Community-level Factors and their Associations with Changing Opioid Overdose Fatality Rates in Kentucky, 2019-2021.

INTRODUCTION

Kentucky has one of the highest opioid overdose fatality rates in the United States, which has increased significantly from 2019 to 2020. The COVID-19 pandemic has caused lasting effects on mental health and health care, which have been linked with increased opioid overdose. These effects are exacerbated in Appalachian regions, where there is a lack of sufficient access to community pharmacies and adequate health care.

PURPOSE

In this study, we characterize changes in opioid overdose fatality rates in Kentucky from 2019 to 2021, with a specific focus on changes in Appalachian vs non-Appalachian counties. We aim to identify associations between community-level factors and opioid overdose fatality rates and how such associations may have changed from 2019 to 2021.

METHODS

County-level data were used to fit a marginal GEE-type negative binomial model to determine factors associated with opioid overdose fatality rates in 2019 (before the COVID-19 pandemic) and 2021 (during the COVID-19 pandemic).

RESULTS

Opioid overdose fatality rates increased from 2019 to 2021 (Rate Ratio: 1.82). This increase was much larger in adjacent-to-metropolitan (RR: 2.54) and Appalachian (RR: 2.38) counties. Age was associated with opioid overdose fatality rates in both 2019 and 2021, and the observed association for age was stronger in 2021. Appalachian status was associated with opioid overdose fatality rates in 2021. Metropolitan county status was associated with opioid overdose fatality rates in 2019, whereas adjacent-to-metropolitan county status was associated with opioid overdose fatality rates in 2021.

IMPLICATIONS

Adjacent-to-metropolitan status's association with overdose fatalities in 2021 may indicate a differential effect of COVID-19 on suburban communities. Future studies should investigate additional factors related to COVID-19 as well the lasting effects of the pandemic on the landscape of opioid overdose in Kentucky.