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

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