Small Area Estimation for Opioid Abuse Prevention and Response

Project Lead:

Lance Waller, PhD | Emory University, Rollins School of Public Health

Project Co-Lead:

Janet Cummings, PhD |  Emory University, Rollins School of Public Health

Collaborators:

Laura Edison, DVM, MPH | Georgia Department of Public Health

Partner Organization:

Geogia Department of Public Health 

Research Gap:

Data sources needed to describe these epidemics are siloed within different agencies leading to fragmentation that stymies identifying emerging hotspots and establishing rapid responses to address overdose.

Description:

The rapid rise in the use/misuse of heroin and prescription and synthetic opioids presents an increasingly urgent set of public health challenges (e.g., prevention, treatment, emergency response) and requires efficient, robust, and reliable responses by state and local health departments. Recent legislation at the state and federal level directs increased financial support for local treatment, prevention, and response efforts. In order to most effectively direct targeted prevention resources, state and local health departments require ongoing situational awareness of local rates and trends, not only of the epidemiologic outcomes themselves (e.g., treatment burden, mortality), but also of the social and contextual determinants (e.g., employment, social engagement, access to treatment facilities) driving rapid local changes in these outcomes. To properly target new prevention resources in efficient, reliable, accurate, and effective ways, as part of the Research Core for the Injury Prevention Research Center at Emory (IPRCE) we will address three primary data processing and analytic challenges in local public health surveillance for the opioid epidemic, namely: (a) rapid curation of relevant data from multiple sources, (b) stable local rate estimation for health outcomes of interest and concern, and (c) analytics to monitor associations between local, community-level drivers of these outcomes across time and location. Specifically, we propose a three-year program within the proposed Prevention Research Center to provide the analytic infrastructure and tools to yield reproducible small area analysis of local opioid-related epidemiologic outcomes, to identify emerging “hot spots” of high local rates of the epidemiologic outcomes, and analytics to identify contextual determinants of these local rates and trends. To enhance impact, we will produce an analytic toolbox for local and state health departments to generate standardized surveillance reports featuring the standardized tables, figures, and maps necessary for regular updates of current status, evaluation of ongoing progress, and detection of emerging challenges to better plan, monitor, and evaluate state and local responses to this dynamic public health issue. 

Aim:

1. Develop small area estimates of county-level statistical summaries relevant to monitoring opioid use and abuse to evaluating responses to these harms in the state of Georgia
2. Extend small area estimation methods of Specific Aim 1 to assess urban-rural disparities in local statistical summaries monitoring opioid use ad abuse in the state of Georgia
3. Develop standardized analytic approaches to detect local clusters of high or low levels of opioid-related epidemiologic indicators (e.g., overdose mortality), and develop spatial regression models to assess associations between local social determinants and these opioid-related epidemiologic outcomes of interest. 
4. Develop and distribute an integrated collection of analytic tools to facilitate routine application of the methods in Aims 1-3 by state departments of public health

Why is this project important?

This project has generated the first stabilized estimates of overdose rates on a county level in Georgia and has conducted novel analyses that have identified social determinants of health that are associated with overdose in Georgia. Hotspots/clusters of overdose deaths have been identified.