Suspected heroin-related overdoses incidents in Cincinnati, Ohio: A spatiotemporal analysis.

Background Opioid misuse and deaths are increasing in the United States. In 2017, Ohio had the second highest overdose rates in the US, with the city of Cincinnati experiencing a 50% rise in opioid overdoses since 2015. Understanding the temporal and geographic variation in overdose emergencies may help guide public policy responses to the opioid epidemic. Methods and findings We used a publicly available data set of suspected heroin-related emergency calls (n = 6,246) to map overdose incidents to 280 census block groups in Cincinnati between August 1, 2015, and January 30, 2019. We used a Bayesian space-time Poisson regression model to examine the relationship between demographic and environmental characteristics and the number of calls within block groups. Higher numbers of heroin-related incidents were found to be associated with features of the built environment, including the proportion of parks (relative risk [RR] = 2.233; 95% credible interval [CI]: [1.075-4.643]), commercial (RR = 13.200; 95% CI: [4.584-38.169]), manufacturing (RR = 4.775; 95% CI: [1.958-11.683]), and downtown development zones (RR = 11.362; 95% CI: [3.796-34.015]). The number of suspected heroin-related emergency calls was also positively associated with the proportion of male population, the population aged 35-49 years, and distance to pharmacies and was negatively associated with the proportion aged 18-24 years, the proportion of the population with a bachelor's degree or higher, median household income, the number of fast food restaurants, distance to hospitals, and distance to opioid treatment programs. Significant spatial and temporal heterogeneity in the risks of incidents remained after adjusting for covariates. Limitations of this study include lack of information about the nature of incidents after dispatch, which may differ from the initial classification of being related to heroin, and lack of information on local policy changes and interventions. Conclusions We identified areas with high numbers of reported heroin-related incidents and features of the built environment and demographic characteristics that are associated with these events in the city of Cincinnati. Publicly available information about opiate overdoses, combined with data on spatiotemporal risk factors, may help municipalities plan, implement, and target harm-reduction measures. In the US, more work is necessary to improve data availability in other cities and states and the compatibility of data from different sources in order to adequately measure and monitor the risk of overdose and inform health policies. Author summaryWhy was this study done? Opioid-related overdose has become one of the most common causes of death in the United States. Information about the spatiotemporal pattern of overdose emergencies may be useful in guiding policy responses to the opioid crisis. What did the researchers do and find? We used publicly available data on emergency medical calls to map incidents of suspected heroin-related incidents to census block groups in Cincinnati between August 1, 2015, and January 30, 2019. We developed a spatiotemporal statistical model that assessed the association between the number of suspected overdose incidents and demographic, socioeconomic, and environmental characteristics in census block groups. We identified features of the built environment and demographic characteristics associated with a higher numbers of heroin-related calls in areas of the city of Cincinnati. What do these findings mean? Understanding the spatiotemporal risk of suspected heroin-related overdose and block group characteristics could inform the design and targeting of public health interventions in the future. Greater access to real-time emergency medical services data would help researchers and policymakers better understand the risk of suspected heroin-related overdose.