Purpose-Opioid misuse is a national epidemic, and Ohio is one of the states most impacted by this crisis. Ohio collects county-level counts of opioid associated deaths and treatment admissions. We jointly model these two outcomes and assess the association of each rate with social and structural factors. Methods-We use a joint spatial rates model of death and treatment counts using a generalized common spatial factor model. In addition to covariate effects, we estimate a spatial factor for each county that characterizes structural factors not accounted for by other covariates in the model that are associated with both outcomes. Results-We observed an association of health professional shortage area with death rates and the rate of people 18-64 on disability with treatment rates. The proportion of single female households was associated with both outcomes. We estimated the presence of unmeasured risk factors in the southwestern part of the state and unmeasured protective factors in the eastern region. Conclusions-We described associations of social and structural covariates with the death and treatment rates. We also characterized counties with latent risk that can provide a launching point for future investigations to determine potential sources of that risk.
Background: Opioid misuse is a major public health issue in the United States and in particular Ohio. However, the burden of the epidemic is challenging to quantify as public health surveillance measures capture different aspects of the problem. Here we synthesize countylevel death and treatment counts to compare the relative burden across counties and assess associations with social environmental covariates. Methods: We construct a generalized spatial factor model to jointly model death and treatment rates for each county. For each outcome, we specify a spatial rates parameterization for a Poisson regression model with spatially varying factor loadings. We use a conditional autoregressive model to account for spatial dependence within a Bayesian framework. Results: The estimated spatial factor was highest in the southern and southwestern counties of the state, representing a higher burden of the opioid epidemic.We found that relatively high rates of treatment contributed to the factor in the southern part of the state; whereas, relatively higher rates of death contributed in the southwest. The estimated 1 arXiv:1806.05232v1 [stat.AP]
Background Little is known about the relationship between opioid prescribing practices and the prevalence of adolescent opioid misuse. Objective To examine relationships between both adolescent and adult opioid prescriptions filled and adolescents seeking treatment for opioid misuse in Ohio. Methods Analyses of large statewide databases from 2008–2012 including all 88 counties in Ohio. The Ohio Board of Pharmacy provided data regarding prescription opioids filled by adolescents (12–20 years, N=50,030,820 doses) and adults (>20 years, N=3,811,288,395 doses) by county of residence. The Ohio Department of Mental Health and Drug Addiction Services provided annual treatment admissions for adolescent opioid misuse by county of residence (N=6446). Results Adults filled prescriptions for nearly 100 oral opioid doses per capita annually while adolescents filled prescriptions for approximately 7 oral opioid doses per capita annually. In Bayesian Poisson modeling examining the effect of annual adult per capita dose on adolescent treatment admissions, adjusted for annual adolescent per capita dose and year, an increase of one in the annual adult per capita opioid dose resulted in an increase of 1.3% (RR = 1.013, 95% HPD CI = [1.008, 1.017]) in the rate of adolescent treatment admissions. This association corresponds to 99.99% chance that the adolescent treatment rate increases when the annual per capita adult dose is increased by one unit. Conclusion The amount of opioids filled by adults in Ohio, although relatively stable from 2008–2012, is approximately 13 times that filled by adolescents, and is significantly associated with adolescents seeking treatment for opioid misuse. Efforts to decrease adolescent opioid misuse should also focus on reducing adult opioid prescriptions.
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