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Cesare N, Lines LM, Chandler R, Gibson EB, Vickers-Smith R, Jackson R, Bazzi AR, Goddard-Eckrich D, Sabounchi N, Chisolm DJ, Vandergrift N, Oga E. Development and validation of a community-level social determinants of health index for drug overdose deaths in the HEALing Communities Study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209186. [PMID: 37866438 DOI: 10.1016/j.josat.2023.209186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 09/11/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Social determinants of health (SDoH), such as socioeconomic status, education level, and food insecurity, are believed to influence the opioid crisis. While global SDoH indices such as the CDC's Social Vulnerability Index (SVI) and Area Deprivation Index (ADI) combine the explanatory power of multiple social factors for understanding health outcomes, they may be less applicable to the specific challenges of opioid misuse and associated outcomes. This study develops a novel index tailored to opioid misuse outcomes, tests the efficacy of this index in predicting drug overdose deaths across contexts, and compares the explanatory power of this index to other SDoH indices. METHODS Focusing on four HEALing Communities Study (HCS) states (Kentucky, Massachusetts, New York and Ohio; encompassing 4269 ZIP codes), we identified multilevel SDoH potentially associated with opioid misuse and aggregated publicly available data for each measure. We then leveraged a random forest model to develop a composite measure that predicts age-adjusted drug overdose mortality rates based on SDoH. We used this composite measure to understand HCS and non-HCS communities in terms of overdose risk across areas of varying racial composition. Finally, we compared variance in drug overdose deaths explained by this index to variance explained by the SVI and ADI. RESULTS Our composite measure included 28 SDoH measures and explained approximately 89 % percent of variance in age-adjusted drug overdose mortality across HCS states. Health care measures, including emergency department visits and primary care provider availability, were top predictors within the index. Index accuracy was robust within and outside of HCS communities and states. This measure identified high levels of overdose mortality risk in segregated communities. CONCLUSIONS Existing SDoH indices fail to explain much variation in area-level overdose mortality rates. Having tailored composite indices can help us to identify places in which residents are at highest risk based on their composite contexts. A comprehensive index can also help to develop effective community interventions for programs such as HCS by considering the context in which people live.
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Affiliation(s)
- Nina Cesare
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, 85 East Newton Street Suite 906, Boston, MA, USA.
| | - Lisa M Lines
- RTI International, 3040 East Cornwallis Road, PI Box 12194, Research Triangle Park, NC, USA.
| | - Redonna Chandler
- National Institute on Drug Abuse, C/O NIH Mail Center 3WFN 16071 Industrial Dr, Gaithersburg, MD, USA.
| | - Erin B Gibson
- Boston Medical Center, 850 Harrison Ave., Boston, MA, USA.
| | | | - Rebecca Jackson
- Ohio State University Medical Center, 410 West Ave, Columbus, OH, USA.
| | - Angela R Bazzi
- University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92161, USA.
| | | | - Nasim Sabounchi
- CUNY Graduate School of Public Health & Health Policy, 55 W 125th St., New York, NY, USA.
| | - Deena J Chisolm
- Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, USA.
| | - Nathan Vandergrift
- RTI International, 3040 East Cornwallis Road, PI Box 12194, Research Triangle Park, NC, USA.
| | - Emmanuel Oga
- RTI International, 3040 East Cornwallis Road, PI Box 12194, Research Triangle Park, NC, USA.
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Davis A, Stringer KL, Drainoni ML, Oser CB, Knudsen HK, Aldrich A, Surratt HL, Walker DM, Gilbert L, Downey DL, Gardner SD, Tan S, Lines LM, Vandergrift N, Mack N, Holloway J, Lunze K, McAlearney AS, Huerta TR, Goddard-Eckrich DA, El-Bassel N. Community-level determinants of stakeholder perceptions of community stigma toward people with opioid use disorders, harm reduction services and treatment in the HEALing Communities Study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104241. [PMID: 37890391 PMCID: PMC10841835 DOI: 10.1016/j.drugpo.2023.104241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/16/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Community stigma toward people with opioid use disorder (OUD) can impede access to harm reduction services and treatment with medications for opioid use disorder (MOUD). Such community OUD stigma is partially rooted in community-level social and economic conditions, yet there remains a paucity of large-scale quantitative data examining community-level factors associated with OUD stigma. We examined whether rurality, social inequity, and racialized segregation across communities from four states in the HEALing Communities Study (HCS) were associated with 1) greater perceived community stigma toward people treated for OUD, 2) greater perceived intervention stigma toward MOUD, and 3) greater perceived intervention stigma toward naloxone by community stakeholders in the HCS. METHODS From November 2019-January 2020, a cross-sectional survey about community OUD stigma was administered to 801 members of opioid overdose prevention coalitions across 66 communities in four states prior to the start of HCS intervention activities. Bivariate analyses assessed pairwise associations between community rural/urban status and each of the three stigma variables, using linear mixed effect modeling to account for response clustering within communities, state, and respondent sociodemographic characteristics. We conducted similar bivariate analyses to assess pairwise associations between racialized segregation and social inequity. RESULTS On average, the perceived community OUD stigma scale score of stakeholders from rural communities was 4% higher (β=1.57, SE=0.7, p≤0.05), stigma toward MOUD was 6% higher (β=0.28, SE=0.1, p≤0.05), and stigma toward naloxone was 10% higher (β=0.46, SE=0.1, p≤0.01) than among stakeholders from urban communities. No significant differences in the three stigma variables were found among communities based on racialized segregation or social inequity. CONCLUSION Perceived community stigma toward people treated for OUD, MOUD, and naloxone was higher among stakeholders in rural communities than in urban communities. Findings suggest that interventions and policies to reduce community-level stigma, particularly in rural areas, are warranted.
