Prescription opioid poisoning across urban and rural areas: identifying vulnerable groups and geographic areas
Prescription opioid poisoning across urban and rural areas: identifying vulnerable groups and geographic areas
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DOI：
10.1111/add.13543
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发表时间：
2017-01-01
期刊：
影响因子：
6
通讯作者：
Gruenewald, Paul
中科院分区：
文献类型：
--
作者：
Cerda, Magdalena;Gaidus, Andrew;Gruenewald, Paul
目的确定(1)处方阿片类药物中毒（处方阿片类药物中毒）医院出院是否随时间在空间上扩散；(2)处方阿片类药物中毒医院出院“热点”的位置；(3)当地环境特征如何促进处方阿片类药物中毒医院出院的增长；(4)每种环境特征在哪里做出了最大的贡献。设计层次贝叶斯泊松时空分析，将10年社区医院年出院人数与邮政编码特征联系起来。加州，美国。参与者2001- 2011年加利福尼亚州18517个邮政编码的居民。邮政编码年度因PO中毒而出院的数量与邮政编码药房密度、PO医疗需求措施（即癌症和关节炎相关的医院出院率）、经济压力因素（即家庭收入中位数、贫困家庭百分比和失业率）以及体力劳动行业的集中度有关。研究发现，与po相关的医院出院从农村和郊区/远郊“热点”向城市地区扩散。邮政编码地区药房密度越大，发病率越高[比率比(RR) = 1.03；95%可信区间(CI) = 1.01, 1.05)，更多的关节炎相关住院出院（RR = 1.08, 95% CI = 1.06, 1.11），更低的收入（RR = 0.85, 95% CI = 0.83, 0.87）和更多的体力劳动行业（RR = 1.15，建筑业95% CI = 1.10, 1.19; RR = 1.12，制造业95% CI = 1.04, 1.20）。药房密度的变化主要影响城市地区的po相关排放，而收入和体力劳动行业的变化尤其影响郊区/远郊和农村地区的po相关排放。结论处方阿片类药物（PO）中毒的出院率由农村和近郊/远郊热点地区向城市扩散，呈现空间传染趋势。农村地区与年龄有关和与工作场所有关的PO医疗需求来源的分布，以及城市地区药房提供PO的情况（在较小程度上），在一定程度上解释了美国加利福尼亚州PO中毒的增长。
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 fromcommunity 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 ofmedical 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) andmoremanual 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.