• Dajun Lin, Siying Liu, and Christopher J Ruhm.
• American Institutes for Research, Arlington, Virginia.
• Am J Prev Med. 2020 Jan 1; 58 (1): 50-58.

IntroductionThis study examines the association between local healthcare intensity and drug death rates.MethodsCounty-level drug death rates were computed for 2003-2014 using vital statistics data adjusted for incomplete reporting of drug involvement. A county-level healthcare intensity index was constructed using Dartmouth Atlas of Health Care data. Linear regression and dose-response models were estimated for all residents and for population subgroups to analyze the relationship between healthcare intensity and drug death rates, as well as for 7 indicators of healthcare quality. Data collection and analysis were conducted in 2018 and 2019.ResultsLinear estimates indicated a positive correlation between healthcare intensity and opioid-involved drug death rates. Dose-response models revealed that the association was especially pronounced for the 2 highest healthcare intensity quintiles. Moving from the lowest to the highest healthcare intensity quintile was associated with a 2.14 (95% CI=1.56, 2.72) per 100,000 rise in opioid-involved drug death rates and a 25.1% (95% CI=18.3%, 31.9%) increase from the base rate of 8.54 per 100,000. Corresponding associations were larger in absolute terms for individuals who were male, white, aged 20-44 years, and not college educated than for their counterparts, but similar in percentages, except for 2 minority racial groups and seniors. Non-opioid drug death rates were unrelated to healthcare intensity. High healthcare intensity was associated with worse healthcare quality for 6 of 7 indicators.ConclusionsIn the U.S., between 2003 and 2014, high medical care intensity was associated with elevated opioid death rates and lower healthcare quality.Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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