Relation between opioid-related harms and socioeconomic inequalities in Ontario: a population-based descriptive study

Zoe F. Cairncross; Jeremy Herring; Trevor van Ingen; Brendan T. Smith; Pamela Leece; Brian Schwartz; Karin Hohenadel

doi:10.9778/cmajo.20180084

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Figure 1:
Crude rates of neonatal abstinence syndrome (A) and opioid poisoning and nonpoisoning events (B) in Ontario, 2003–2016. Note: ED = emergency department.
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Figure 2:
Crude rates of emergency department visits (A) and hospital admission (B) for opioid poisoning, nonpoisoning opioid-related emergency department visits (E) and hospital admission (F), and neonatal abstinence syndrome (D) by neighbourhood income quintile in Ontario in 2016, and of opioid-related death by neighbourhood income quintile in Ontario in 2015 (C). Note: Q1 = lowest-income neighbourhood, Q5 = highest-income neighbourhood.

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Table 1:

Descriptive characteristics of neonatal abstinence syndrome and opioid poisoning and nonpoisoning events in 2016, and opioid-related death in 2015

Characteristic	Indicator; no. (%) of cases

	Neonatal abstinence syndrome n = 882	Opioid poisoning			Nonpoisoning event

		Emergency department visit n = 4420	Hospital admission n = 1893	Death n = 730	Emergency department visit n = 7575	Hospital admission n = 3886
Age, yr

≤ 14	–	89 (2.0)	42 (2.2)	1 (0.1)	11 (0.1)	33 (0.8)

15–24	–	701 (15.8)	164 (8.7)	71 (9.7)	1226 (16.2)	445 (11.4)

25–44	–	1898 (42.9)	533 (28.2)	303 (41.5)	4307 (56.8)	1804 (46.4)

45–64	–	1257 (28.4)	721 (38.1)	318 (43.6)	1701 (22.4)	1140 (29.3)

≥ 65	–	475 (10.7)	432 (22.8)	34 (4.6)	325 (4.3)	464 (11.9)

Missing	–	0 (0.0)	1 (0.05)	3 (0.4)	5 (0.1)	0 (0.0)

Sex

Male	–	2461 (55.7)	910 (48.1)	474 (64.9)	4610 (60.8)	1881 (48.4)

Female	–	1958 (44.3)	982 (51.9)	256 (35.1)	2965 (39.1)	2005 (51.6)

Not identified	–	1 (0.02)	1 (0.05)	0 (0.0)	0 (0.0)	0 (0.0)

Income quintile

1 (lowest)	384 (43.5)	1283 (29.0)	562 (29.7)	251 (34.4)	2214 (29.2)	1456 (37.5)

2	176 (20.0)	806 (18.2)	364 (19.2)	148 (20.3)	1381 (18.2)	692 (17.8)

3	135 (15.3)	790 (17.9)	350 (18.5)	109 (14.9)	1653 (21.8)	634 (16.3)

4	103 (11.7)	728 (16.5)	335 (17.7)	102 (14.0)	1021 (13.5)	572 (14.7)

5 (highest)	64 (7.2)	480 (10.8)	208 (11.0)	74 (10.1)	638 (8.4)	384 (9.9)

Undetermined^*	20 (2.3)	333 (7.5)	74 (3.9)	46 (6.3)	668 (8.8)	148 (3.8)

↵* Owing to missing postal code, invalid postal code or suppressed dissemination area information.

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Table 2:

Prevalence ratios, potential rate reductions and cases attributable to socioeconomic inequality of neonatal abstinence syndrome and opioid poisoning and nonpoisoning emergency department visits and hospital admissions in 2016, and opioid-related deaths in 2015

Indicator	PR (95% CI)	PRR, % (95% CI)	Attributable cases (95% CI)
Neonatal abstinence syndrome	3.70 (2.62–5.23)	49.9 (36.7–60.5)	440.1 (324.0–533.7)
Opioid poisoning
Emergency department visit	2.36 (2.15–2.58)	34.8 (29.1–40.1)	1538.9 (1287.8–1772.4)
Hospital admission	2.38 (2.07–2.73)	36.5 (28.0–44.2)	691.6 (529.2–836.9)
Death	2.99 (2.25–3.97)	40.0 (25.8–51.7)	291.7 (188.1–377.5)
Nonpoisoning events
Emergency department visit	3.06 (2.77–3.38)	48.7 (44.8–52.4)	3691.6 (3394.9–3969.3)
Hospital admission	3.34 (2.92–3.83)	43.0 (37.4–48.2)	1670.4 (1451.5–1871.7)