Small Area Estimation of Opioid Abuse and Comorbid Psychological Distress Among Females Living in the Thirteen Appalachian Region States

This study sought to estimate the prevalence of opioid misuse and abuse with comorbid psychological distress among females living in Appalachian region (AR) counties of the United States and, further, to compare the prevalence of these estimates against non-AR counties in the 13 states with AR counties. Small area estimation methodology was used to predict opioid misuse and abuse with comorbid psychological distress among females in the AR. Using data from the 2016 National Survey on Drug Use and Health, four logistic regression models were calculated, in which opioid misuse with comorbid psychological distress (Models 1 and 2) and opioid abuse with comorbid psychological distress (Models 3 and 4) were regressed on age, race, sex, veteran status, and county rural- urban codes. Probabilities for each combination of independent variables were generated and matched with Census population counts for said combinations to estimate and map prevalence rates for all counties in the 13 states that encapsulate the AR. Compared with non-AR counties, higher average prevalence estimates were observed in AR counties for opioid misuse (1.79% vs. 1.90%, p < .001), opioid abuse (1.11% vs. 1.22%, p < .001), comorbid opioid misuse and psychological distress (0.59% vs. 0.65%, p < .001), and comorbid opioid abuse and psychological distress (0.55% vs. 0.60%, p < .001). Interventions are needed to address the dearth of opioid addiction services in rural Appalachia, and some of them must be individually tailored for females in these regions.