Kolak Marynia A, Chen Yen-Tyng, Joyce Sam, Ellis Kaitlin, Defever Kali, McLuckie Colleen, Friedman Sam, Pho Mai T
Center for Spatial Data Science, University of Chicago, 1155 East 60th St, Rm 204, Chicago, IL 60637, United States.
Department of Medicine, Section of Infectious Diseases & Global Health, University of Chicago Medicine, 5841 South Maryland Ave., MC 5065, Chicago, IL, 60637, United States.
Int J Drug Policy. 2020 Nov;85:102727. doi: 10.1016/j.drugpo.2020.102727. Epub 2020 Jun 6.
Much remains unknown in rural risk environments, despite a growing crisis in these areas. We adapt a risk environment framework to characterize rural southern Illinois and describe the relations of risk environments, opioid-related overdose, HIV, Hepatitis C, and sexually transmitted infection rates between 2015 and 2017.
Over two dozen risk environment variables are summarized across zip-code (n = 128) or county levels (n = 16) based on availability and theoretical relevance. We calculate data attribute associations and characterize spatial and temporal dimensions of longitudinal health outcomes and the rural risk environment. We then use a "regional typology analysis" to generate data-driven risk regions and compare health outcomes.
Pervasive risk hotspots were identified in more populated locales with higher rates of overdose and HCV incidence, whereas emerging risk areas were isolated to more rural locales that had experienced an increase in analgesic opiate overdoses and generally lacked harm-reduction resources. At-risk areas were characterized with underlying socioeconomic vulnerability but in differing ways, reflecting a nuanced and shifting structural risk landscape.
Rural risk environment vulnerabilities and associated opioid-related health outcomes are multifaceted and spatially heterogeneous. More research is needed to better understand how refining geographies to more precisely define risk can support intervention efforts and further enrich investigations of the opioid epidemic.
尽管农村地区的危机日益严重，但农村风险环境中仍有许多未知之处。我们采用一种风险环境框架来描述伊利诺伊州南部农村地区的特征，并描述2015年至2017年间风险环境、阿片类药物相关过量用药、艾滋病毒、丙型肝炎和性传播感染率之间的关系。
根据数据可用性和理论相关性，在邮政编码级别（n = 128）或县级别（n = 16）汇总二十多个风险环境变量。我们计算数据属性关联，并描述纵向健康结果和农村风险环境的空间和时间维度。然后，我们使用“区域类型分析”来生成数据驱动的风险区域并比较健康结果。
在人口较多、过量用药率和丙型肝炎发病率较高的地区发现了普遍存在的风险热点，而新出现的风险区域则集中在农村地区，这些地区的止痛阿片类药物过量用药有所增加，并且普遍缺乏减少危害的资源。风险区域的特点是存在潜在的社会经济脆弱性，但方式不同，反映出细微且不断变化的结构性风险格局。
农村风险环境的脆弱性以及与之相关的阿片类药物相关健康结果是多方面的，且在空间上具有异质性。需要更多研究来更好地理解如何细化地理区域以更精确地定义风险，从而支持干预措施，并进一步丰富对阿片类药物流行的调查。