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Affiliation(s)
- Alissa Davis
- Columbia University School of Social Work, New York, NY, United States.
| | - Kristi Lynn Stringer
- Department of Health and Human Performance, Community and Public Health, Middle Tennessee State University, Murfreesboro, TN, United States
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center, Boston, MA, United States; Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, United States
| | - Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, KY, United States
| | - Hannah K Knudsen
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Alison Aldrich
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Hilary L Surratt
- Department of Behavioral Science, Center on Drug & Alcohol Research, University of Kentucky, Lexington, KY, United States
| | - Daniel M Walker
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Louisa Gilbert
- Columbia University School of Social Work, New York, NY, United States
| | - Dget L Downey
- Columbia University School of Social Work, New York, NY, United States
| | - Sam D Gardner
- Columbia University School of Social Work, New York, NY, United States
| | - Sylvia Tan
- RTI International, Research Triangle Park, NC, United States
| | - Lisa M Lines
- RTI International, Research Triangle Park, NC, United States
| | | | - Nicole Mack
- RTI International, Research Triangle Park, NC, United States
| | - JaNae Holloway
- RTI International, Research Triangle Park, NC, United States
| | - Karsten Lunze
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedesian School of Medicine/Boston Medical Center, Boston, MA, United States
| | - Ann Scheck McAlearney
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Timothy R Huerta
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States; Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
| | | | - Nabila El-Bassel
- Columbia University School of Social Work, New York, NY, United States
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Cook RR, Jaworski EN, Hoffman KA, Waddell EN, Myers R, Korthuis PT, Vergara-Rodriguez P. Treatment Initiation, Substance Use Trajectories, and the Social Determinants of Health in Persons Living With HIV Seeking Medication for Opioid Use Disorder. Subst Abus 2023; 44:301-312. [PMID: 37842910 PMCID: PMC10830143 DOI: 10.1177/08897077231200745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND People living with HIV and opioid use disorder (OUD) are disproportionally affected by adverse socio-structural exposures negatively affecting health, which have shown inconsistent associations with uptake of medications for OUD (MOUD). This study aimed to determine whether social determinants of health (SDOH) were associated with MOUD uptake and trajectories of substance use in a clinical trial of people seeking treatment. METHODS Data are from a 2018 to 2019 randomized trial comparing the effectiveness of different MOUD to achieve viral suppression among people living with HIV and OUD. SDOH were defined by variables mapping to Healthy People 2030 domains: education (Education Access and Quality), income (Economic Stability), homelessness (Neighborhood and Built Environment), criminal justice involvement (Social and Community Context), and recent SUD care (Health Care Access and Quality). Associations between SDOH and MOUD initiation were assessed with Cox proportional hazards models, and SDOH and substance use over time with generalized estimating equation models. RESULTS Participants (N = 114) averaged 47 years old, 63% were male, 56% were Black, and 12% Hispanic. Participants reported an average of 2.3 out of 5 positive SDOH indicators (SD = 1.2). Stable housing was the most commonly reported SDOH (61%), followed by no recent criminal justice involvement (59%), having a high-school level education or greater (56%), income stability (45%), and recent SUD care (13%). Each additional favorable SDOH was associated with a 25% increase in the likelihood of MOUD initiation during the study period [adjusted HR = 1.25, 95% CI = (1.01, 1.55), P = .044]. Positive SDOH were also associated with a decrease in the odds of baseline opioid use and a greater reduction in opioid use during subsequent weeks of the study (P < .001 for a joint test of baseline and slope differences). CONCLUSIONS Positive social determinants of health, in aggregate, may increase the likelihood of MOUD treatment initiation among people living with HIV and OUD.
