Identifying Spatiotemporal Patterns in Opioid Vulnerability: Investigating the Links Between Disability, Prescription Opioids and Opioid-Related Mortality

TL;DR

This study analyzes county-level data from 2014-2020 to identify spatiotemporal patterns in opioid vulnerability, revealing regional hotspots, shifts in drug abuse drivers, and the increased risk among disabled populations using a novel spatial Kalman filter.

Contribution

It introduces a spatial Kalman filter to predict opioid-related rates and maps vulnerability hotspots, highlighting regional shifts and the role of disability in opioid mortality.

Findings

Appalachia remains the most vulnerable region from 2014-2018.

A dramatic shift from prescription to illegal drugs occurred starting in 2019.

Disabled populations are at higher risk of opioid-related mortality.

Abstract

The opioid crisis remains one of the most daunting and complex public health problems in the United States. This study investigates the national epidemic by analyzing vulnerability profiles of three key factors: opioid-related mortality rates, opioid prescription dispensing rates, and disability rank ordered rates. This study utilizes county level data, spanning the years 2014 through 2020, on the rates of opioid-related mortality, opioid prescription dispensing, and disability. To successfully estimate and predict trends in these opioid-related factors, we augment the Kalman Filter with a novel spatial component. To define opioid vulnerability profiles, we create heat maps of our filter's predicted rates across the nation's counties and identify the hotspots. In this context, hotspots are defined on a year-by-year basis as counties with rates in the top 5 percent nationally. Our spatial Kalman filter demonstrates strong predictive performance. From 2014 to 2018, these predictions highlight consistent spatiotemporal patterns across all three factors, with Appalachia distinguished as the nation's most vulnerable region. Starting in 2019 however, the dispensing rate profiles undergo a dramatic and chaotic shift. The initial primary drivers of opioid abuse in the Appalachian region were likely prescription opioids; however, it now appears that abuse is sustained by illegal drugs. Additionally, we find that the disabled subpopulation may be more at risk of opioid-related mortality than the general population. Public health initiatives must extend beyond controlling prescription practices to address the transition to and impact of illicit drug use.