Suspected heroin-related overdoses incidents in Cincinnati, Ohio: A spatiotemporal analysis

English version

Autoři: Zehang Richard Li ^aff001; Evaline Xie ^aff002; Forrest W. Crawford ^aff001; Joshua L. Warren ^aff001; Kathryn McConnell ^aff006; J. Tyler Copple ^aff007; Tyler Johnson ^aff007; Gregg S. Gonsalves ^aff007
Působiště autorů: Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America ^aff001; Yale College, New Haven, Connecticut, United States of America ^aff002; Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut, United States of America ^aff003; Department of Statistics & Data Science, Yale University, New Haven, Connecticut, United States of America ^aff004; Yale School of Management, New Haven, Connecticut, United States of America ^aff005; Yale School of Forestry & Environmental Studies, New Haven, Connecticut, United States of America ^aff006; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America ^aff007; Yale Law School, New Haven, Connecticut, United States of America ^aff008
Vyšlo v časopise: Suspected heroin-related overdoses incidents in Cincinnati, Ohio: A spatiotemporal analysis. PLoS Med 16(11): e32767. doi:10.1371/journal.pmed.1002956
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1002956

Souhrn

Background

Opioid misuse and deaths are increasing in the United States. In 2017, Ohio had the second highest overdose rates in the US, with the city of Cincinnati experiencing a 50% rise in opioid overdoses since 2015. Understanding the temporal and geographic variation in overdose emergencies may help guide public policy responses to the opioid epidemic.

Methods and findings

We used a publicly available data set of suspected heroin-related emergency calls (n = 6,246) to map overdose incidents to 280 census block groups in Cincinnati between August 1, 2015, and January 30, 2019. We used a Bayesian space-time Poisson regression model to examine the relationship between demographic and environmental characteristics and the number of calls within block groups. Higher numbers of heroin-related incidents were found to be associated with features of the built environment, including the proportion of parks (relative risk [RR] = 2.233; 95% credible interval [CI]: [1.075–4.643]), commercial (RR = 13.200; 95% CI: [4.584–38.169]), manufacturing (RR = 4.775; 95% CI: [1.958–11.683]), and downtown development zones (RR = 11.362; 95% CI: [3.796–34.015]). The number of suspected heroin-related emergency calls was also positively associated with the proportion of male population, the population aged 35–49 years, and distance to pharmacies and was negatively associated with the proportion aged 18–24 years, the proportion of the population with a bachelor's degree or higher, median household income, the number of fast food restaurants, distance to hospitals, and distance to opioid treatment programs. Significant spatial and temporal heterogeneity in the risks of incidents remained after adjusting for covariates. Limitations of this study include lack of information about the nature of incidents after dispatch, which may differ from the initial classification of being related to heroin, and lack of information on local policy changes and interventions.

Conclusions

We identified areas with high numbers of reported heroin-related incidents and features of the built environment and demographic characteristics that are associated with these events in the city of Cincinnati. Publicly available information about opiate overdoses, combined with data on spatiotemporal risk factors, may help municipalities plan, implement, and target harm-reduction measures. In the US, more work is necessary to improve data availability in other cities and states and the compatibility of data from different sources in order to adequately measure and monitor the risk of overdose and inform health policies.

Klíčová slova:

Critical care and emergency medicine – Public and occupational health – Opioids – Census – Heroin – Open data – Built environment – Spatial epidemiology

Zdroje

1. Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999–2017. Centers for Disease Control and Prevention. 2019. Available from: https://www.cdc.gov/nchs/products/databriefs/db329.htm. [cited 2019 Jun 5].

2. Katz J. Drug deaths in America are rising faster than ever. The New York Times. June 5, 2017. Available from: https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemic-drug-overdose-deaths-are-rising-faster-than-ever.html. [cited 2019 Feb 1].

3. Gomes T, Tadrous M, Mamdani MM, Paterson JM, Juurlink DN. The burden of opioid-related mortality in the United States. JAMA Network Open. 2018;1(2):e180217–e180217. doi: 10.1001/jamanetworkopen.2018.0217 30646062

4. Centers for Disease Control and Prevention. Drug Overdose Mortality by State; 2019. Available from: https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/drug_poisoning.htm. [cited 2019 Jun 5].

5. Anstead A. Hamilton County coroner: Fatal opioid overdoses rise for third straight year. WCPO. Mar 2, 2018. Available from: https://www.wcpo.com/news/local-news/hamilton-county/hamilton-county-coroner-fatal-opioid-overdoses-rise-for-third-straight-year. [cited 2019 Feb 1].

