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ABSTRACT
Background: Reports indicate a geographic effect of socioeconomic inequalities on the occurrence of opioid-related fatal overdoses. This study aims to (1) estimate the rates of opioid-related overdoses, (2) estimate the association of benzodiazepine co-ingestion with opioid-related deaths, (3) estimate associations between socioeconomic indicators and opioid-related deaths, and (4) map the distribution of fatal overdoses, in Orange County (OC), California. Methods: An ecologic study was conducted of all opioid- related deaths (1205 total) from 2010 to 2014 obtained from the OC Coroner Division database (1065 OC residents, 55 nonresidents, 85 OC homeless) (analyzed 2016–2017). Rates of opioid overdose, benzodiazepine co-ingestion prevalence, and associations with socioeconomic status (SES; education, poverty, median income) using ZIP code analysis in the residential and homeless communities were calculated. Results: Of 1205 deaths, 904 involved prescription-type opioids, 223 involved heroin, 39 involved both, and 39 not stated; 973 were classified unintentional overdoses, 180 suicides, and 52 undetermined; 49% of cases involved benzodiazepines. Prescription-type opioid and heroin death rates for residents were 5.4/ 100,000 person-years (95% confidence interval [CI]: 5.0–5.8) and 1.2/100,000 person-years (95% CI: 1.0–1.4), respectively. Males, age group 45–54, and Caucasian race had the highest rate (13.6/100,000) of opioid mortality. The highest death rates were seen in homeless adults, at 136/100,000 person-years for prescription-type opioids (95% CI: 99.0–185.5) and 156/100,000 person-years for heroin (95% CI: 116.8–209.5). Conclusions: The burden of prescription-type opioid–related deaths in OC affects all demographics and levels of SES; there is a disproportionately high rate of opioid-related deaths in the OC homeless population.
Author contributions
John R. Marshall contributed to idea context, literature review, data gathering, analysis, formation of text body, tables, and figures, editing text, submission of article, and is the corresponding author. Stephen F. Gassner contributed to literature review, data gathering, analysis of data, and text. Craig L. Anderson contributed to data analysis and interpretation and geo-mapping of data. Richelle J. Cooper contributed to literature review, text, and editing of text. Shahram Lotfipour contributed to the literature review, idea context, and editing of text. Bharath Chakravarthy, the senior author, contributed to the idea context, literature review, data gathering, and editing of text.