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Open Access Publications from the University of California

Prescription opioid poisoning across urban and rural areas: identifying vulnerable groups and geographic areas.

  • Author(s): Cerdá, Magdalena
  • Gaidus, Andrew
  • Keyes, Katherine M
  • Ponicki, William
  • Martins, Silvia
  • Galea, Sandro
  • Gruenewald, Paul
  • et al.

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AIMS:To determine (1) whether prescription opioid poisoning (PO) hospital discharges spread across space over time, (2) the locations of 'hot-spots' of PO-related hospital discharges, (3) how features of the local environment contribute to the growth in PO-related hospital discharges and (4) where each environmental feature makes the strongest contribution. DESIGN:Hierarchical Bayesian Poisson space-time analysis to relate annual discharges from community hospitals to postal code characteristics over 10 years. SETTING:California, USA. PARTICIPANTS:Residents of 18 517 postal codes in California, 2001-11. MEASUREMENTS:Annual postal code-level counts of hospital discharges due to PO poisoning were related to postal code pharmacy density, measures of medical need for POs (i.e. rates of cancer and arthritis-related hospital discharges), economic stressors (i.e. median household income, percentage of families in poverty and the unemployment rate) and concentration of manual labor industries. FINDINGS:PO-related hospital discharges spread from rural and suburban/exurban 'hot-spots' to urban areas. They increased more in postal codes with greater pharmacy density [rate ratio (RR) = 1.03; 95% credible interval (CI) = 1.01, 1.05], more arthritis-related hospital discharges (RR = 1.08; 95% CI = 1.06, 1.11), lower income (RR = 0.85; 95% CI = 0.83, 0.87) and more manual labor industries (RR = 1.15; 95% CI = 1.10, 1.19 for construction; RR = 1.12; 95% CI = 1.04, 1.20 for manufacturing industries). Changes in pharmacy density primarily affected PO-related discharges in urban areas, while changes in income and manual labor industries especially affected PO-related discharges in suburban/exurban and rural areas. CONCLUSIONS:Hospital discharge rates for prescription opioid (PO) poisoning spread from rural and suburban/exurban hot-spots to urban areas, suggesting spatial contagion. The distribution of age-related and work-place-related sources of medical need for POs in rural areas and, to a lesser extent, the availability of POs through pharmacies in urban areas, partly explain the growth of PO poisoning across California, USA.

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