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Affiliation(s)
- Ryan R. Cook
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland
| | - Erin N. Jaworski
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois-Chicago, Chicago, IL
| | - Kim A. Hoffman
- Oregon Health and Science University-Portland State University School of Public Health, Portland
| | - Elizabeth N Waddell
- Oregon Health and Science University-Portland State University School of Public Health, Portland
| | - Renae Myers
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland
| | - P. Todd Korthuis
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland
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Markatou M, Kennedy O, Brachmann M, Mukhopadhyay R, Dharia A, Talal AH. Social determinants of health derived from people with opioid use disorder: Improving data collection, integration and use with cross-domain collaboration and reproducible, data-centric, notebook-style workflows. Front Med (Lausanne) 2023; 10:1076794. [PMID: 36936205 PMCID: PMC10017859 DOI: 10.3389/fmed.2023.1076794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/30/2023] [Indexed: 03/06/2023] Open
Abstract
Deriving social determinants of health from underserved populations is an important step in the process of improving the well-being of these populations and in driving policy improvements to facilitate positive change in health outcomes. Collection, integration, and effective use of clinical data for this purpose presents a variety of specific challenges. We assert that combining expertise from three distinct domains, specifically, medical, statistical, and computer and data science can be applied along with provenance-aware, self-documenting workflow tools. This combination permits data integration and facilitates the creation of reproducible workflows and usable (reproducible) results from the sensitive and disparate sources of clinical data that exist for underserved populations.
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Affiliation(s)
- Marianthi Markatou
- Department of Biostatistics (CDSE Program), University at Buffalo, Buffalo, NY, United States
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
- *Correspondence: Marianthi Markatou
| | - Oliver Kennedy
- Department of Computer Science and Engineering, University at Buffalo, Buffalo, NY, United States
- Breadcrumb Analytics, Buffalo, NY, United States
| | | | - Raktim Mukhopadhyay
- Department of Biostatistics (CDSE Program), University at Buffalo, Buffalo, NY, United States
| | - Arpan Dharia
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Andrew H. Talal
- Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
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Sex-Differences in Pain and Opioid Use Disorder Management: A Cross-Sectional Real-World Study. Biomedicines 2022; 10:biomedicines10092302. [PMID: 36140403 PMCID: PMC9496267 DOI: 10.3390/biomedicines10092302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: It is essential to focus attention on sex-specific factors which are clinically relevant in pain management, especially with regards to opioid use disorder (OUD) risk. The aim of this study was to explore potential sex-differences in chronic non-cancer pain (CNCP) outpatients. (2) Methods: An observational cross-sectional study was conducted under CNCP outpatients with long-term prescribed opioids (n = 806), wherein 137 patients had an OUD diagnosis (cases, 64% females) and 669 did not (controls, 66% females). Socio-demographic, clinical, and pharmacological outcomes were analyzed. (3) Results: Female controls presented an older age and less intensive pain therapy but higher psychotropic prescriptions and emergency department visits compared to male controls. Meanwhile, cases demonstrated a younger age, higher work disability, double morphine equivalent daily dose, and benzodiazepine use compared with controls. Here, female cases showed an 8% greater substance use disorder (OR 2.04 [1.11–3.76]) and 24% lower tramadol use, while male cases presented a 22% higher fentanyl use (OR 2.97 [1.52–5.81]) and reported the highest number of adverse drug reactions (24%, OR 2.40 [1.12–5.16]) compared with controls. (4) Conclusions: An OUD individual risk profile was evidenced with sex-differences to take into consideration to design equal prevention programs.
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Ndanga M, Sulley S, Saka AK. Trend Analysis of Substance Use Disorder During Pregnancy. Cureus 2022; 14:e23548. [PMID: 35494976 PMCID: PMC9045802 DOI: 10.7759/cureus.23548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives: This study aims to analyze the trends in substance use among pregnant women in the United States. Methodology: In this retrospective study, we utilized the National Inpatient Sample (NIS) dataset sponsored by the Agency for Healthcare Research and Quality (AHRQ) under the Healthcare Cost and Utilization Project (HCUP). Major Diagnostic Category (MDC) 14 (Pregnancy, Childbirth, and the Puerperium) and International Classification of Disease (ICD 10) codes were used to identify pregnancy-related diagnoses and presentations with any of the substance use disorder (SUD) indicators that met the inclusion criteria among the birthing population in the NIS dataset (2016-2018). We analyzed the demographic and regional characteristics between 2015 and 2018. Results: Among the population, a total of 23,475 (2.7%) had a primary or secondary diagnosis of SUD, and 851,428 (97.3%) did not. In the study group of 332,275 (2.8%) that met the inclusion criteria, 12,750 (0.1%) use alcohol, 108,960 (0.9%) had opioid use disorder (OUD), 171,490 (1.4%) use cannabis, 6,375 (0.1%) use sedatives, 28,075 (0.2%) use cocaine, 48,765 (0.4%) use other stimulants, 1,155 (0%) use hallucinogens, 115 (0%) use inhalants, and 23,950 (0.2%) had other psychoactive diagnosis. Further analysis comparing the risk of severity and mortality at presentation, procedure type, delivery method, and cost of care shows statistically significant differences (p < 0.005) between the study and control groups. Conclusion: The current trends necessitate a further assessment and implementation of comprehensive community-based treatment programs tailored to the most frequent regional SUD presentations, which could aid in mitigating drug use during pregnancy.
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