No abstract

ObjectiveThe opioid crisis brought scrutiny to opioid prescribing. Understanding how opioid prescribing patterns and corresponding patient outcomes changed during the epidemic is essential for future targeted policies. Many studies attempt to model trends in opioid prescriptions therefore understanding the temporal shift in opioid prescribing patterns across populations is necessary. This study characterized postoperative opioid prescribing patterns across different populations, 2010–2020.Data SourceAdministrative data from Veteran Health Administration (VHA), six Medicaid state programs and an Academic Medical Center (AMC).Data extractionSurgeries were identified using the Clinical Classifications Software.Study DesignTrends in average daily discharge Morphine Milligram Equivalent (MME), postoperative pain and subsequent opioid prescription were compared using regression and likelihood ratio test statistics.Principal FindingsThe cohorts included 595,106 patients, with populations that varied considerably in demographics. Over the study period, MME decreased significantly at VHA (37.5–30.1; p = 0.002) and Medicaid (41.6–31.3; p = 0.019), and increased at AMC (36.9–41.7; p < 0.001). Persistent opioid users decreased after 2015 in VHA (p < 0.001) and Medicaid (p = 0.002) and increase at the AMC (p = 0.003), although a low rate was maintained. Average postoperative pain scores remained constant over the study period.ConclusionsVHA and Medicaid programs decreased opioid prescribing over the past decade, with differing response times and rates. In 2020, these systems achieved comparable opioid prescribing patterns and outcomes despite having very different populations. Acknowledging and incorporating these temporal distribution shifts into data learning models is essential for robust and generalizable models.

In recent years, significant work has been done to include fairness constraints in the training objective of machine learning algorithms. Many state-of the-art algorithms tackle this challenge by learning a fair representation which captures all the relevant information to predict the output Y while not containing any information about a sensitive attribute S. In this paper, we propose an adversarial algorithm to learn unbiased representations via the Hirschfeld-Gebelein-Renyi (HGR) maximal correlation coefficient. We leverage recent work which has been done to estimate this coefficient by learning deep neural network transformations and use it as a minmax game to penalize the intrinsic bias in a multi dimensional latent representation. Compared to other dependence measures, the HGR coefficient captures more information about the non-linear dependencies with the sensitive variable, making the algorithm more efficient in mitigating bias in the representation. We empirically evaluate and compare our approach and demonstrate significant improvements over existing works in the field.Preprint. Under review.

No abstract

No abstract