ArticleThe International journal on drug policy2023
Residence in urban or rural counties in relation to opioid overdose mortality among Kentucky hospitalizations before and during the COVID-19 pandemic.
Article in The International journal on drug policy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Organizational perspectives on the impacts of scaling up overdose education and naloxone distribution in Kentucky.Addiction science & clinical practice · 2025Trial
- Experiences of People Who Use Drugs in Rural Southeastern Ohio During the COVID-19 Pandemic: Harm Reduction, Substance Use Treatment, and Trusted Information Sources.Journal of studies on alcohol and drugs · 2026Article
- A lesson for post-COVID healthcare: assessment of physical and psychosocial risk factors on perceived pain intensity among urban individuals.Frontiers in psychology · 2024Article
- Unleashing the link between the relaxation of the COVID-19 control policy and residents' mental health in China: the mediating role of family tourism consumption.Frontiers in public health · 2023Article
- Implementing a "Naloxone Hub With Many Spokes" Model in Kentucky: Partner Agency Perspectives on Implementation Strategies.Implementation research and practiceArticle
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Abstract
backgroundAt the beginning of the opioid overdose epidemic, overdose mortality rates were higher in urban than in rural areas. We examined the association between residence in an urban or rural county and subsequent opioid overdose mortality in Kentucky, a state highly impacted by the opioid epidemic, and whether this was modified by the COVID-19 pandemic.
methodsWe captured hospitalizations in Kentucky from 2016 to 2020, involving an opioid using ICD-10-CM codes T40.0-T40.4 and T40.6. Patient's county was classified as urban or rural based on the NCHS Urban-Rural Classification Scheme. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of opioid overdose mortality, adjusted for demographics, hospitalization severity, and zip code SES. We assessed effect modification by the COVID-19 pandemic.
resultsOverall, patients living in urban counties had 46% higher odds of opioid overdose death than patients residing in rural counties (adjusted OR=1.46; 95% CI=1.22, 1.74). Before the pandemic, patients in urban counties had 63% increased odds of opioid overdose death (adjusted OR=1.63; 95% CI=1.34, 1.97); however, during the COVID-19 pandemic, patients in urban and rural counties became more similar in regard to opioid overdose mortality (adjusted OR=0.72; 95% CI=0.45, 1.16; p-value for interaction =0.02).
conclusionBefore the pandemic, living in urban counties was associated with higher opioid overdose mortality among Kentucky hospitalizations; however, during the COVID-19 pandemic, opioid overdose mortality in rural areas increased, approaching rates in urban areas. COVID-19 posed social, economic, and healthcare challenges that may be contributing to worsening mortality trends affecting both urban and rural patients.
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