Title : Disparities in drug related mortality in Appalachian and non Appalachian regions of Kentucky
Introduction: The opioid epidemic is a significant public health crisis faced by the United States, and some areas in the country are suffering more than others. It is crucial to identify differences in drug-related mortality’s geographical distribution to ensure the appropriate focus of governmental interventions addressing this issue. This study’s objective was to compare Appalachian rural, Appalachian urban, non-Appalachian rural, and non-Appalachian urban regions of Kentucky in terms of crude drug-related mortality, opioid-related mortality, and overall crude mortality rates. Methods: We used the Center for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) data from 1999-2018 to calculate crude drug-related mortality, opioid-related mortality, and overall crude mortality rates. We compared these outcomes between Appalachian rural, Appalachian urban, non-Appalachian rural, and non-Appalachian urban regions of Kentucky with and without adjusting for county-level demographic (age, sex, race, and ethnicity) and socioeconomic (poverty). Statistical analyses were performed with Poisson regression with a log link. Results: According to the 2010 population estimates of KY, the population in the four regions was as follows: non-Appalachian urban = 2317,627, non-Appalachian rural = 785,562, Appalachian urban = 133,683, and Appalachian rural 1048,956. Across all the four regions, there was comparable distributions of males and females, with the age group of 18 to 65 years comprising of the majority of the population, and the elderly (65+ years) making up the least of the population. The White made up the majority of the population within each region with Appalachian rural having a significant higher rate than non-Appalachian urban (97% vs 85%, p = 0.021). Conversely, the black population was significantly lower in Appalachian rural (2%) compared to non-Appalachian urban (12%, p = < 0.0001), and non-Appalachian rural (6%, p = < 0.0001). There was a significantly lower all-cause mortality for the non-Appalachian urban region (872 per 100,000) compared to non-Appalachian rural (1,131 per 100,000, p = < 0.0001), Appalachian urban (1,154 per 100,000, p = < 0.0001), and Appalachian rural (1,144 per 100,000, p = < 0.0001). The Appalachian rural region (26 ± 0.36 per 100,000) had significantly higher drug-related mortality when compared to non-Appalachian urban (19 ± 0.2 per 100,000, p = < 0.0001) and non-Appalachian rural regions (15 ± 0.31 per 100,000, p = < 0.0001). Similarly, the opioid-related mortality was significantly higher (p < 0.05) for Appalachian urban (20 ± 0.86) and Appalachian rural (17 ± 0.28) regions compared to the non-Appalachian (urban = 11 ± 0.16 and rural = 7 ± 0.21). Conclusion: The study demonstrated significant intra-state geographical disparities in Kentucky in all-cause, drug-related, and opioid-related mortalities, with the Appalachian region having significantly higher mortalities (all-cause, drug-related, and opioid-related) when compared to the non-Appalachian regions of Kentucky. Public Health Implications: The findings from this study can inform healthcare practitioners and public health officials to develop interventions addressing drug-related and opioid-related mortalities in Kentucky, targeting the regions where the mortalities are significantly higher. Also, the information on geographic, demographic, and socioeconomic factors related to these mortalities can be factored into the interventions’ design specific to targeting the population’s socio-demographics.