Table 5

Longitudinal step-up and step-down analyses

 Stepping up to stronger opioidsStepping down from stronger opioids
Unadjusted OR (95% CI)Adjusted OR (95% CI)Unadjusted OR (95% CI)Adjusted OR (95% CI)
Patient demography
Female 18–49 years1111
Female 50–64 years1.05 (0.89 to 1.25)0.94 (0.79 to 1.12)1.07 (0.84 to 1.35)1.07 (0.84 to 1.35)
Female 65–100 years1.45 (1.25 to 1.69)1.17 (1.00 to 1.38)1.19 (0.96 to 1.47)1.21 (0.97 to 1.50)
Male 18–49 years0.99 (0.79 to 1.23)1.21 (0.96 to 1.52)0.55 (0.39 to 0.79)0.53 (0.37 to 0.75)
Male 50–64 years1.02 (0.84 to 1.23)0.97 (0.79 to 1.19)0.88 (0.66 to 1.16)0.90 (0.68 to 1.20)
Male 65–100 years0.9 (0.74 to 1.09)0.77 (0.63 to 0.94)1.16 (0.89 to 1.52)1.20 (0.91 to 1.58)
British1Random effectRandom effect
Pakistani0.36 (0.30 to 0.44)Random effect1.56 (1.22 to 2.00)Random effect
Other0.79 (0.67 to 0.94)Random effect1.31 (1.04 to 1.65)Random effect
Unknown0.8 (0.70 to 0.90)Random effect1.06 (0.90 to 1.27)Random effect
Patient morbidity, behaviour and healthcare use
Mental health problem1.25 (0.98 to 1.59)0.99 (0.69 to 1.43)
Definitively diagnosed disease2.25 (2.02 to 2.50)1.64 (1.46 to 1.85)1.03 (0.86 to 1.22)
Clinical presentation without a definite diagnosis1.87 (1.69 to 2.06)1.60 (1.43 to 1.79)0.95 (0.83 to 1.10)
Pain-associated syndrome1.76 (1.13 to 2.74)0.90 (0.43 to 1.89)
Alcohol problem1.13 (0.69 to 1.84)0.57 (0.21 to 1.60)
Smoking1.09 (0.93 to 1.26)0.87 (0.69 to 1.09)
Body mass index
 Normal111
 Overweight0.93 (0.62 to 1.40)0.95 (0.62 to 1.45)1.05 (0.60 to 1.84)
 Obese1.13 (0.77 to 1.67)1.08 (0.72 to 1.62)1.31 (0.74 to 2.32)
 Underweight2.94 (1.39 to 6.22)3.26 (1.49 to 7.17)
 Weight unrecorded0.96 (0.71 to 1.31)0.91 (0.66 to 1.25)1.07 (0.70 to 1.65)
Number of repeat prescriptions
 None1111
 1–42.2 (1.75 to 2.76)1.66 (1.32 to 2.09)0.73 (0.57 to 0.94)0.71 (0.55 to 0.91)
 5–93.84 (3.06 to 4.82)2.8 (2.21 to 3.54)0.68 (0.53 to 0.89)0.66 (0.51 to 0.86)
 10–565.86 (4.68 to 7.34)4.15 (3.26 to 5.29)0.65 (0.50 to 0.83)0.60 (0.46 to 0.77)
Number of consultations
 0–6111
 7–121.97 (1.59 to 2.44)1.52 (1.22 to 1.88)1.07 (0.85 to 1.35)
 13–3665.42 (4.48 to 6.56)3.04 (2.48 to 3.73)0.95 (0.77 to 1.16)
Number of missed appointments
 01111
 1–21.25 (1.12 to 1.39)1.01 (0.87 to 1.17)
 3–291.32 (1.13 to 1.55)0.84 (0.67 to 1.06)
Referrals
 Medical specialty1.81 (1.59 to 2.06)1.17 (1.02 to 1.34)1.01 (0.84 to 1.23)
 Musculoskeletal specialty2.39. 2.14 to 2.67)1.48 (1.31 to 1.66)1.14 (0.97 to 1.36)
 Neurology2.97 (2.42 to 3.65)1.77 (1.42 to 2.21)0.54 (0.34 to 0.83)0.59 (0.38 to 0.91)
 Specialist pain management7.72 (6.60 to 9.02)5.17 (4.37 to 6.12)0.57 (0.42 to 0.77)0.61 (0.45 to 0.83)
 Surgical specialty1.83 (1.57 to 2.14)1.29 (1.09 to 1.52)1.03 (0.81 to 1.31)
Practice characteristics
List size
 1500–699911
 7000–10 9991.18 (1.13 to 1.21)0.79 (0.67 to 0.93)
 11 000–25 1121.15 (1.12 to 1.19)0.83 (0.7 to 0.99)
Practice Index of Multiple Deprivation
 7–26.711
 26.7–39.51.01 (0.98 to 1.05)0.95 (0.79 to 1.12)
 39.5–57.50.92 (0.89 to 0.95)1.22 (1.02 to 1.45)
Number of GPs
 0–411
 5–91.16 (1.12 to 1.19)0.83 (0.71 to 0.96)
 9–201.14 (1.11 to 1.18)0.66 (0.54 to 0.8)
 Teaching status1.03 (1.01 to 1.06)1.03 (1.01 to 1.06)
Total QOF clinical domain points
 198–40311
 403–6551.18 (1.04 to 1.33)0.93 (0.78 to 1.11)
 655–6971.38 (1.22 to 1.55)0.84 (0.70 to 0.99)
  • Bold typeface represent odds ratios for which the 95% confidence intervals did not cross 1.

  • GP, general practitioner; QOF, Quality and Outcomes Framework.