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Alcohol use disorder (AUD) is increasingly becoming a widespread concern. The World Health Organization (WHO) reports nearly 3 million deaths occurring each year due to problematic alcohol use. Unfortunately, there are disproportionate number of rural populations being impacted. Rural areas have unique challenges that urban areas do not face. This includes having lack of transportation, lack of anonymity in the community, as well as lack of available services. To mitigate these challenges, Geographical Information Systems (GIS) is being used to create geographically targeted health interventions. Currently, GIS is being used in moderating physical illness, including HIV, cancer, and diabetes. In community health, investigation of health disparity issues is also being monitored using GIS.
Methods:
We used the Alabama Medicaid administrative claims data from all 67 counties in Alabama. Starting from January 1, 2015, to December 31, 2020, we identified Medicaid recipients with AUD. 100% of the claims from 2015 – 2020 were included. All data were managed by using the ESERI ArcGIS software program. By using the rural-urban continuum codes (RUCC) designated by the United States Department of Agriculture (USDA), counties with 1-3 as RUCCs were coded as urban and counties with 4-9 RUCCs were coded as rural. Geographical hotspots were created to calculate the relative rate of AUD claims between counties.
Results:
Among all 67 counties in Alabama, a total of 38 counties were counted as rural. Sixty-four counties reported an increase in AUD rate from 2015-2020, while 13 counties reported larger than 50% increase from 2015-2020. These growths are applicable in both urban and rural areas. However, when the data was examined, hotspots were more frequently observed in rural areas. In addition, when looking at the past five years, the growth in rural areas were faster than the urban areas. Our result is consistent with the existing literature, as higher level of drinking is often associated with rurality. Consequently, rurality is the highest predictor of drinking, compared to other factors, including race.
Conclusions and Implications:
As there is an increase in AUD rate in rural areas, there is a need to better understand and support these individuals to prevent further increase in AUD rates. By using the GIS technology to provide geographically targeted interventions, the goal will be to provide services that can overcome the barriers that rural populations face.