@article{ref1,
title="Place, poverty and prescriptions: a cross-sectional study using Area Deprivation Index to assess opioid use and drug-poisoning mortality in the USA from 2012 to 2017",
journal="BMJ open",
year="2020",
author="Kurani, Shaheen and McCoy, Rozalina Grubina and Inselman, Jonathan and Jeffery, Molly Moore and Chawla, Sagar and Finney Rutten, Lila J. and Giblon, Rachel and Shah, Nilay D.",
volume="10",
number="5",
pages="e035376-e035376",
abstract="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.<p /> <p>Language: en</p>",
language="en",
issn="2044-6055",
doi="10.1136/bmjopen-2019-035376",
url="http://dx.doi.org/10.1136/bmjopen-2019-035376"
}