Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States.
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States.
Prev Med. 2024 Sep;186:108088. doi: 10.1016/j.ypmed.2024.108088. Epub 2024 Jul 30.
Fatal opioid-related overdoses (OOD) continue to be a leading cause of preventable death across the US. Opioid Overdose Education and Naloxone Distribution programs (OENDs) play a vital role in addressing morbidity and mortality associated with opioid use, but access to such services is often inequitable. We utilized a geographic information system (GIS) and spatial analytical methods to inform prioritized placement of OEND services in Massachusetts.
We obtained addresses for OEND sites from the Massachusetts Department of Public Health and address-level fatal OOD data for January 2019 to December 2021 from the Massachusetts Registry of Vital Records and Statistics. Using location-allocation approaches in ArcGIS Pro, we created p-median models using locations of existing OEND sites and fatal OOD counts to identify areas that should be prioritized for future OEND placement. Variables included in our analysis were transportation mode, distance from public schools, race and ethnicity, and location feasibility.
Three Massachusetts communities - Athol, Dorchester, and Fitchburg - were identified as priority sites for new OEND locations using location-allocation models based on capacity to maximize OOD prevention. Communities identified by the models for OEND placement had similar demographics and overdose rates (42.8 per 100,000 vs 40.1 per 100,000 population) to communities with existing OEND programs but lower naloxone kit distribution rates (2589 doses per 100,000 vs 3704 doses per 100,000). Further models demonstrated differential access based on location and transportation.
Our analyses identified key areas of Massachusetts with greatest need for OEND services. Further, these results demonstrate the utility of using spatial epidemiological methods to inform public health recommendations.
在美国，致命的阿片类药物相关过量用药（OOD）仍是可预防死亡的主要原因。阿片类药物过量教育和纳洛酮分发计划（OEND）在解决与阿片类药物使用相关的发病率和死亡率方面发挥着至关重要的作用，但此类服务的获取往往存在不平等。我们利用地理信息系统（GIS）和空间分析方法，为马萨诸塞州的 OEND 服务提供优先定位。
我们从马萨诸塞州公共卫生部获取了 OEND 地点的地址，并从马萨诸塞州生命记录和统计注册表中获取了 2019 年 1 月至 2021 年 12 月致命 OOD 数据的地址级别数据。我们使用 ArcGIS Pro 中的位置分配方法，使用现有 OEND 地点的位置和致命 OOD 计数创建了 p 中位数模型，以确定应优先考虑未来 OEND 位置的区域。我们的分析包括交通方式、距离公立学校的距离、种族和族裔以及位置可行性等变量。
基于最大限度地预防 OOD 的能力，使用位置分配模型确定了马萨诸塞州的三个社区——阿特（Athol）、多切斯特（Dorchester）和菲奇堡（Fitchburg）——作为新的 OEND 地点的优先地点。模型确定的用于 OEND 安置的社区具有类似的人口统计学特征和过量用药率（每 10 万人 42.8 例与每 10 万人 40.1 例），但纳洛酮试剂盒的分发率较低（每 10 万人 2589 剂与每 10 万人 3704 剂）。进一步的模型表明，基于位置和交通方式存在不同的获取情况。
我们的分析确定了马萨诸塞州最需要 OEND 服务的关键领域。此外，这些结果表明，使用空间流行病学方法为公共卫生建议提供信息具有实用性。
