Evaluating tramadol utilization and patterns by county-level social determinants of health characteristics from 2015 to 2022

BackgroundTramadol, an opioid analgesic, is liable to abuse and implicated in drug overdose deaths in the U.S. However, tramadol use and its driving factors have not been intricately examined. This study aims to evaluate the tramadol utilization trends by dosage and county, and social determinants of health (SDoH)-related factors associated with the utilization rates. MethodsThe retrospective study utilized 2015-2022 WV controlled substances monitoring program, CDC opioid dispensing rate, and County Health Ranking and Roadmaps data. Average tramadol daily dose and morphine milligram equivalent were calculated. Annual tramadol dispensing and use rate per 100 population were calculated for WV and each county. Pooled Poisson regression model was used to analyze the relationship between tramadol dispensing rate, opioid dispensing rate, and SDoH variables. ResultsTramadol dispensing rate declined by 35% (2015-2022), but varied within counties with Grant (34.10), McDowell (28.91), and Wyoming (26.67) average annual rates exceeding the overall WV rate (17.90). High tramadol dispensing rate was associated with a high percentage of the population with poor/fair health ({beta}=0.07, p=0.01), physically inactive ({beta}=0.10, p=0.0003), uninsured ({beta}=0.09, p=0.001), and elevated primary care provider (PCP) rate ({beta}=0.10, p=0.0003) and opioid dispensing rate ({beta}=0.14, p<0.0001). ConclusionOur study found heterogenous trends of tramadol dispensing rate within WV and was associated with county-wise health status, physical inactivity, insurance, PCP, and opioid dispensing rates. Considering these factors in local surveillance might improve health, and reduce disease burden, drug, and health resource utilization.