Department of Biostatistics, University of Kentucky College of Public Health, Lexington, Kentucky.
Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky.
J Rural Health. 2019 Jan;35(1):97-107. doi: 10.1111/jrh.12300. Epub 2018 Apr 17.
Increased opioid analgesic prescribing (OAP) has been associated with increased risk of prescription opioid diversion, misuse, and abuse. We studied regional and rural-urban variations in OAP trends in Kentucky, from 2012 to 2015, and examined potential county-level risk and protective factors.
This study used prescription drug monitoring data. Marginal models employing generalized estimating equations were used to model repeated counts of residents with opioid analgesic prescriptions within county-quarter, 2012-2015, with offset for resident population, by rural-urban classification exposure, and adjusting for time-varying socioeconomic and relevant health status measures.
There were significant downward trends in rates of residents receiving dispensed opioid analgesic prescriptions, with no regional or rural/urban differences in the degree of decline over time. The adjusted models showed the Kentucky Appalachian region retained a significantly higher rate of residents with opioid analgesic prescriptions per 1,000 residents (30% higher than Central Kentucky and 19% higher than Kentucky Delta regions). Residents of nonmetropolitan not adjacent-to-metropolitan counties had significantly higher adjusted rates of OAP (33% higher than metropolitan counties and 17% higher compared to nonmetropolitan adjacent-to-metropolitan counties). The rate of OAP was significantly positively associated with emergency department visit injury rates and negatively associated with buprenorphine/naloxone prescribing rates.
Information on OAP trends and patterns will be used by Kentucky stakeholders to inform targeted interventions. Further research is needed to evaluate the availability and accessibility of nonopioid pain treatment in rural counties and the role of geography and time/distance traveled as risk factors for increased OAP.
阿片类镇痛药处方（OAP）的增加与处方类阿片药物的转移、滥用和误用风险的增加有关。我们研究了肯塔基州从 2012 年到 2015 年 OAP 趋势的地区和城乡差异，并研究了潜在的县一级风险和保护因素。
本研究使用了处方药物监测数据。采用广义估计方程的边缘模型，对 2012-2015 年间居民每季度接受阿片类镇痛药处方的情况进行了重复计数建模，居民人数为偏移量，按城乡分类暴露情况，调整了随时间变化的社会经济和相关健康状况指标。
接受分发的阿片类镇痛药处方的居民人数呈显著下降趋势，但在随时间推移的下降程度上没有地区或城乡差异。调整后的模型显示，肯塔基州阿巴拉契亚地区每千名居民的阿片类镇痛药处方率仍然明显较高（比中肯塔基州高 30%，比肯塔基三角洲地区高 19%）。非毗邻大都市的非大都市县的居民的 OAP 调整后率明显较高（比大都市县高 33%，比非大都市毗邻大都市县高 17%）。OAP 率与急诊科就诊伤害率呈显著正相关，与丁丙诺啡/纳洛酮处方率呈显著负相关。
肯塔基州的利益相关者将利用有关 OAP 趋势和模式的信息来为有针对性的干预措施提供信息。需要进一步研究以评估农村县非阿片类疼痛治疗的可及性和可及性，以及地理和旅行时间/距离作为增加 OAP 的风险因素的作用。
