Rural areas of British Columbia, Canada, experience high fatal overdose risk, potentially due to contamination of the illicit drug supply with Fentanyl and minimal access to harm reduction services, finds a study published in BMCPublicHealth
is the number of months between Jan 1, 2015 and when the event happened. Then risk surfaces were mapped every 6 months to resemble the spatial-temporal trends. Similarly, we also included a year variable and its interaction with urbanicity in the logistic model to reflect the temporal aspect.
Two sensitivity analyses were performed. First, events with incomplete location information were removed from the data analyses; consequently, we investigated the potential bias arising from this exclusion. As the missing data is mainly in the location type variable, we fitted an adjusted model without the location type variable using almost all events. Then, it was compared to an identical model with data exclusion.
. The proportion of cases from rural areas was higher among fatal overdoses than non-fatal overdoses . Also, the two types of events differ notably by age, sex, and being a recurrent event . Recurrent overdose was the least prevalent in rural communities . Furthermore, location type seems to profoundly impact the likelihood of fatal overdose; deaths in public buildings and healthcare facilities were infrequent.
We present the multivariable logistic regression results comparing different combinations of adjustment sets in Table . All models agree that rural events had significantly higher odds of being fatal than events in large population centers , and the odds ratio for rural events ranges from 1.59 unadjusted to 1.31 adjusted for all selected covariates. The odds of fatal overdose in medium and small population centers were also higher than the reference but lost significance after full adjustment.
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