Social science & medicine (1982) · 2026
Community social environment in relation to opioid use disorder across an urban-rural spectrum.
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Poulsen Melissa N, Nordberg Cara M, DeWalle Joseph, Schwartz Brian S
Аннотация
BACKGROUND: Addressing the opioid epidemic requires understanding environmental factors influencing population-level risk of opioid use disorder (OUD). To elucidate the role of social environmental conditions on opioid-related risk environments, we assessed two community-level measures-social disorganization and social capital-in relation to OUD across an urban-rural spectrum.
METHODS: In a case-control study using medical records (2012-2020) from a Pennsylvania health system, 14,674 OUD cases were frequency matched (on age, sex, year, medical record duration) to 58,696 controls. Study individuals were geocoded using residential addresses and assigned to community-level measures created from secondary data. Using logistic regression, we analyzed associations of social environmental measures with OUD in non-stratified models and models stratified by community type, adjusting for individual-level socio-demographic characteristics and community socioeconomic deprivation. Sub-scales of social capital (bonding, bridging, linking) were assessed.
RESULTS: Higher social disorganization was associated (odds ratio [95% CI]) with increasing OUD odds with an exposure-effect relationship (quartile [Q] 2: 1.21 [1.10, 1.32]; Q3: 1.42 [1.28, 1.59]; Q4: 1.77 [1.59, 1.98]; vs Q1). Higher social capital was associated with decreasing OUD odds, with an exposure-effect relationship (Q2: 0.89 [0.82, 0.96]; Q3: 0.85 [0.78, 0.93]; Q4: 0.80 [0.72, 0.89]; vs Q1). Bonding social capital accounted for most of this association. Results for social environmental measures remained consistent when adjusting for socioeconomic deprivation but differed by community type.
CONCLUSIONS: Findings add to prior evidence suggesting an influence of the social environment on opioid-related risk. To respond to the opioid epidemic, structural responses should address social environments to improve conditions.
METHODS: In a case-control study using medical records (2012-2020) from a Pennsylvania health system, 14,674 OUD cases were frequency matched (on age, sex, year, medical record duration) to 58,696 controls. Study individuals were geocoded using residential addresses and assigned to community-level measures created from secondary data. Using logistic regression, we analyzed associations of social environmental measures with OUD in non-stratified models and models stratified by community type, adjusting for individual-level socio-demographic characteristics and community socioeconomic deprivation. Sub-scales of social capital (bonding, bridging, linking) were assessed.
RESULTS: Higher social disorganization was associated (odds ratio [95% CI]) with increasing OUD odds with an exposure-effect relationship (quartile [Q] 2: 1.21 [1.10, 1.32]; Q3: 1.42 [1.28, 1.59]; Q4: 1.77 [1.59, 1.98]; vs Q1). Higher social capital was associated with decreasing OUD odds, with an exposure-effect relationship (Q2: 0.89 [0.82, 0.96]; Q3: 0.85 [0.78, 0.93]; Q4: 0.80 [0.72, 0.89]; vs Q1). Bonding social capital accounted for most of this association. Results for social environmental measures remained consistent when adjusting for socioeconomic deprivation but differed by community type.
CONCLUSIONS: Findings add to prior evidence suggesting an influence of the social environment on opioid-related risk. To respond to the opioid epidemic, structural responses should address social environments to improve conditions.