Fatal Opioid Overdoses Geospatially Cluster With Level 1 Trauma Centers In Ohio
*Brett M Tracy, Andrew J Young, *Erin J Hoover, *Carrie A Sims, Wendy L Wahl, *Carrie L Valdez
The Ohio State University Wexner Medical Center, Columbus, OH
OBJECTIVE(S): In 2015, Ohio was ranked the highest in the country for prescription opioid overdoses. Numerous programs have been implemented to mitigate the epidemic, yet the role of trauma centers (TC) has been poorly studied. We sought to examine if geospatial clustering occurs between county-level fatal opioid overdoses and TC level.
METHODS: We obtained 2019 county-level data from the Ohio Department of Health for fatal overdoses from opioids (methadone, fentanyl, heroin, and prescription opioids). Rates were standardized for each county’s population and presented per 100,000 people. The number of opioid doses prescribed and morphine milligram equivalents (MMEs) for each county with TCs were obtained from the Ohio Automated Rx Reporting System (OARRS). American College of Surgeons (ACS) designated TC locations within Ohio were obtained from the ACS website. County-level opioid overdose rates, opioid doses, and MMEs were compared amongst TC levels. We used geospatial analysis to assess if clustering occurred between TC level and prescription opioid overdoses. Each analysis was adjusted for MMEs, 8 socioeconomic determinants, and the number of TCs per county.
RESULTS: There were 48 TCs: 25.6% were Level 1 (L1) (n=11), 23.3% were Level 2 (L2) (n=10), and 51.2% were Level 3 (L3) (n=33). There was no difference in opioid doses prescribed in counties with L1 versus counties without L1 centers (3.2 vs 3.5, p=0.3); however, significantly more MMEs were prescribed in counties with L1 centers compared to those without (2.8 vs 0.4, p<.0001). Rates of fentanyl, methadone, and prescription opioid overdoses were significantly higher in counties with L1 centers but only fentanyl overdoses (β 7.1, 95% CI 4.94-9.26, p<.0001) and prescription opioid overdoses (β 6.88, 95% CI 4.6-9.16, p<.0001) geospatially clustered with L1 TCs. Geospatial clustering between prescription opioid overdoses and L2 or L3 TCs was not observed.
CONCLUSIONS: Geospatial clustering exists between county-level fatal prescription opioid overdoses and counties with L1 TCs in Ohio. The number of opioid doses prescribed were similar amongst all counties with TCs, yet MMEs prescribed were 6-times higher in counties with L1 centers. Additional research is needed to explore the nature of this geospatial correlation to help guide targeted interventions.
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