6. Alexander M, Barbieri M, Kiang M. Opioid deaths by race in the United States, 2000–2015. In: Population Association of America meetings, Chicago; 2017. p. 27–29.

7. Alexander MJ, Kiang MV, Barbieri M. Trends in black and white opioid mortality in the United States, 1979–2015. Epidemiology. 2018;29(5):707. doi: 10.1097/EDE.0000000000000858 29847496

8. Bohnert AS, Nandi A, Tracy M, Cerdá M, Tardiff KJ, Vlahov D, et al. Policing and risk of overdose mortality in urban neighborhoods. Drug and Alcohol Dependence. 2011;113(1):62–68. doi: 10.1016/j.drugalcdep.2010.07.008 20727684

9. Hepler S, McKnight E, Bonny A, Kline D. A latent spatial factor approach for synthesizing opioid-associated deaths and treatment admissions in Ohio counties. Epidemiology. 2019;30(3):365–370. doi: 10.1097/EDE.0000000000000978 30882402

10. Abraham AJ, Andrews CM, Yingling ME, Shannon J. Geographic disparities in availability of opioid use disorder treatment for Medicaid enrollees. Health Services Research. 2018;53(1):389–404. doi: 10.1111/1475-6773.12686 28345210

11. Islam MM, McRae IS, Mazumdar S, Simpson P, Wollersheim D, Fatema K, et al. Prescription opioid dispensing in New South Wales, Australia: spatial and temporal variation. BMC Pharmacology and Toxicology. 2018;19(1):30. doi: 10.1186/s40360-018-0219-0 29914572

12. Rowe C, Santos GM, Vittinghoff E, Wheeler E, Davidson P, Coffin PO. Neighborhood-level and spatial characteristics associated with lay naloxone reversal events and opioid overdose deaths. Journal of Urban Health. 2016;93(1):117–130. doi: 10.1007/s11524-015-0023-8 26800987

13. Mair C, Sumetsky N, Burke JG, Gaidus A. Investigating the social ecological contexts of opioid use disorder and poisoning hospitalizations in Pennsylvania. Journal of Studies on Alcohol and Drugs. 2018;79(6):899–908. doi: 10.15288/jsad.2018.79.899 30573021

14. DiMaggio C, Bucciarelli A, Tardiff KJ, Vlahov D, Galea S. Spatial analytic approaches to explaining the trends and patterns of drug overdose deaths. In: Geography and Drug Addiction. Springer, Dordrecht; 2008. p. 447–464.

15. Puniewska M. Coroners might be hiding the truth about overdose deaths. Tonic. Jun 19, 2017. Available from: https://www.vice.com/en_us/article/aemyyp/so-much-can-go-wrong-when-investigating-an-overdose. [cited 2019 Feb 1].

16. Warner M, Paulozzi LJ, Nolte KB, Davis GG, Nelson LS. State variation in certifying manner of death and drugs involved in drug intoxication deaths. Academic Forensic Pathology. 2013;3(2):231–237.

17. Chou R, Korthuis PT, McCarty D, Coffin PO, Griffin JC, Davis-O'Reilly C, et al. Management of suspected opioid overdose with naloxone in out-of-hospital settings: a systematic review. Annals of Internal Medicine. 2017;167(12):867–875. doi: 10.7326/M17-2224 29181532

18. Samuels EA, McDonald JV, McCormick M, Koziol J, Friedman C, Alexander-Scott N. Emergency department and hospital care for opioid use disorder: implementation of statewide standards in Rhode Island, 2017–2018. American Journal of Public Health. 2019;109(2):263–266. doi: 10.2105/AJPH.2018.304847 30571304

19. Garza A, Dyer S. EMS data can help stop the opioid epidemic. Journal of Emergency Medical Services. 2016. Published Nov 1, 2016.

20. Bearnot B, Pearson JF, Rodriguez JA. Using publicly available data to understand the opioid overdose epidemic: geospatial distribution of discarded needles in Boston, Massachusetts. American Journal of Public Health. 2018;108(10):1355–1357. doi: 10.2105/AJPH.2018.304583 30138067

21. Carter JG, Mohler G, Ray B. Spatial concentration of opioid overdose deaths in Indianapolis: an application of the law of crime concentration at place to a public health epidemic. Journal of Contemporary Criminal Justice. 2019;35(2):161–185.

22. Dworkis DA, Weiner SG, Liao VT, Rabickow D, Goldberg SA. Geospatial clustering of opioid-related emergency medical services runs for public deployment of naloxone. Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health. 2018;19(4):641–648.

