Nahian Ahmed, Shepherd Jewel Goodman
Center of Brain and Behavior Research, University of South Dakota, 901 Rose St. Apt 133-A, Vermillion, SD 57069, USA.
University of South Dakota, 414 E. Clark St. Vermillion, SD 57069, USA.
J Addict Res Ther. 2022;13(11). Epub 2022 Oct 14.
Rural hospitals and patient population tend to be medically underserved. The states with more rural population dispensed the most opioids per person in the last 10 years. We aimed to explore if rurality contributed to the likelihood of higher opioid adversity and how it affected substance-use rehabilitation in federally designated Medically Underserved Areas (MUAs).
We analyzed data dispensed by the South Dakota Department of Health (DOH) on opioid-led poisoning International Classification of Disease (ICD) codes that were active within the state in the last decade. After locating MUA rural and partially rural counties, we cross profiled the counties to the state datasets. Assessments were conducted using the PROC SURVEY methods in SAS version 9.3 (SAS Institute) and checked for multicollinearity with the Belsley-Kuh-Welsch technique. Finally, we used the American Hospital Association (AHA) database for analyzing substance use rehabilitation availability on per hospital basis.
The chi-square statistic for comparing opioid codes against non-opioid codes distributed among three categories, rural, non-rural, and partially rural was significant at the limit of p <0.05. 81.134% of opioid-led poisoning codes were activated in a rural county. Only four hospitals had substance-use rehabilitation, three of which were in a non-rural area. More people from the teenage and early-adulthood years (10-19) were prone to opioid usage.
Rural counties in South Dakota were more likely to dispense opioid care and not have access to rehabilitation. We also found that as the opioid dispensing rate at hospitals within a state decreased as the state had less rural counties. Introducing public programs to train more physicians and cutting down cost of non-opioid based care may lower opioid distribution and increase rehabilitation options in rural hospitals.
农村医院和患者群体往往在医疗服务方面得不到充分保障。在过去10年中，农村人口较多的州人均阿片类药物配给量最高。我们旨在探讨农村地区是否会导致更高的阿片类药物不良事件发生率，以及它如何影响联邦指定的医疗服务不足地区（MUA）的药物使用康复情况。
我们分析了南达科他州卫生部（DOH）提供的数据，这些数据涉及过去十年该州内有效的阿片类药物导致中毒的国际疾病分类（ICD）代码。在确定MUA农村和部分农村县后，我们将这些县与该州数据集进行交叉分析。使用SAS 9.3版（SAS Institute）中的PROC SURVEY方法进行评估，并使用Belsley-Kuh-Welsch技术检查多重共线性。最后，我们使用美国医院协会（AHA）数据库，按每家医院分析药物使用康复服务的可获得性。
将阿片类药物代码与非阿片类药物代码在农村、非农村和部分农村三个类别中进行比较的卡方统计量在p<0.05的临界值时具有显著性。81.134%的阿片类药物导致中毒代码在农村县被激活。只有四家医院提供药物使用康复服务，其中三家在非农村地区。青少年和青年早期（10 - 19岁）的人群更容易使用阿片类药物。
南达科他州的农村县更有可能提供阿片类药物治疗，但无法获得康复服务。我们还发现，随着一个州内农村县数量的减少，该州医院的阿片类药物配给率也会下降。引入公共项目以培训更多医生并降低非阿片类药物治疗的成本，可能会减少农村医院的阿片类药物配给，并增加康复选择。
