Relationships between places of residence, injury, and death: Spatial and statistical analysis of fatal opioid overdoses across Massachusetts. (November 2022)

• Record Type: Journal Article
• Authors: Pustz, Jennifer; Srinivasan, Sumeeta; Larochelle, Marc R.; Walley, Alexander Y.; Stopka, Thomas J.
• Is Part Of: Spatial and spatio-temporal epidemiology. Volume 43(2022)
• Publication Date: 2022-11
• Subjects: Opioids -- Overdose -- Massachusetts -- GIS -- Spatial epidemiology; Epidemiology -- Statistical methods -- Periodicals; Epidemiology -- Periodicals; 614.4072
• DOI: 10.1016/j.sste.2022.100541
• Languages: English
• ISSNs: 1877-5845

Abstract

Highlights: Understanding spatial distribution of where individuals experience fatal opioid-involved overdose (at home or in public locations) can help target interventions appropriately. The percentage of decedents who experienced fatal overdose at home may be underestimated unless injury fields in death certificate data, when available, are used to reclassify deaths recorded at hospitals. Statistical models that are sensitive to local variation, such as geographically weighted regression, can highlight subregions where factors associated with fatal overdose at home are the strongest. Abstract: Understanding the factors associated with where people who use opioids live, where their fatal overdoses occur, and where deaths are recorded can improve our knowledge of local risk environments and inform intervention planning. Through geospatial analyses of death certificate data between 2015 and 2017, we found that a majority of opioid-involved fatal overdoses in Massachusetts occurred at home. Age (adjusted odds ratio [AOR], 1.03; 95% confidence interval [CI], 1.02-1.04), living in a census tract with a higher percentage of crowded households (AOR, 1.04; 95% CI, 1.01-1.08), households without vehicles (AOR, 1.01; 95% CI, 1.00-1.02), and Hispanic ethnicity (AOR, 0.56; 95% CI, 0.42-0.74) were independently associated with fatal overdose at home. Using geographically weighted regression, we identified locations where these associations were stronger and could benefit most from home-based and culturally sensitive overdose prevention efforts, including expanded overdose education and naloxone distribution.