Factor Models

The opioid epidemic is really the opioid syndemic. A syndemic is when multiple epidemics interact synergystically withing specific social, temporal, and geographic contexts. In the case of opioid misuse, the syndemic is formed by epidemics of opioid use disorder, overdose, hepatitis C, and HIV. We know that each epidemic is driven by opioid misuse, but we are unable to measure opioid misuse at the population level. However, this assumed structure lends itself to spatial factor modeling. We have been working on developing and applying dynamic spatial factor models to estimate the common underlying drivers and synergy of the epidemics. Doing so helps us to understand sources of shared variation and uncorrelated heterogeneity and can help to identify areas of interest for public health interventions and investigations.

Selected Publications

Kline D, Hepler S, Bonny A, McKnight E. A joint spatial model of opioid-associated deaths and treatment admissions in Ohio. Annals of Epidemiology. 2019;33:19-23. doi:10.1016/j.annepidem.2019.02.004
Hepler S, McKnight E, Bonny A, Kline D. A Latent Spatial Factor Approach for Synthesizing Opioid-Associated Deaths and Treatment Admissions in Ohio Counties. Epidemiology. 2019;30(3):365-370. doi:10.1097/EDE.0000000000000978
Kline D, Ji Y, Hepler S. A multivariate spatio-temporal model of the opioid epidemic in Ohio: a factor model approach. Health Serv Outcomes Res Method. 2021;21(1):42-53. doi:10.1007/s10742-020-00227-3
Kline D, Hepler SA. Estimating the burden of the opioid epidemic for adults and adolescents in Ohio counties. Biometrics. 2021;77(2):765-775. doi:10.1111/biom.13295
Kline D, Waller LA, McKnight E, Bonny A, Miller WC, Hepler SA. A Dynamic Spatial Factor Model to Describe the Opioid Syndemic in Ohio. Epidemiology. 2023;34(4):487. doi:10.1097/EDE.0000000000001617
Murphy E, Kline D, Egan KL, Lancaster KE, Miller WC, Waller LA, Hepler SA. Understanding the opioid syndemic in North Carolina: A novel approach to modeling and identifying factors. Biostatistics. 2025;26(1):kxae052. doi:10.1093/biostatistics/kxae052
Murphy E, Kline D, McKnight E, Bonny A, Miller WC, Waller L, Hepler SA. Integrating data at multiple spatial scales to estimate the local burden of the opioid syndemic. Spatial and Spatio-temporal Epidemiology. Published online April 2025:100720. doi:10.1016/j.sste.2025.100720
Murphy E, Kline D, Hepler SA. The rold of spatially varying loadings in dynamic spatial factor models for modeling the opioid syndemic. Health Services and Outcomes Research Methodology. 2025. (in press)

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