Impacts of Occupation and Urbanicity on Prescription Pain Reliever Abuse Open Access
Milloy, Aaron (Fall 2020)
Abstract
Introduction: In 2017, rural counties had higher age-adjusted rates of natural and semisynthetic
(prescription) opioid overdose deaths (4.9 per 100,000) compared to urban counties (4.3 per
100,000). A Centers for Disease Control report suggested that one potential explanation for why
prescription opioid rates are higher in rural counties is due to having higher rates of chronic pain,
which has also been found to be associated with physical activity in the workplace. People
working in physically strenuous jobs also have the highest rates of workplace injuries. This
combination may cause individuals with more physically strenuous jobs to be more likely to be
prescribed opioids.
Methods: This secondary analysis uses publicly available data acquired through the National
Survey on Drug Use and Health in 2014. In addition to examining descriptive statistics of the
sample population, we estimated adjusted prevalence ratios between past-year prescription pain
reliever misuse and abuse/dependence, using logistic regression models with conditional
margins.
Results: Adjusting for demographic and other covariates, neither exposure of interest, urbanicity
and occupational injury risk, were found to have statistically significant association with pastyear
prescription pain reliever misuse or abuse/dependence. Other covariates were found to have
statistically significant associations, including gender, education, marital status, insurance
coverage, overall health, and past-year mental illnesses, which increased in magnitude as
severity of illness increased. In an adjusted model examining past-year pain reliever
abuse/dependence, compared to those with no mental illness, the prevalence ratio was 1.88 (95%
CI: 1.59 – 2.22) for those with mild mental illness in the past year, 2.36 (95% CI: 1.91 – 2.92)
for moderate mental illness, and 2.79 (95% CI: 2.23 – 3.47) for those with serious mental illness
in the past year.
Discussion: Neither urbanicity nor occupational injury risk was found to have an association
with prescription pain reliever misuse or abuse/dependence. Though mental illness was
associated with pain reliever misuse and abuse/dependence, we are unable to infer a causal
relationship. There were limitations in this study, including concerns that those misusing or
being abusive/dependent on pain relievers may no longer be employed full-time.
Table of Contents
Chapter 1: Introduction & Expanded Literature Review 1
Thesis Introduction 2
Literature Review Introduction 3
Rise in Prescription Opioid Abuse 4
Urbanicity 5
Occupation Type 7
Age 10
Gender 12
Race & Ethnicity 12
Education 13
Marital Status 13
Income 14
Insurance Coverage 14
Physical Health 15
Mental Health 16
Presence of Other Substance Abuse 17
Pharmacy & Prescription Practices 18
Military Service 18
Chapter 2: Manuscript 20
Introduction 21
Methods 22
Results 26
Discussion 31
Chapter 3: Expanded Conclusion 35
Conclusions 36
Recommendations 39
References 41
Tables & Figures 47
Appendices 55
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