Opioid Use Disorder Among the Economically Disadvantaged in the Rural South.

Objective: This study aimed to identify county-level hotspots and associated risk factors for opioid use disorder (OUD) in the state of Alabama.

Methods: Using 2015 to 2019 Alabama Medicaid administrative claims data, Medicaid recipients with OUD were identified. We performed local indicators of spatial association analysis to identify hotspots of OUD rates. Using logistic regression, we examined county-level social determinants of health associated with county OUD hotspots.

Results: There was a +14.13% percentage change from 2015 to 2019. The county level local indicators of spatial association analysis found that 5 counties in the northwestern part of Alabama remained "hotspots" throughout the entire study period. Results of the logistic regression model showed that location within the Appalachian region was an independent predictor of high OUD rates ( b = 2.58; adjusted odds ratio, 13.27, P = 0.04).

Conclusions: The high rates of OUD may reflect the economic distress and lack of access to resources germane to the Appalachian region in Alabama.