Date of Award

Spring 2020

Document Type

Open Access Thesis


Epidemiology and Biostatistics

First Advisor

Dr. Suzanne McDermott


Background – The opioid epidemic persists as a significant concern to public health as the proliferation of fentanyl presents additional risks for illicit opioid users. States such as Maine and New Hampshire experience far greater opioid overdose rates compared to the overall US opioid overdose rate. Many studies on the opioid epidemic use socioeconomic and macroeconomic factors individually but few use a composite index of multiple of these measures. Limited attention has been paid to the need for a composite index of socioeconomic status at the small area (county) level designed to quantify the impact of socioeconomic status on the opioid epidemic.

Methods – Negative binomial regression was used to compare the opioid overdose rate between quartiles of county-level socioeconomic status (SES) amongst the 40 counties of the three northern New England states of Maine, New Hampshire, and Vermont between the years of 2015 and 2017. Data sources include CDC Wonder, NIH SEER*Stat, US Census, and SAMHSA.

Results– Counties in the lowest two quartiles of county-level SES had 1.35 (95% CI=1.02, 1.79) and 1.31 (95% CI=1.01, 1.71) times the opioid overdose death rate compared to counties in the third quartile respectively after controlling for county-level urbanicity and county-level population density of practitioners waived to prescribe buprenorphine. Metropolitan counties had 1.24 (95% CI=1.01, 1.55) times the opioid overdose death rate compared to rural counties after controlling for county-level SES and county-level population density of level practitioners waived to prescribe buprenorphine.

Conclusions – County-level SES and county urbanicity may play a role in the opioid epidemic within the Northern New England Region of the United States. Studies designed to consider the longitudinal implications of increased access to buprenorphine treatment are required to properly assess the effect of the availability of this treatment on the opioid crisis. Fentanyl also poses a substantial threat to public health and safety, especially amongst illicit drug users who may be unaware to the presence of fentanyl in their drug supply.


© 2020, Samuel Godfrey

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Epidemiology Commons