TY - JOUR
T1 - Prescription opioid poisoning across urban and rural areas
T2 - identifying vulnerable groups and geographic areas
AU - Cerdá, Magdalena
AU - Gaidus, Andrew
AU - Keyes, Katherine M.
AU - Ponicki, William
AU - Martins, Silvia
AU - Galea, Sandro
AU - Gruenewald, Paul
N1 - Publisher Copyright:
© 2016 Society for the Study of Addiction
PY - 2017/1/1
Y1 - 2017/1/1
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.
AB - 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.
KW - Bayesian space-time models
KW - drug overdose
KW - geography
KW - hospital discharges
KW - prescription opioids
KW - rural and urban
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U2 - 10.1111/add.13543
DO - 10.1111/add.13543
M3 - Article
C2 - 27470224
AN - SCOPUS:84985898315
SN - 0965-2140
VL - 112
SP - 103
EP - 112
JO - Addiction
JF - Addiction
IS - 1
ER -