Rural risk environments, opioid-related overdose, and infectious diseases: A multidimensional, spatial perspective
Rural risk environments, opioid-related overdose, and infectious diseases: A multidimensional, spatial perspective
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DOI：
10.1016/j.drugpo.2020.102727
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发表时间：
2020-11-01
影响因子：
4.4
通讯作者：
Pho, Mai T.
中科院分区：
文献类型：
--
作者：
Kolak, Marynia A.;Chen, Yen-Tyng;Pho, Mai T.
背景：尽管农村地区的危机日益严重，但这些地区的风险环境仍有许多未知之处。我们采用风险环境框架来描述伊利诺伊州南部农村的特征，并描述2015年至2017年期间风险环境，阿片类药物相关过量，HIV，丙型肝炎和性传播感染率的关系。方法：根据可用性和理论相关性，总结了邮政编码（n = 128）或县级（n = 16）的20多个风险环境变量。我们计算数据属性关联和纵向健康结果和农村风险环境的空间和时间维度的特征。然后，我们使用“区域类型学分析”，以产生数据驱动的风险区域和比较健康outcome.Results：普遍存在的风险热点被确定在人口较多的地区，过量和HCV的发病率较高，而新兴的风险地区被隔离到更多的农村地区，经历了镇痛阿片类药物过量的增加，普遍缺乏减少危害的资源。风险地区的特点是潜在的社会经济脆弱性，但在不同的方式，反映了一个微妙的和不断变化的结构性risk landscape.Conclusions：农村风险环境的脆弱性和相关的阿片类药物相关的健康结果是多方面的，空间异质性。需要更多的研究来更好地了解如何细化地理区域以更精确地定义风险，从而支持干预工作，并进一步丰富对阿片类药物流行病的调查。
Background: Much remains unknown in rural risk environments, despite a growing crisis in these areas. We adapt a risk environment framework to characterize rural southern Illinois and describe the relations of risk environments, opioid-related overdose, HIV, Hepatitis C, and sexually transmitted infection rates between 2015 and 2017.Methods: Over two dozen risk environment variables are summarized across zip-code (n = 128) or county levels (n = 16) based on availability and theoretical relevance. We calculate data attribute associations and characterize spatial and temporal dimensions of longitudinal health outcomes and the rural risk environment. We then use a "regional typology analysis" to generate data-driven risk regions and compare health outcomes.Results: Pervasive risk hotspots were identified in more populated locales with higher rates of overdose and HCV incidence, whereas emerging risk areas were isolated to more rural locales that had experienced an increase in analgesic opiate overdoses and generally lacked harm-reduction resources. At-risk areas were characterized with underlying socioeconomic vulnerability but in differing ways, reflecting a nuanced and shifting structural risk landscape.Conclusions: Rural risk environment vulnerabilities and associated opioid-related health outcomes are multifaceted and spatially heterogeneous. More research is needed to better understand how refining geographies to more precisely define risk can support intervention efforts and further enrich investigations of the opioid epidemic.