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Opioid Deaths and Local Healthcare Intensity: A Longitudinal Analysis of the U.S. Population, 2003–2014

      Introduction

      This study examines the association between local healthcare intensity and drug death rates.

      Methods

      County-level drug death rates were computed for 2003–2014 using vital statistics data adjusted for incomplete reporting of drug involvement. A county-level healthcare intensity index was constructed using Dartmouth Atlas of Health Care data. Linear regression and dose–response models were estimated for all residents and for population subgroups to analyze the relationship between healthcare intensity and drug death rates, as well as for 7 indicators of healthcare quality. Data collection and analysis were conducted in 2018 and 2019.

      Results

      Linear estimates indicated a positive correlation between healthcare intensity and opioid-involved drug death rates. Dose–response models revealed that the association was especially pronounced for the 2 highest healthcare intensity quintiles. Moving from the lowest to the highest healthcare intensity quintile was associated with a 2.14 (95% CI=1.56, 2.72) per 100,000 rise in opioid-involved drug death rates and a 25.1% (95% CI=18.3%, 31.9%) increase from the base rate of 8.54 per 100,000. Corresponding associations were larger in absolute terms for individuals who were male, white, aged 20–44 years, and not college educated than for their counterparts, but similar in percentages, except for 2 minority racial groups and seniors. Non-opioid drug death rates were unrelated to healthcare intensity. High healthcare intensity was associated with worse healthcare quality for 6 of 7 indicators.

      Conclusions

      In the U.S., between 2003 and 2014, high medical care intensity was associated with elevated opioid death rates and lower healthcare quality.
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