin, is affecting the entire nation, but not in the same way or to the same extent in every location. Having previously published white papers on national trends in the opioid epidemic and the impact of the epidemic on the healthcare system, FAIR Health now turns its attention in this third white paper in the series to regional variations in the effects of the opioid crisis. A national, independent, nonprofit organization dedicated to transparency in healthcare costs and health insurance information, FAIR Health analyzed data from its database of billions of privately billed healthcare claims to study the opioid crisis in rural and urban settings and in the nation's five most populous cities and the states in which they are situated during the recent ten-year period 2007 to 2016. Among the findings from the database's private insurance claims: (1) Claim lines with opioid abuse and dependence diagnoses were more concentrated among middle-aged people in rural than urban settings, where they were spread more broadly among young and middle-aged people. (2) Of the five most populous cities in the country--Chicago, Houston, Los Angeles, New York and Philadelphia--Philadelphia had the greatest percentage of claim lines with opioid-related diagnoses compared to all services in the state. It far outstripped the others in this measure: number of claim lines with opioid-related diagnoses in a city compared to number of claim lines for all medical care in the relevant state. (3) Of six regions in California, the greatest increase in claim lines with opioid-related diagnoses from 2007 to 2016 was in southern California (including Los Angeles), where the increase was 31,897 percent--more than five times as great as the next largest increase. (4) In New York State, New York City constituted 43 percent of the population but only 13 percent of the distribution of claim lines with opioid-related diagnoses. (5) In Texas, San Antonio and its immediate surrounding areas constituted 5 percent of the population, but 66 percent of the distribution of claim lines with opioid-related diagnoses. (6) In both Illinois and Pennsylvania, claim lines with an opioid dependence diagnosis occurred more frequently in males than females in all age groups--but the gap narrowed over the age of 50 years, with males at 55 percent and females at 45 percent. (7) The top five procedures associated with opioid-related diagnoses, and the top five expenditures, differed in each of the five states profiled in this study.
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