Place, poverty and prescriptions: A cross-sectional study using Area Deprivation Index to assess opioid use and drug-poisoning mortality in the USA from 2012 to 2017

Shaheen Kurani, Rozalina Grubina McCoy, Jonathan Inselman, Molly Moore Jeffery, Sagar Chawla, Lila J. Finney Rutten, Rachel Giblon, Nilay D. Shah

Research output: Contribution to journalArticle

Abstract

Objective To identify the relationships between county-level area deprivation and patterns of both opioid prescriptions and drug-poisoning mortality. Design, setting and participants For this retrospective cross-sectional study, we used the IQVIA Xponent data to capture opioid prescriptions and Centres for Disease Control and Prevention National Vital Statistics System to assess drug-poisoning mortality. The Area Deprivation Index (ADI) is a composite measure of social determinants of health comprised of 17 US census indicators, spanning four socioeconomic domains. For all US counties with available opioid prescription (2712 counties) and drug-poisoning mortality (3133 counties) data between 2012 and 2017, we used negative binomial regression to examine the association between quintiles of county-level ADI and the rates of opioid prescriptions and drug-poisoning mortality adjusted for year, age, race and sex. Primary outcome measures County-level opioid prescription fills and drug-poisoning mortality. Results Between 2012 and 2017, overall rates of opioid prescriptions decreased from 96.6 to 72.2 per 100 people, while the rates of drug-poisoning mortality increased from 14.3 to 22.8 per 100 000 people. Opioid prescription and drug-poisoning mortality rates were consistently higher with greater levels of deprivation. The risk of filling an opioid prescription was 72% higher, and the risk of drug-poisoning mortality was 36% higher, for most deprived compared with the least deprived counties (both p<0.001). Discussion Counties with greater area-level deprivation have higher rates of filled opioid prescriptions and drug-poisoning mortality. Although opioid prescription rates declined across all ADI quintiles, the rates of drug-poisoning mortality continued to rise proportionately in each ADI quintile. This underscores the need for individualised and targeted interventions that consider the deprivation of communities where people live.

Original languageEnglish (US)
Article numbere035376
JournalBMJ open
Volume10
Issue number5
DOIs
StatePublished - May 17 2020

Keywords

  • health policy
  • public health
  • substance misuse

ASJC Scopus subject areas

  • Medicine(all)

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