Rethinking urban-rural designations in public health surveillance of the overdose crisis and crafting an agenda for future monitoring

Lauren Textor; Joseph Friedman; Philippe Bourgois; Shoshana Aronowitz; Caty Simon; Marie Jauffret-Roustide; Sarah Namirembe; Sarah Brothers; Ryan McNeil; Kelly Ray Knight; Helena Hansen

doi:10.1016/j.drugpo.2023.104072

Rethinking urban-rural designations in public health surveillance of the overdose crisis and crafting an agenda for future monitoring

Int J Drug Policy. 2023 Aug:118:104072. doi: 10.1016/j.drugpo.2023.104072. Epub 2023 Jun 14.

Authors

Affiliations

¹ University of California Los Angeles, Medical Scientist Training Program; UCLA Department of Anthropology; Center for Social Medicine, Department of Psychiatry, UCLA, 760 Westwood Plaza Suite B7-435, Los Angeles, CA, 90095-1759. Electronic address: laurentextor@gmail.com.
² University of California Los Angeles, Medical Scientist Training Program.
³ Center for Social Medicine, Department of Psychiatry, UCLA, 760 Westwood Plaza Suite B7-435, Los Angeles, CA, 90095-1759.
⁴ University of Pennsylvania School of Nursing.
⁵ National Survivors Union, 1116 Grove St., Greensboro, NC, 27403; Whose Corner Is It Anyway, 1187 Northampton St., Holyoke, MA, 01040; NC Survivors Union, 1116 Grove St., Greensboro, NC, 27403.
⁶ Centre d'Étude des Mouvements Sociaux (Inserm U1276/CNRS UMR 8044/EHESS), Paris, France.
⁷ Department of Mental Health Faculty of Medicine Gulu University, P.o.Box 166, Gulu, Uganda.
⁸ The Pennsylvania State University, 316 Oswald Tower University Park, PA, 16802.
⁹ Program in Addiction Medicine at Yale University.
¹⁰ Department of Humanities and Social Sciences University of California, San Francisco.
¹¹ Professor of Psychiatry and Chair of Research Theme in Translational Social Science and Health Equity at David Geffen School of Medicine, UCLA; Interim Chair, Department of Psychiatry and Biobehavioral Sciences, UCLA; Interim Director, UCLA Semel Institute for Neuroscience and Human Behavior at DGSOM; Interim Physician-in-Chief, Resnick Neuropsychiatric Hospital, UCLA.

Abstract

Rurality has served as a key concept in popular and scientific understandings of the US overdose crisis, with White, rural, and low-income areas thought to be most heavily affected. However, we observe that overdose trends have risen nearly uniformly across the urban-rural designations employed in most research, implying that their importance has likely been overstated or incorrectly conceptualized. Nevertheless, urbanicity/rurality does serve as a key axis to understand inequalities in overdose mortality when assessed with more nuanced modalities-employing a more granular analysis of geography at the sub-county level, and intersecting rurality sociodemographic indices such as race/ethnicity. Using national overdose data from 1999-2021, we illustrate the intersectional importance of rurality for overdose surveillance. Finally, we offer recommendations for integrating these insights into drug overdose surveillance moving forward.

Keywords: Ethnography; Inequality; Opioids; Overdose; Rural urban categories; Surveillance.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Drug Overdose* / epidemiology
Humans
Public Health Surveillance*
Rural Population
Urban Population

Abstract

Publication types

MeSH terms

Grants and funding