Prescription opioid poisoning across urban and rural areas: identifying vulnerable groups and geographic areas

Magdalena Cerda, Andrew Gaidus, Katherine M. Keyes, William Ponicki, Silvia Martins, Sandro Galea, Paul Gruenewald

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Aims: To determine (1) whether prescription opioid poisoning (PO) hospital discharges spread across space over time, (2) the locations of ‘hot-spots’ of PO-related hospital discharges, (3) how features of the local environment contribute to the growth in PO-related hospital discharges and (4) where each environmental feature makes the strongest contribution. Design: Hierarchical Bayesian Poisson space–time analysis to relate annual discharges from community hospitals to postal code characteristics over 10 years. Setting: California, USA. Participants: Residents of 18 517 postal codes in California, 2001–11. Measurements: Annual postal code-level counts of hospital discharges due to PO poisoning were related to postal code pharmacy density, measures of medical need for POs (i.e. rates of cancer and arthritis-related hospital discharges), economic stressors (i.e. median household income, percentage of families in poverty and the unemployment rate) and concentration of manual labor industries. Findings: PO-related hospital discharges spread from rural and suburban/exurban ‘hot-spots’ to urban areas. They increased more in postal codes with greater pharmacy density [rate ratio (RR)�=�1.03; 95% credible interval (CI)�=�1.01, 1.05], more arthritis-related hospital discharges (RR�=�1.08; 95% CI�=�1.06, 1.11), lower income (RR�=�0.85; 95% CI�=�0.83, 0.87) and more manual labor industries (RR�=�1.15; 95% CI�=�1.10, 1.19 for construction; RR�=�1.12; 95% CI�=�1.04, 1.20 for manufacturing industries). Changes in pharmacy density primarily affected PO-related discharges in urban areas, while changes in income and manual labor industries especially affected PO-related discharges in suburban/exurban and rural areas. Conclusions: Hospital discharge rates for prescription opioid (PO) poisoning spread from rural and suburban/exurban hot-spots to urban areas, suggesting spatial contagion. The distribution of age-related and work-place-related sources of medical need for POs in rural areas and, to a lesser extent, the availability of POs through pharmacies in urban areas, partly explain the growth of PO poisoning across California, USA.

Original languageEnglish (US)
Pages (from-to)103-112
Number of pages10
JournalAddiction
Volume112
Issue number1
DOIs
StatePublished - Jan 1 2017

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Poisoning
Opioid Analgesics
Prescriptions
Industry
Arthritis
Hospital Economics
Unemployment
Pharmacies
Age Distribution
Community Hospital
Poverty
Growth
Workplace

Keywords

  • Bayesian space-time models
  • drug overdose
  • geography
  • hospital discharges
  • prescription opioids
  • rural and urban

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

Cite this

Cerda, M., Gaidus, A., Keyes, K. M., Ponicki, W., Martins, S., Galea, S., & Gruenewald, P. (2017). Prescription opioid poisoning across urban and rural areas: identifying vulnerable groups and geographic areas. Addiction, 112(1), 103-112. https://doi.org/10.1111/add.13543

Prescription opioid poisoning across urban and rural areas : identifying vulnerable groups and geographic areas. / Cerda, Magdalena; Gaidus, Andrew; Keyes, Katherine M.; Ponicki, William; Martins, Silvia; Galea, Sandro; Gruenewald, Paul.

In: Addiction, Vol. 112, No. 1, 01.01.2017, p. 103-112.

