Gabapentinoid Use among Medicare Beneficiaries during the Post-Stroke Recovery Period

Background Most studies of gabapentinoid prescribing trends have focused on younger, commercially insured populations. Patterns among vulnerable groups, including older stroke survivors, remain poorly characterized. We described patterns of gabapentinoid initiation among Medicare beneficiaries following acute ischemic stroke (AIS). Methods We analyzed claims data from a 20% sample of U.S. Medicare beneficiaries aged ≥ 65 years hospitalized for AIS between 2009 and 2022. We included individuals enrolled in traditional Medicare for ≥ 12 months before hospitalization, without prior stroke during this interval, and discharged home or to an inpatient destination for ≤30 days. After excluding those with gabapentinoid use before stroke, we analyzed outpatient gabapentin prescriptions six months after stroke discharge by demographic and clinical characteristics. We calculated the percentage of gabapentinoid initiators by year and U.S. census division, standardized by age, discharge destination, and modified Rankin Score (mRS). Results Among 153,728 Medicare stroke survivors who had not previously been prescribed a gabapentinoid in the 6 months before hospitalization, 4.9% received new prescriptions within 6 months after discharge. The median age was 78 years (Quartile Range: 72 - 84), 55% were female, and 81% were Non-Hispanic White. The crude percentage of gabapentinoid initiators increased from 3.6% in 2009 to 5.8% in 2022. The standardized percentages were 3.8% in 2009 and 5.9% in 2022. We reported a 2.1 percentage point difference in gabapentinoid initiation between U.S. census divisions, with the lowest percentage in the New England Division (3.9%) and the highest in the West South Central Division (6.0%). After standardization, the percentage point difference was 1.9% between the highest and lowest U.S. division. Conclusion The percentage of U.S. Medicare stroke survivors initiating gabapentinoid increased from 2009 to 2022. We also identified geographic variation, with the highest initiation percentage in the West South Central and the lowest in the New England U.S. Division. Twitter: @MGHValue