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Your Neighborhood Matters: An Ecological Analysis of Neighborhood Disadvantage and Fatal Opioid Overdose in Nevada
AuthorMiceli, David P.
AdvisorBassett, Scott D.
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Despite signs of a looming opioid crisis in the United States more than a decade ago, efforts to change course have had mixed success. After nearly a decade of policy focused on controlling the supply of prescription opioids, national overdose mortality rates have continued to rise, indicating a need for new strategies. A growing body of research has shown that neighborhood disadvantage is positively associated with fatal opioid overdose (FOD) and may help to facilitate interventions targeting areas of greatest need, yet neighborhood disadvantage has received limited attention from researchers and policymakers. The state of Nevada is well positioned to develop and implement new strategies to address the opioid crisis, but little is known about geographic variation in overdose rates below the county level and whether rates are correlated with level of disadvantage. This ecological study had two primary objectives: 1) conduct the first small-area spatial analysis of FOD prevalence in Nevada; and 2) examine the association between neighborhood disadvantage and FOD rates. Cumulative counts of FOD from mortality records spanning 2011 to 2015 were aggregated to the census tract level and evaluated against tract-level disadvantage using the Social Deprivation Index (SDI). Census tracts with high rates of FOD and high levels of disadvantage were concentrated in the metropolitan areas of Reno and Las Vegas. In addition, rates of FOD in the most disadvantaged tracts were more than twice rates in the least disadvantaged tracts [IRR 2.08(1.51-2.84), p<0.001] when controlling for location, age, race, gender and marital status. Nevada’s response to the opioid crisis may be improved by increasing resources in urban areas and targeting factors related to neighborhood disadvantage. More research is needed to develop interventions targeting neighborhood disadvantage and determine if this can more efficiently reduce rates of FOD in Nevada by focusing on areas of greatest need.