{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:50:09Z","timestamp":1792291809031,"version":"4.4.0"},"reference-count":13,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,4,25]],"date-time":"2019-04-25T00:00:00Z","timestamp":1556150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["NU17CE924884"],"award-info":[{"award-number":["NU17CE924884"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Opioid overdose death rates rose 36% from 2015 to 2016 in Missouri, indicating a worsening of the opioid overdose epidemic. To better understand urban and rural differences in nonfatal opioid overdoses treated in Missouri emergency departments, this paper analyzed hospital billing data from emergency departments due to opioid overdose from 2012 to 2016.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Emergency department records meeting the opioid overdose case definition were aggregated into 6 progressively rural groups using the National Center for Health Statistics (NCHS) urban\u2010rural county classification from 2013. These data were analyzed to determine significant trends amongst and between the geographic groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Generally, the magnitude of opioid overdose morbidity decreased as levels of rurality increased, using annual percentage change as the metric of change. Over the study period, Missouri's most urban counties had significantly higher rates of opioid overdose and saw larger percentage increases in rates compared to more rural areas. Statewide, all rural\u2010urban classifications experienced increases in heroin overdose morbidity; however, there was extreme variation in the trajectory of those increases. Heroin overdose rates were much higher in urban areas than rural areas. Conversely, rural and urban areas saw relatively similar patterns for non\u2010heroin opioid overdoses, though overall magnitude of these increases was more modest across all geographic groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The results from this analysis can help inform prioritization of strategies and resources to implement activities addressing the opioid overdose epidemic. Using a rich hospital discharge database could allow for further analysis of subpopulations to enhance personalization and customization of care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jrh.12368","type":"journal-article","created":{"date-parts":[[2019,4,25]],"date-time":"2019-04-25T16:14:26Z","timestamp":1556208866000},"page":"177-186","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Rural\u2010Urban Trends in Opioid Overdose Discharges in Missouri Emergency Departments, 2012\u20102016"],"prefix":"10.1111","volume":"36","author":[{"given":"Whitney","family":"Coffey","sequence":"first","affiliation":[{"name":"Missouri Department of Health and Senior Services Bureau of Health Care Analysis and Dissemination  Jefferson City Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Hunter","sequence":"additional","affiliation":[{"name":"Missouri Department of Health and Senior Services Bureau of Health Care Analysis and Dissemination  Jefferson City Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Mobley","sequence":"additional","affiliation":[{"name":"Missouri Department of Health and Senior Services Bureau of Health Care Analysis and Dissemination  Jefferson City Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alana","family":"Vivolo\u2010Kantor","sequence":"additional","affiliation":[{"name":"Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control Centers for Disease Control and Prevention  Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,4,25]]},"reference":[{"key":"e_1_2_5_2_1","unstructured":"Centers for Disease Control and Prevention National Center for Health Statistics.Underlying Cause of Death 1999\u20102016 on CDC WONDER Online Database released December 2017. Available at:https:\/\/wonder.cdc.gov\/. Accessed April 10 2018."},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm655051e1"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6712a1"},{"key":"e_1_2_5_5_1","unstructured":"HedegaardH WarnerM Mini\u00f1oAM.Drug overdose deaths in the United States 1999\u20132016. NCHS Data Brief no 294. Hyattsville MD: National Center for Health Statistics; 2017."},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6709e1"},{"key":"e_1_2_5_7_1","unstructured":"IngramDD FrancoSJ.2013 NCHS urban\u2013rural classification scheme for counties. National Center for Health Statistics. Vital Health Stat 2.2014;166:40\u201042."},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6619a1"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6643e1"},{"key":"e_1_2_5_10_1","unstructured":"ShrobaJ.State of the State for Law Enforcement and Heroin\/Opioids. 2017 Missouri Opioid Summit\u2014St. Louis December 14 2017. Available at:https:\/\/www.stlouis-mo.gov\/government\/departments\/health\/documents\/upload\/Opioid-Summit-St-Louis_Public.pdf. Accessed April 27 2018."},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6634a2"},{"key":"e_1_2_5_12_1","unstructured":"Drug Enforcement Administration.2016 National Drug Threat Assessment Summary. Washington DC: US Department of Justice Drug Enforcement Administration; 2016. Available at:https:\/\/www.dea.gov\/resource-center\/2016%20NDTA%20Summary.pdf. Accessed April 15 2018."},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6614a2"},{"key":"e_1_2_5_14_1","unstructured":"US Department of Justice Drug Enforcement Administration. Fentanyl: a briefing guide for first responders. Available at:https:\/\/www.dea.gov\/druginfo\/Fentanyl_BriefingGuideforFirstResponders_June2017.pdf. Accessed April 27 2018."}],"container-title":["The Journal of Rural Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jrh.12368","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jrh.12368","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jrh.12368","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T00:17:14Z","timestamp":1694045834000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jrh.12368"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,25]]},"references-count":13,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2020,3]]}},"alternative-id":["10.1111\/jrh.12368"],"URL":"https:\/\/doi.org\/10.1111\/jrh.12368","archive":["Portico"],"relation":{},"ISSN":["0890-765X","1748-0361"],"issn-type":[{"value":"0890-765X","type":"print"},{"value":"1748-0361","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,25]]},"assertion":[{"value":"2018-10-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-20","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-04-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}