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Link to original content: http://pubmed.ncbi.nlm.nih.gov/36427682/
Substance use disorders and social determinants of health from electronic medical records obtained during Kentucky's "triple wave" - PubMed Skip to main page content
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. 2022 Nov:221:173495.
doi: 10.1016/j.pbb.2022.173495. Epub 2022 Nov 22.

Substance use disorders and social determinants of health from electronic medical records obtained during Kentucky's "triple wave"

Chris Delcher  1 , Daniel R Harris  2 , Nicholas Anthony  3 , William W Stoops  4 , Katherine Thompson  5 , Dana Quesinberry  6
Affiliations

Substance use disorders and social determinants of health from electronic medical records obtained during Kentucky's "triple wave"

Chris Delcher et al. Pharmacol Biochem Behav. 2022 Nov.

Abstract

Social determinants of health (SDOH) play a critical role in the risk of harmful drug use. Examining SDOH as a means of differentiating populations with multiple co-occurring substance use disorders (SUDs) is particularly salient in the era of prevalent opioid and stimulant use known as the "Third Wave". This study uses electronic medical records (EMRs) from a safety net hospital system from 14,032 patients in Kentucky from 2017 to 2019 in order to 1) define three types of SUD cohorts with shared/unique risk factors, 2) identify patients with unstable housing using novel methods for EMRs and 3) link patients to their residential neighborhood to obtain quantitative perspective on social vulnerability. We identified patients in three cohorts with statistically significant unique risk factors that included race, biological sex, insurance type, smoking status, and urban/rural residential location. Adjusting for these variables, we found a statistically significant, increasing risk gradient for patients experiencing unstable housing by cohort type: opioid-only (n = 7385, reference), stimulant-only (n = 4794, odds ratio (aOR) 1.86 95 % confidence interval (CI): 1.66-2.09), and co-diagnosed (n = 1853, aOR = 2.75, 95 % CI: 2.39 to 3.16). At the neighborhood-level, we used 8 different measures of social vulnerability and found that, for the most part, increasing proportions of patients with stimulant use living in a census tract was associated with more social vulnerability. Our study identifies potentially modifiable factors that can be tailored by substance type and demonstrates robust use of EMRs to meet national goals of enhancing research on social determinants of health.

Keywords: Housing; Opioid use disorder; Social determinants; Stimulants.

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Figures

Figure 1.
Figure 1.
Adjusted odds ratios and 95% confidence intervals (CI) from multinomial regression analyses to identify unique (non-overlapping CIs) and shared factors associated with substance use cohort membership. Age (significant but not shown) is included in the adjusted model. Appalachian county status was removed since urban/rural status was included. *Reference group for educational status is “less than highschool”. The aOR=1.0 reference line represents the variables as distributed in the opioid-only cohort (comparison cohort).
Figure 2.
Figure 2.
Top 10 co-occurring drug combinations in the co-diagnosed cohort (having both opioid and stimulant use disorders). The cardinality bar chart (right) shows the counts for specific combinations of drugs (only top 10 shown) and the bar chart (top left) counts single occurrences of select drugs.
Figure 3.
Figure 3.
Top. Kolak’s social determinants of health (SDOH) components of US census tracts for patients residing in UKHC primary and secondary catchment areas (n=9,040). Lower scores indicate more vulnerability. Bottom. CDC’s Social Vulnerability Index Components. Higher percentiles indicate higher vulnerability. Hashed bars show values for those with unstable housing and dashed horizontal lines and labels show group mean values from SDOH scores assigned to each patient.
Figure 4.
Figure 4.
Linear regression estimates of proportion of each drug use cohort living in a census tract and the tracts vulnerability score. The estimate=0 reference line represents the opioid-only cohort (comparison group). The top graph are components of Kolak’s measures. The bottom graph are components of the US Centers for Disease Control and Prevention’s Social Vulnerability Index.
See this image and copyright information in PMC

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