Spatial association between social vulnerability and accidental poisoning mortality in Pennsylvania and its adjacent states

The purpose of the current study is to investigate the spatial relationship between county-level social factors that are a proxy to measure the social vulnerability to adverse events and accidental poisoning mortality, or overdose deaths, in Pennsylvania and surrounding states. This study explores the suggestion that the opioid epidemic is an aggregate of individual sub-epidemics by looking at mortality rates and social determinants of health at the county level. We evaluate this by examining local spatial distribution of overdose mortality rates and social factors, such as poverty, overcrowding, and unemployment. This regional analysis compares spatial and non-spatial models for modeling overdose mortality, and the magnitude of influence of each variable at the county level compared to its global impact. We discuss the public health importance of non-homogeneous effects of social determinants of health on the opioid epidemic, and how they may help us to better understand and diagnose its contributing factors