Rurality and opioid prescribing rates in U.S. counties from 2006 to 2018: A spatiotemporal investigation.

Previous literature on the uneven development of the opioid crisis across U.S. counties fails to account for the temporal and spatial dependency simultaneously. Assembling a spatiotemporal dataset from 2006 to 2018 based on the U.S. Opioid Dispensing Rate Maps, the American Community Survey, and other national data sources, this study examines how rurality impacts the county-level opioid prescribing rates. The results show significant spatial clustering patterns of opioid prescribing rates over the years. Taking the spatial structures into account, it is found that counties with a higher degree of rurality have higher opioid prescribing rates and this association could be explained by higher percentages of whites, higher unemployment rates, less nurse practitioners and physician assistants, and more specialized opioid prescribers such as surgeons and oncologists. Higher level of social capital is related to higher opioid prescribing rates, but it cannot explain the association between rurality and opioid prescribing. The findings highlight the role of healthcare services play in shaping the spatial inequality of opioid prescribing.