TY - JOUR
T1 - Place, poverty and prescriptions
T2 - A cross-sectional study using Area Deprivation Index to assess opioid use and drug-poisoning mortality in the USA from 2012 to 2017
AU - Kurani, Shaheen
AU - McCoy, Rozalina Grubina
AU - Inselman, Jonathan
AU - Jeffery, Molly Moore
AU - Chawla, Sagar
AU - Finney Rutten, Lila J.
AU - Giblon, Rachel
AU - Shah, Nilay D.
N1 - Funding Information:
1Mayo Clinic Graduate School of Biomedical Sciences, Rochester, Minnesota, USA 2Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA 3Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA 4Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA 5Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA 6Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA twitter Shaheen Kurani @shaheenkurani and Molly Moore Jeffery @mollyjeffery Acknowledgements We would like to acknowledge Ezra Haber Glenn, Dr Cindy Crowson and Ricky Rojas for their programming and statistical guidance. Contributors SK and NDS conceived and designed the study; SK and JI acquired data; SK, RGM, SC, LJFR analysed/interpreted the data; NDS, MMJ, JI and RG supervised data analysis. All authors refined the various versions of the full paper and approved the final manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. SK and NDS are the guarantors. Funding This work was supported in part by a Centre of Excellence in Regulatory Science and Innovation (CERSI) grant to Yale University and Mayo Clinic by the US Food and Drug Administration grant number U01FD005938. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the HHS or FDA. This work was supported by the Mayo Clinic Robert D. and Patricia E. Kern Centre for the Science of Healthcare Delivery. SK is supported by the National Institutes of Health Clinical and Translational Science Awards programme (TL1TR002380) and the Food and Drug Administration-funded Yale-Mayo Centre for Excellence in Regulatory Science and Innovation (CERSI) programme (U01FD005938). In the past 36 months, NDS has received research support through Mayo Clinic from the Food and Drug Administration to establish Yale-Mayo Clinic CERSI programme (U01FD005938); the Centres of Medicare and Medicaid Innovation under the Transforming Clinical Practice Initiative (TCPI); the Agency for Healthcare Research and Quality (R01HS025164; R01HS025402; R03HS025517); the National Heart, Lung and Blood Institute of the National Institutes of Health (NIH) (R56HL130496; R01HL131535); the National Science Foundation; and the Patient Centred Outcomes Research Institute (PCORI) to develop a Clinical Data Research Network (LHSNet). RGM is supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number K23DK114497. MMJ has received research support through Mayo Clinic from the National Heart, Lung and Blood Institute (R56HL130496 and R21HL140287), the Agency for Healthcare Research and Quality (R01HS025164), the American Cancer Society (131611-RSGI-17-154-01-CPHPS), the Food and Drug Administration-funded Yale-Mayo CERSI (U01FD005938), the National Centre for Advancing Translational Sciences (UL1TR 02377; U01TR 02743).
Publisher Copyright:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2020/5/17
Y1 - 2020/5/17
N2 - 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.
AB - 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.
KW - health policy
KW - public health
KW - substance misuse
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U2 - 10.1136/bmjopen-2019-035376
DO - 10.1136/bmjopen-2019-035376
M3 - Article
C2 - 32423933
AN - SCOPUS:85084872990
SN - 2044-6055
VL - 10
JO - BMJ open
JF - BMJ open
IS - 5
M1 - e035376
ER -