Division of Research and Evaluation, Comagine Health, Portland, OR, United States; School of Public Health, Department of Epidemiology and Biostatistics, University of Nevada, Las Vegas, United States.
General Medical Sciences division, Washington University School of Medicine, St. Luis, MO, United States.
Drug Alcohol Depend. 2023 Nov 1;252:110991. doi: 10.1016/j.drugalcdep.2023.110991. Epub 2023 Oct 12.
This study aims to assess the association of community social vulnerability and community prescription opioid availability with individual non-fatal or fatal opioid overdose.
We identified patients 12 years of age or older from the Oregon All Payer Claims database (APCD) linked to other public health datasets. Community-level characteristics were captured in an exposure period (EP) (1/1/2018-12/31/2018) and included: census tract-level social vulnerability domains (socio-economic status, household composition, racial and ethnic minority status, and housing type and transportation), census tract-level prescriptions and community-level opioid use disorder (OUD) diagnoses per 100 capita binned into quartiles or quintiles. We employed Cox models to estimate the risk of fatal and non-fatal opioid overdoses events in the 12 months following the EP.
We identified 1,548,252 individuals. Patients were mostly female (54%), White (61%), commercially insured (54%), and lived in metropolitan areas (81%). Of the total sample, 2485 (0.2%) experienced a non-fatal opioid overdose and 297 died of opioid overdose. There was higher hazard for non-fatal overdose in communities with greater OUD per 100 capita. We also found higher non-fatal and fatal hazards for opioid overdose among patients in communities with higher housing type and transportation-related vulnerability compared to the lowest quintile. Conversely, patients were at less risk of opioid overdose when living in communities with greater prevalence of the young or the elderly, the disabled, single parent families or low English proficiency.
These findings underscore the importance of the environmental context when considering public health policies to reduce opioid harms.
本研究旨在评估社区社会脆弱性和社区处方类阿片类药物可获得性与个体非致命性或致命性阿片类药物过量之间的关联。
我们从俄勒冈州所有支付者索赔数据库（APCD）中识别出 12 岁或以上的患者，并将其与其他公共卫生数据集相关联。社区层面的特征在暴露期（EP）（2018 年 1 月 1 日至 2018 年 12 月 31 日）中进行了捕获，包括：按社会经济地位、家庭构成、种族和少数民族地位以及住房类型和交通状况划分的普查区层面社会脆弱性领域、按每 100 人 100 人分箱的普查区层面处方和社区层面阿片类药物使用障碍（OUD）诊断。我们采用 Cox 模型估计 EP 后 12 个月内致命和非致命阿片类药物过量事件的风险。
我们确定了 1548252 名个体。患者主要为女性（54%）、白人（61%）、商业保险（54%）和居住在大都市区（81%）。在总样本中，有 2485 人（0.2%）经历了非致命性阿片类药物过量，有 297 人死于阿片类药物过量。每 100 人 OUD 患病率较高的社区发生非致命性过量的风险较高。我们还发现，与最低五分位数相比，住房类型和交通相关脆弱性较高的社区中，非致命性和致命性阿片类药物过量的风险更高。相反，当患者居住在年轻人或老年人、残疾、单亲家庭或英语水平较低的社区时，他们发生阿片类药物过量的风险较低。
这些发现强调了在考虑减少阿片类药物危害的公共卫生政策时，环境背景的重要性。
