title: Temporal and geographic shifts in urban and nonurban cocaine-related fatal overdoses in British Columbia, Canada.
abstract: OBJECTIVE
  Illicit drug overdose is a leading cause of premature mortality. We sought to examine fatal overdose trends from 2001 to 2005 in urban and nonurban areas of British Columbia, Canada.
  
  
  METHODS
  We conducted a review of all provincial coroner files in which drug overdose was the cause of death between January 1, 2001, and December 31, 2005. We compared cocaine and non-cocaine-related overdoses and examined temporal changes in cocaine-related mortality rates in urban and nonurban areas. Multilevel mixed effects models were used to determine the independent risk factors for cocaine-related death. Spatial analyses were conducted to identify clusters of these cases.
  
  
  RESULTS
  During the study period, 904 illicit drug overdoses were recorded, including 369 (40.8%) in nonurban areas and 532 (58.9%) related to cocaine consumption. In a multilevel model, we observed a significant interaction (p = .010) between population density and year, indicating a considerable and differential increase in the likelihood of cocaine-related deaths in nonurban areas. Cocaine-related deaths were clustered in the southeast region of the province.
  
  
  CONCLUSIONS
  Cocaine-related overdoses in nonurban areas should be a public health concern. Evidence-based interventions to reduce the risks associated with cocaine consumption and reach drug users in nonurban settings are needed.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Brandon D L
authors.initials: BD
authors.lastname: Marshall
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
mesh_terms: D000328:Adult; D001955:British Columbia / Q000453:epidemiology / Q000208:ethnology; D002423:Cause of Death / Q000639:trends; D019970:Cocaine-Related Disorders / Q000208:ethnology / Q000401:mortality*; D062787:Drug Overdose / Q000401:mortality*; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012042:Registries; D012423:Rural Health / Q000639:trends; D013029:Space-Time Clustering; D018881:Suburban Health / Q000639:trends; D014504:Urban Health / Q000639:trends