Factors Associated With County-Level Differences in U.S. Drug-Related Mortality Rates

Abstract

Introduction: Over the past 2 decades, drug-related deaths have grown to be a major U.S. population health problem. County-level differences in drug-related mortality rates are large. The relative contributions of social determinants of health to this variation, including the economic, social, and healthcare environments, are unknown. Methods: Using data from the U.S. Centers for Disease Control and Prevention Multiple-Cause of Death Files (2006–2015, analyzed in 2017), U.S. Census Bureau, U.S. Department of Agriculture Economic Research Service, Agency for Healthcare Research and Quality, and Northeast Regional Center for Rural Development, this paper modeled associations between county-level drug-related mortality rates and economic, social, and healthcare environments. Spatial autoregressive models controlled for state fixed effects and county demographic characteristics. Results: The average county-level age-adjusted drug-related mortality rate was 16.6 deaths per 100,000 population (2006–2015), but there were substantial geographic disparities in rates. Net of state effects and demographic characteristics, average mortality rates were significantly higher in counties with greater economic and family distress and in counties economically dependent on mining. Average mortality rates were significantly lower in counties with a larger presence of religious establishments, a greater percentage of recent in-migrants, and counties with economies reliant on public (government) sector employment. Healthcare supply factors did not contribute to between-county disparities in mortality rates. Conclusions: Drug-related mortality rates are not randomly distributed across the U.S. Future research should consider the specific pathways through which economic, social, and healthcare environments are associated with drug-related mortality.

Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the Mortality Disparities in American Communities Study (MDAC)

“…In compliance with privacy protection requirements of U.S. Code Title 13, data access was obtained by submitting a research proposal form to the MDAC Steering Committee. [12] Data were accessed with Census Bureau analyst assistance rather than at a Research Data Center, the two processes available to all investigators to access the full MDAC dataset.…”

“…[10] People who are divorced or separated are also at increased risk for fatal opioid overdose. [11] Although data on SES attributes including education, income, and employment are available at the county [12] and census tract-level [13], the gold standard for analysis is use of individual-level data to examine effects of personal attributes. There is a paucity of individual-level data on prospective relationships between individuallevel SES measures and risk of fatal opioid overdose, including for critical factors such as health insurance coverage, employment and marital status, and incarceration.…”

Trends in Non‐Hispanic White Mortality in the United States by Metropolitan‐Nonmetropolitan Status and Region, 1990–2016

“…). However, these “deaths of despair” cannot fully explain the slowdown in mortality declines, since the adverse trends persist even after eliminating mortality from these causes (Squires and Blumenthal ; Monnat ; Rigg, Monnat, and Chavez ). Other causes of death are also hypothesized to be important contributors to stagnating mortality declines.…”

“…Elevated mortality from these causes of death is especially concentrated among individuals with low levels of education (see also Ho 2017;Kochanek et al 2016b). However, these "deaths of despair" cannot fully explain the slowdown in mortality declines, since the adverse trends persist even after eliminating mortality from these causes (Squires and Blumenthal 2016;Monnat 2018;Rigg, Monnat, and Chavez 2018). Other causes of death are also hypothesized to be important contributors to stagnating mortality declines.…”

Understanding Rural Social Class in an Era of Global Challenge

“…I'm talking about life and death. For example, our colleague Shannon Monnat has been at the forefront of advancing our empirical understanding of the opioid epidemic (Monnat ; Monnat and Rigg ; Rigg, Monnat, and Chavez forthcoming). On her office door, Shannon has a time series of 12 U.S. maps from the New York Times , showing the explosion of overdose deaths since 2003.…”