Rural-Urban Disparities in Opioid Misuse in the United States

To explore the impact of health insurance on the rural-urban disparities in opioid misuse in the United States.

A secondary analysis of the National Survey on Drug Use and Health (NSDUH) was conducted using datasets from 2021 to ​2023. Outcomes examined were past-month and past-year opioid misuse. Residence was categorized using the Core Based Statistical Area (CBSA) classifications: large CBSA (>1 million persons); small CBSA (<1 million persons); rural: residing in a non-CBSA. Statistical analysis included univariate analysis, multivariable logistic regression, and a model for each outcome that accounted for moderation between residence and insurance.

The weighted sample comprised 281,769,638 individuals, of whom 3.2% and 1.0% reported past-year and past-month opioid misuse, respectively. The multivariable analysis without moderation showed that, compared with non-Hispanic Whites, non-Hispanic Asians had lower odds of past-year opioid misuse (p < .001). Significant moderation was observed only for past-month opioid misuse. The main effect of residence showed that past-month misuse was lower among individuals living in non-CBSAs than among those in large CBSAs (aOR = 0.58; 95% CI, 0.39,0.85). After adjusting for moderation, individuals in non-CBSAs without health insurance had higher odds of past-month misuse than those in large CBSAs without insurance (aOR = 3.41, 95% CI, 1.37, 8.51). Higher income was protective against opioid misuse, but being male was associated with increased odds of misuse.

People from rural areas without health insurance had higher odds of past-month opioid misuse than those without health insurance in large CBSAs. These findings can guide focused interventions to address opioid misuse.