Spatial analysis of methamphetamine and amphetamine use disorder among Alabama Medicaid recipients in rural and urban areas

Background: The current study uses geographic information system (GIS) methods to better understand structural risks significantly associated with substance misuse and how those risks may be driven by urbanicity versus rurality. Methods: Using Alabama Medicaid administrative claims data from January 1, 2015, to December 31, 2020, we identified Medicaid recipients with claims for methamphetamine use. Our dataset included 100% of claims for the 2015-2020 study period. County-level geocodes were also obtained for each Medicaid recipient aged > 18 years (n = 9,861). We added a rural-urban designation variable for each county by utilizing the rural-urban continuum codes from the United States Department of Agriculture. Results: Fifty-one counties (76.12%), specifically, had changes in methamphetamine use rates > 0% during the study period, with 10 (14.93%) counties exhibiting >100% increases in methamphetamine use rates. Findings suggest that Alabamians residing in rural portions of the state engaged in greater usage as compared with those in urban locations. Conclusion: Findings point to the need for intervention in rural Alabama targeting methamphetamine use. The development of prevention and intervention approaches that target risks stemming from geographical differences may bolster current efforts to reduce methamphetamine and other forms of substance misuse.