Community social environment in relation to opioid use disorder across an urban-rural spectrum

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.

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.

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.

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.