A new study published in the American Journal of Preventive Medicine looks into county-level differences in drug-related mortality rates across the United States and finds a range of socioeconomic factors that influence them, including family distress and a county's main source of income.
The Centers for Disease Control and Prevention (CDC) say that 515,060 people in the United States died from a drug overdose and "other drug-related causes" in 2006–2015. Over 42 percent of these involved opioids.
Drug-related mortality rates
Although well-documented, the differences in drug-related deaths between counties were unexplored until now.
It was also unknown to what extent socioeconomic factors and access to healthcare environments contributed to such county-level differences.
So, Shannon M. Monnat, Ph.D. — an associate professor of sociology and Lerner Chair for Public Health Promotion at Syracuse University in New York — set out to study the data from various national databases to better understand what drives county-level differences in drug-related deaths.
Studying county-level differences
Prof. Monnat examined data gathered from: the CDC's Multiple-Cause of Death Files in 2006–2015; the U.S. Census Bureau; the U.S. Department of Agriculture Economic Research Service; the Agency for Healthcare Research and Quality; and the Northeast Regional Center for Rural Development.
She modeled the correlations between mortality rates at county level and "social determinants of health" as defined by the World Health Organization (WHO).
"Social determinants of health are the structural conditions in which populations live, work, and socialize that influence stress, relationships, health behaviors, and mortality, including economic resources, the social environment, and the healthcare infrastructure," Prof. Monnat explains.
The analysis found that, on average, the county-level drug-related mortality rate was 16.6 per 100,000 people. However, there were large disparities from county to county.
Specifically, Appalachia, Oklahoma, parts of the Southwest, and northern California had the highest drug-related mortality rates, whereas the Northeast, the Black Belt, Texas, and the Great Plains had the lowest.
Additionally, the analysis found that higher "economic and family distress" correlated with higher drug mortality rates.
Counties that had the highest level of family distress — or with the highest number of monoparental families or with families that experienced divorce or separation — had at least eight additional drug deaths per 100,000 people, on average, compared with counties with the lowest level of family distress.
By contrast, "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."
The healthcare infrastructure did not have any impact on drug mortality variability, and neither did the difference between rural and urban environments.
'Addiction is also a social disease'
Prof. Monnat also comments on the sociopolitical significance of the findings. "The drug epidemic is a pressing concern among policymakers [...] The media portrayal of the drug overdose epidemic has largely been that it is a national crisis."
"However, drug deaths are not randomly distributed across the U.S.," she notes. "My analyses show that some places in the U.S. have much higher drug mortality rates than others."
"We need to get real with ourselves about the U.S. drug problem," Prof. Monnat adds. "Opioids are a symptom of much larger social and economic problems. Just as other chronic diseases have underlying social determinants, addiction is also a social disease."
" 'Addiction does not discriminate' is a soundbite that ignores the reality that overdose rates are highest in economically distressed communities, particularly places that have experienced declines in job opportunities for people without a college degree."
Prof. Shannon M. Monnat
"Addressing economic and social conditions will be key to reversing the rising tide of drug deaths."