Opioid crisis in rural and urban counties from 2010 to 2018: in light of the index of relative rurality

Abstract

Abstract Previous studies have documented the rural-urban disparities of the opioid crisis, but rarely consider the heterogeneities within rural and urban areas, nor the changing dynamics of the rural-urban boundaries. Taking advantage of a continuous measure of rurality, this study separates counties into “becoming-more-rural” and “becoming-more-urban” groups according to the change of rurality between 2000 and 2010, and compares the determinants of the development of prescription opioid-, heroin-, and synthetic opioid-related opioid mortality in the two groups of counties. The analysis uses longitudinal data of 2010–2018 from a variety of national datasets such as the confidential Multiple-Cause of Death data, the U.S. Opioid Dispensing Rate Maps, and the American Community Survey. The results show that while increasing rurality does not predict increasing prescription opioid- and synthetic opioid-involved mortality, the growth of heroin-involved mortality could be a severe issue for becoming-more-rural counties that have already observed heroin overdose deaths. The demographic groups that have higher risk of opioid overdoses may be different in different areas, for example increasing males and people engaged in manual labor occupations are associated with increasing prescription opioid-involved mortality for becoming-more-rural counties but in becoming-more-urban areas, heroin-involved mortality correlates to a higher percentage of Hispanics. Concentrations of socioeconomically disadvantaged populations like veterans and people in poverty increase opioid overdose deaths particularly for becoming-more-urban counties, while healthcare services shown more beneficial to becoming-more-rural areas. The findings suggest that the programs and regulations to reduce opioid-involved mortality should consider the changing nature of counties in the degree of rurality.