23. Dodson ZM, Enki Yoo EH, Martin-Gill C, Roth R. Spatial methods to enhance public health surveillance and resource deployment in the opioid epidemic. American Journal of Public Health. 2018;108(9):1191–1196. doi: 10.2105/AJPH.2018.304524 30024793

24. Lasher L, Jason Rhodes MPA AC, Viner-Brown S. Identification and description of non-fatal opioid overdoses using Rhode Island EMS data, 2016–2018. Rhode Island Medical Journal. 2019;102(2):41–45. 30823701

25. Pesarsick J, Gwilliam M, Adeniran O, Rudisill T, Smith G, Hendricks B. Identifying high risk areas for non-fatal overdose: a spatial case-cohort study utilizing EMS run data. Annals of Epidemiology. 2019;.

26. ODMAP. Overdose Detection Mapping Application Program; 2019. Data retrieved from ODMAP, http://www.odmap.org/#agency. [cited 2019 Aug 20].

27. Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Annals of Internal Medicine. 2007;147(8):573–577. doi: 10.7326/0003-4819-147-8-200710160-00010 17938396

28. City of Cincinnati. Cincinnati Fire Incidents (CAD) (including EMS: ALS/BLS); 2019. Data retrieved from Open Data Cincinnati, https://data.cincinnati-oh.gov/Safer-Streets/Cincinnati-Fire-Incidents-CAD-including-EMS-ALS-BL/vnsz-a3wp. [cited 2019 Feb 1].

29. City of Cincinnati, Office of Performance & Data Analytics; 2019. Personal Communication Aug 9, 2019.

30. U S Census Bureau. 2017 American Community Survey (ACS); 2017. Available from: https://factfinder.census.gov/. [cited 2019 Feb 1].

31. HRSA Data Warehouse. Find a Health Center.; 2019. Retrieved from: https://findahealthcenter.hrsa.gov. [cited 2018 Dec 6].

32. SAMHSA. OTP Directory; 2019. Retrieved from: https://dpt2.samhsa.gov/treatment/directory.aspx. [cited 2018 Nov 30].

33. City of Cincinnati. CFD Fire Districts; 2018. Available from: https://www.cincinnati-oh.gov/fire/about-fire/cfd-fire-districts/. [cited 2018 Nov 15].

34. de Montigny L, Moudon AV, Leigh BC, Kim SY. A spatial analysis of the physical and social environmental correlates of discarded needles. Health & Place. 2011;17(3):757–766.

35. Wolfson-Stofko B, Bennett AS, Elliott L, Curtis R. Drug use in business bathrooms: An exploratory study of manager encounters in New York City. International Journal of Drug Policy. 2017;39:69–77. doi: 10.1016/j.drugpo.2016.08.014 27768996

36. Bates S, Leonenko V, Rineer J, Bobashev G. Using synthetic populations to understand geospatial patterns in opioid related overdose and predicted opioid misuse. Computational and Mathematical Organization Theory. 2018; p. 1–12.

37. City of Cincinnati. Cincinnati Area Geographic Information System; 2014. Available from: http://cagismaps.hamilton-co.org/cagisportal/mapdata/. [cited 2019 Feb 1].

38. Cincinnati Bell. White Pages; 2019. Available from: https://www.cincinnatibell.com/whitepages. [cited 2019 Jan 10].

39. City of Cincinnati. PDI (Police Data Initiative) Crime Incidents; 2019. Available from: https://data.cincinnati-oh.gov/Safer-Streets/PDI-Police-Data-Initiative-Crime-Incidents/k59e-2pvf. [cited 2019 Feb 1].

40. National Weather Service. NOWData—NOAA Online Weather Data.; 2019. Available from: https://w2.weather.gov/climate/xmacis.php?wfo=iln. [cited 2019 Feb 1].

41. United States Census Bureau. 2017 Cartographic Boundary File, Current Block Group for Ohio, 1:500,000; 2017. Available from: https://www2.census.gov/geo/tiger/GENZ2017/shp/cb_2017_39_bg_500k.zip. [cited 2019 Jan 31].

42. Wakefield J. Disease mapping and spatial regression with count data. Biostatistics. 2006;8(2):158–183. doi: 10.1093/biostatistics/kxl008 16809429

43. Lawson AB. Bayesian disease mapping: hierarchical modeling in spatial epidemiology. Chapman and Hall/CRC; 2013.

44. Besag J, York J, Mollié A. Bayesian image restoration, with two applications in spatial statistics. Annals of the Institute of Statistical Mathematics. 1991;43(1):1–20.

45. Besag J. Spatial interaction and the statistical analysis of lattice systems. Journal of the Royal Statistical Society, Series B. 1974;36:192–236.

