Association Between Social Vulnerability and Opioid Dispensing By Contiguous County in the United States

OBJECTIVES: To evaluate the county-level association between opioid dispensing and social vulnerability index (SVI) in the United States

METHODS: Nation-wide, contiguous county-level data from the Centers for Disease Control and Prevention (CDC) were aggregated to evaluate the association between opioid dispensing and social vulnerability. SVI provides an indication of county-level response to hazardous events and social conditions during a disaster and is based on four domains (socioeconomic status, household characteristics, racial/ethnic minority status, and housing type & transportation). Opioid dispensing rate per 100 population was based on county-level data from the CDC for 2020. SVI was divided into quintiles (1=lowest social vulnerability and 5=highest social vulnerability). Linear regression model evaluated the association of SVI quintiles to opioid dispensing rate per county controlling for destiny of primary care and mental healthcare providers, premature death, percentage of adults reporting fair to poor health, and state.

RESULTS: Compared to counties with the lowest social vulnerability, there was a significantly higher level of opioid dispensing rate with increasing quintile of the SVI. Counties with SVI quintile of 2 were associated with a significant increase in opioid dispensing by 7.23 opioids dispensed per 100 population (95%CI: 4.10-10.35). Counties with SVI quintile of 3 were associated with a significant increase in opioid dispensing by 13.77 opioids dispensed per 100 population (95%CI: 10.19-17.35). Counties with SVI quintile of 4 were associated with a significant increase in opioid dispensing by 21.87 opioids dispensed per 100 population (95%CI: 17.57-26,18). Lastly, counties with SVI quintile of 5 were associated with a significant increase in opioid dispensing by 26.58 opioids dispensed per 100 population (95%CI: 20.36-32.80).

CONCLUSIONS: As SVI increased, there was a significant increase in the number of opioid prescriptions dispensed at the county-level. Policy makers will need to consider SVI when implementing strategies to mitigate the opioid crisis.