Characterizing opioid-involved overdose risk in local communities: An opioid overdose vulnerability assessment across Indiana, 2017.
Characterizing opioid-involved overdose risk in local communities: An opioid overdose vulnerability assessment across Indiana, 2017.
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表征当地社区中阿片类药物的过量风险：印第安纳州的阿片类药物过量脆弱性评估，2017年。
DOI：
10.1016/j.pmedr.2021.101538
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发表时间：
2021-12
影响因子：
2.8
通讯作者：
Stopka TJ
中科院分区：
文献类型：
--
作者：
Sawyer JL;Shrestha S;Pustz JC;Gottlieb R;Nichols D;Van Handel M;Lingwall C;Stopka TJ
该倡议的目的是在印第安纳州进行全面的阿片类药物过量脆弱性评估，并评估阿片类药物使用障碍治疗、减少危害服务和阿片类药物应对计划的空间可及性。我们从公开的州和联邦来源汇编了2017年县级（n = 92）阿片类药物相关和社会经济指标的数据。首先，我们评估了地理信息系统（GIS）中阿片类药物相关指标的空间分布。接下来，我们使用了一种新的回归加权排名方法，平均标准化协变量和阿片类药物过量死亡率结果来计算县级脆弱性评分。最后，我们研究了阿片类药物使用障碍治疗服务和阿片类药物反应计划在人口普查区水平（n = 1511）使用两步浮动集水区分析。阿片类药物相关的急诊就诊率、阿片类药物相关的逮捕率、慢性丙型肝炎病毒感染率、阿片类药物处方率、失业率和女性主导家庭的百分比与阿片类药物相关的过量死亡率独立且正相关（p <0.05）。我们确定了城乡结合部的高风险县，主要是在印第安纳州中东部。我们发现，在19个最脆弱的县中，只有一个县在治疗服务方面处于前五分之一，并且在其所有人口普查区都有纳洛酮提供者。我们的脆弱性评估结果提供了地方层面的背景和证据，以支持和告知印第安纳州未来的公共卫生政策和有针对性的干预措施，这些政策和干预措施适用于阿片类药物过量高脆弱性和低服务可及性的地区。我们的方法可以在其他州和地方公共卫生管辖区复制，以评估阿片类药物涉及的公共卫生脆弱性。
The objective of this initiative was to conduct a comprehensive opioid overdose vulnerability assessment in Indiana and evaluate spatial accessibility to opioid use disorder treatment, harm reduction services, and opioid response programs. We compiled 2017 county-level (n = 92) data on opioid-related and socioeconomic indicators from publicly available state and federal sources. First, we assessed the spatial distribution of opioid-related indicators in a geographic information system (GIS). Next, we used a novel regression-weighted ranking approach with mean standardized covariates and an opioid-involved overdose mortality outcome to calculate county-level vulnerability scores. Finally, we examined accessibility to opioid use disorder treatment services and opioid response programs at the census tract-level (n = 1511) using two-step floating catchment area analysis. Opioid-related emergency department visit rate, opioid-related arrest rate, chronic hepatitis C virus infection rate, opioid prescription rate, unemployment rate, and percent of female-led households were independently and positively associated with opioid-involved overdose mortality (p < 0.05). We identified high-risk counties across the rural–urban continuum and primarily in east central Indiana. We found that only one of the 19 most vulnerable counties was in the top quintile for treatment services and had naloxone provider accessibility in all of its census tracts. Findings from our vulnerability assessment provide local-level context and evidence to support and inform future public health policies and targeted interventions in Indiana in areas with high opioid overdose vulnerability and low service accessibility. Our approach can be replicated in other state and local public health jurisdictions to assess opioid-involved public health vulnerabilities.
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