Research output: Contribution to journalArticle

Cerda, M, Gaidus, A, Keyes, KM, Ponicki, W, Martins, S, Galea, S & Gruenewald, P 2017, 'Prescription opioid poisoning across urban and rural areas: identifying vulnerable groups and geographic areas', Addiction, vol. 112, no. 1, pp. 103-112. https://doi.org/10.1111/add.13543
Cerda, Magdalena ; Gaidus, Andrew ; Keyes, Katherine M. ; Ponicki, William ; Martins, Silvia ; Galea, Sandro ; Gruenewald, Paul. / Prescription opioid poisoning across urban and rural areas : identifying vulnerable groups and geographic areas. In: Addiction. 2017 ; Vol. 112, No. 1. pp. 103-112.
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abstract = "Aims: To determine (1) whether prescription opioid poisoning (PO) hospital discharges spread across space over time, (2) the locations of ‘hot-spots’ of PO-related hospital discharges, (3) how features of the local environment contribute to the growth in PO-related hospital discharges and (4) where each environmental feature makes the strongest contribution. Design: Hierarchical Bayesian Poisson space–time analysis to relate annual discharges from community hospitals to postal code characteristics over 10 years. Setting: California, USA. Participants: Residents of 18 517 postal codes in California, 2001–11. Measurements: Annual postal code-level counts of hospital discharges due to PO poisoning were related to postal code pharmacy density, measures of medical need for POs (i.e. rates of cancer and arthritis-related hospital discharges), economic stressors (i.e. median household income, percentage of families in poverty and the unemployment rate) and concentration of manual labor industries. Findings: PO-related hospital discharges spread from rural and suburban/exurban ‘hot-spots’ to urban areas. They increased more in postal codes with greater pharmacy density [rate ratio (RR){\"i}¿½={\"i}¿½1.03; 95{\%} credible interval (CI){\"i}¿½={\"i}¿½1.01, 1.05], more arthritis-related hospital discharges (RR{\"i}¿½={\"i}¿½1.08; 95{\%} CI{\"i}¿½={\"i}¿½1.06, 1.11), lower income (RR{\"i}¿½={\"i}¿½0.85; 95{\%} CI{\"i}¿½={\"i}¿½0.83, 0.87) and more manual labor industries (RR{\"i}¿½={\"i}¿½1.15; 95{\%} CI{\"i}¿½={\"i}¿½1.10, 1.19 for construction; RR{\"i}¿½={\"i}¿½1.12; 95{\%} CI{\"i}¿½={\"i}¿½1.04, 1.20 for manufacturing industries). Changes in pharmacy density primarily affected PO-related discharges in urban areas, while changes in income and manual labor industries especially affected PO-related discharges in suburban/exurban and rural areas. Conclusions: Hospital discharge rates for prescription opioid (PO) poisoning spread from rural and suburban/exurban hot-spots to urban areas, suggesting spatial contagion. The distribution of age-related and work-place-related sources of medical need for POs in rural areas and, to a lesser extent, the availability of POs through pharmacies in urban areas, partly explain the growth of PO poisoning across California, USA.",
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AU - Galea, Sandro

AU - Gruenewald, Paul

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N2 - Aims: To determine (1) whether prescription opioid poisoning (PO) hospital discharges spread across space over time, (2) the locations of ‘hot-spots’ of PO-related hospital discharges, (3) how features of the local environment contribute to the growth in PO-related hospital discharges and (4) where each environmental feature makes the strongest contribution. Design: Hierarchical Bayesian Poisson space–time analysis to relate annual discharges from community hospitals to postal code characteristics over 10 years. Setting: California, USA. Participants: Residents of 18 517 postal codes in California, 2001–11. Measurements: Annual postal code-level counts of hospital discharges due to PO poisoning were related to postal code pharmacy density, measures of medical need for POs (i.e. rates of cancer and arthritis-related hospital discharges), economic stressors (i.e. median household income, percentage of families in poverty and the unemployment rate) and concentration of manual labor industries. Findings: PO-related hospital discharges spread from rural and suburban/exurban ‘hot-spots’ to urban areas. They increased more in postal codes with greater pharmacy density [rate ratio (RR)�=�1.03; 95% credible interval (CI)�=�1.01, 1.05], more arthritis-related hospital discharges (RR�=�1.08; 95% CI�=�1.06, 1.11), lower income (RR�=�0.85; 95% CI�=�0.83, 0.87) and more manual labor industries (RR�=�1.15; 95% CI�=�1.10, 1.19 for construction; RR�=�1.12; 95% CI�=�1.04, 1.20 for manufacturing industries). Changes in pharmacy density primarily affected PO-related discharges in urban areas, while changes in income and manual labor industries especially affected PO-related discharges in suburban/exurban and rural areas. Conclusions: Hospital discharge rates for prescription opioid (PO) poisoning spread from rural and suburban/exurban hot-spots to urban areas, suggesting spatial contagion. The distribution of age-related and work-place-related sources of medical need for POs in rural areas and, to a lesser extent, the availability of POs through pharmacies in urban areas, partly explain the growth of PO poisoning across California, USA.

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