Abstract
BackgroundOpioid overdoses have had a serious impact on the public health systems and socioeconomic welfare of several countries. Within this broader context, we focus our study on primary care opioid prescribing in England from 2015 to 2018, particularly the patterns of spatial variations at the community level and the socioeconomic and environmental factors that drive consumption.MethodsLeveraging open data sources, we combine prescription records with aggregated data on patient provenance and build highly granular maps of Oral Morphine Equivalent (OME) prescribing rates for Lower Layer Super Output Areas (LSOA). We quantify the strength of spatial associations by means of the Empirical Bayes Index (EBI) that accounts for geographical variations in population density. We explore the interplay between socioeconomic and environmental determinants and prescribing rates by implementing a multivariate logistic regression model across different temporal snapshots and spatial scales.ResultsWe observe, across time and geographical resolutions, a significant spatial association with the presence of localized hot and cold spots that group neighboring areas with homogeneous prescribing rates (e.g., EBI = 0.727 at LSOA level for 2018). Accounting for spatial dependency effects, we find that LSOA with both higher employment deprivation (OR = 62.6, CI 52.8–74.3) and a higher percentage of ethnically white (OR = 30.1, CI 25.4–35.7) inhabitants correspond to higher prescribing rates. Looking at educational attainment, we find LSOA with the prevalent degree of education being apprenticeship (OR = 2.33, CI 1.96–2.76) a risk factor and those with level 4+ (OR = 0.41, CI 0.35–0.48) a protective factor. Focusing on environmental determinants, housing (OR = 0.18, CI 0.15–0.21) and outdoor environment deprivation (OR = 0.62, CI 0.53–0.72) indices capture the bi-modal behavior observed in the literature concerning rural/urban areas. The results are consistent across time and spatial aggregations.ConclusionsFailing to account for local variations in opioid prescribing rates smooths out spatial dependency effects that result in underestimating/overestimating the impact on public health policies at the community level. Our study suggests a novel approach to inform more targeted interventions toward the most vulnerable population strata.
Highlights
Opioid overdoses have had a serious impact on the public health systems and socioeconomic welfare of several countries
The dataset covers National Health Service (NHS) prescriptions written in England and dispensed in the community in the United Kingdom (UK) by general practitioners (GPs) and other non-medical prescribers who are attached to practices
Mapping prescribing data into Oral Morphine Equivalent consumption rates The proposed approach to estimate the prescribing rates at fine-grained administrative units provides an accurate picture of the spatial heterogeneity underpinning the phenomenon
Summary
Opioid overdoses have had a serious impact on the public health systems and socioeconomic welfare of several countries. Annual deaths related to drug overdoses have incessantly risen in the last decade in the USA, with more than 130 cases estimated to result from opioid overdoses every day [1] This is seriously impacting the national public health system, as well as social and economic welfare, and seems to be the result of a triple wave epidemic of three classes of opioids: prescription pain relievers [2], heroin, and novel synthetic opioids such as fentanyl [3]. The issue dates back to the late 1990s when healthcare providers became increasingly willing to prescribe opioids for chronic pain with causes other than cancer This led to a surge in the misuse of opioid medications before it became evident that they could be highly addictive. Access to medical opioids is often made even easier by the sharing of pharmaceuticals among friends and relatives [6]
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