46. Gelman A, Carlin JB, Stern HS, Dunson DB, Vehtari A, Rubin DB. Bayesian data analysis. Chapman and Hall/CRC; 2013.

47. Rue H, Martino S, Chopin N. Approximate Bayesian inference for latent Gaussian models by using integrated nested Laplace approximations. Journal of the Royal Statistical Society: Series B. 2009;71(2):319–392.

48. R Core Team. R: A Language and Environment for Statistical Computing; 2018. Available from: https://www.R-project.org/.

49. Mettler K. 'This is unprecedented': 174 heroin overdoses in 6 days in Cincinnati. The Washington Post. Aug 29, 2016. Available from: https://www.washingtonpost.com/news/morning-mix/wp/2016/08/29/this-is-unprecedented-174-heroin-overdoses-in-6-days-in-cincinnati. [cited 2019 Feb 1].

50. DeMio T. OD crisis: Flying blind in search of killer heroin's source. The Cincinnati Enquirer. Aug 26, 2016. Available from: https://www.cincinnati.com/story/news/2016/08/25/od-crisis-flying-blind-search-killer-heroins-source/89339560/. [cited 2019 Feb 1].

51. DeMio T. Cincinnati shifts tactics in response to ODs. The Cincinnati Enquirer. Sept 2, 2016. Available from: https://www.cincinnati.com/story/news/2016/09/02/cincinnati-shifts-tactics-response-ods/89761806/. [cited 2019 Feb 1].

52. Hawkins D. As overdoses surge, two accused of selling deadly heroin laced with elephant tranquilizer. The Washington Post. Sept 23, 2016. Available from: https://www.washingtonpost.com/news/morning-mix/wp/2016/09/23/as-overdoses-surge-two-accused-of-selling-deadly-heroin-laced-with-elephant-tranquilizer. [cited 2019 Feb 1].

53. DeMio T. County on alert as 9 die over weekend in suspected ODs. The Cincinnati Enquirer. Feb 26, 2017. Available from: https://www.cincinnati.com/story/news/2017/02/26/city-sees-overdose-surge/98462124/. [cited 2019 Feb 1].

54. DeMio T. Overdoses once again rising in Cincinnati region, officials warn. The Cincinnati Enquirer. May 17, 2017. Available from: https://www.cincinnati.com/story/news/2017/05/17/overdoses-once-again-rising-cincinnati-region-officials-warn/328244001/. [cited 2019 Feb 1].

55. DeMio T. Overdoses surging in Hamilton County, public health issues alert. The Cincinnati Enquirer. July 11, 2018. Available from: https://www.cincinnati.com/story/news/2018/07/11/overdose-surge-prompts-health-alert-hamilton-county/774376002/. [cited 2019 Feb 1].

56. Compton WM, Jones CM, Baldwin GT. Relationship between nonmedical prescription-opioid use and heroin use. New England Journal of Medicine. 2016;374(2):154–163. doi: 10.1056/NEJMra1508490 26760086

57. Seth P, Rudd RA, Noonan RK, Haegerich TM. Quantifying the epidemic of prescription opioid overdose deaths. American Journal of Public Health. 2018;108(4):500–502. doi: 10.2105/AJPH.2017.304265 29513577

58. Welsh-Huggins A. Opioid combo 'gray death' is latest danger. NBC News. May 4, 2017. Available from: https://www.nbcdfw.com/news/health/Opioid-Combo-Gray-Death-Mixing-Trend-421315433.html. [cited 2019 Feb 1].

59. Pear VA, Ponicki WR, Gaidus A, Keyes KM, Martins SS, Fink DS, et al. Urban-rural variation in the socioeconomic determinants of opioid overdose. Drug and Alcohol Dependence. 2019;195:66–73. doi: 10.1016/j.drugalcdep.2018.11.024 30592998

60. Helmerhorst G, Teunis T, Janssen S, Ring D. An epidemic of the use, misuse and overdose of opioids and deaths due to overdose, in the United States and Canada: is Europe next? The Bone & Joint Journal. 2017;99(7):856–864.

61. NEMSIS TAC. National Emergency Medical Services Information System; 2019. Available from: https://www.nemsis.org. [cited 2019 Sept 15 ].

62. City of Cincinnati. Open Data Cincinnati; 2019. Available from: https://www.cincinnati-oh.gov/manager/opda/about-leadership-contact/initiatives/open-data-cincinnati/. [cited 2019 Jun 5 ].

63. Abel B, MMS Legislative and Regulatory Affairs Counsel. Game-changing use of data drives opioid practice; 2018. http://www.massmed.org/News-and-Publications/Vital-Signs/Game-Changing-Use-of-Data-Drives-Opioid-Practice/#.XQJyQdNKjUJ. [cited 2019 Jun 5 ].