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Four survival models\u2014traditional Cox, Cox with backward variable selection, LASSO\u2013penalized Cox, and survival random forest\u2014were used to account for time-fixed and time-varying predictors to predict time to first OUD or OD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Results<\/jats:title>\n                    <jats:p>Of 4190 older adults, 181 experienced incident OUD or OD during a mean (SD) follow-up of 6.1 (4.0) years. All 4 survival models performed equally, with mean C statistics from 0.753 (0.043) to 0.849 (0.018) and from 0.723 (0.054) to 0.790 (0.042) in training and testing sets, respectively, in predicting time to first OUD or OD during follow-up. Across all models, the top leading predictors of OUD or OD for older adults were duration of opioid use, uncontrolled pain, and use of other central nervous system medications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this prognostic study, traditional Cox and machine learning predictive models developed using patient-reported and claims-based measures performed equally well in predicting time to first OUD or OD and identified predictors for older adults. These models may be useful to monitor and identify older adults at risk for OUD or OD for early intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11606-026-10628-8","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T19:21:45Z","timestamp":1784229705000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictive Models for Time to First Opioid Use Disorder or Opioid Overdose Among Older Adults"],"prefix":"10.1007","author":[{"given":"Chien-Wei","family":"Chiang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Brock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siegfried","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger B.","family":"Fillingim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8861-6907","authenticated-orcid":false,"given":"Yu-Jung Jenny","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"10628_CR1","doi-asserted-by":"crossref","unstructured":"Kramarow EA, Tejada-Vera B. 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