Compositional and contextual factors associated with drug overdose deaths in the United States

Abstract

Background: In 2017, the US Department of Health and Human Services declared the Opioid epidemic a public health emergency. In the US, emergency rooms treat more than 1,000 people each day for drug overdose, and 115 of them die. This study examines compositional and contextual factors associated with drug overdose deaths rates in the US. Methods: Local spatial autocorrelation statistics were used to estimate hot spot areas to identify census tracts with high risk of drug overdose death. Logistic regressions investigated the relationship between drug overdose death rates and various compositional and contextual variables across census tracks. Results: The adjusted logistic model shows that compositional variables: depression (OR = 2.47 [2.37-2.58]), poor mental health (OR = 1.71 [1.63-1.79]), median age 1.41 (1.36-1.47) and the percentage of people with a high school diploma (OR = 1.30 [1.24-1.35]) were positively associated with the rate of drug overdose deaths. On the other hand, contextual variables: the percentage having health insurance (OR = 0.66 [0.64-0.69]), the Theil's H index (OR = 0.69 [0.66-0.71]), population density (OR = 0.80 [0.77-0.84]), poverty (OR = 0.90 [0.86-0.95]), and median household income (OR = 0.91[0.86-0.96]) were negatively associated with drug overdose deaths. Discussion: The analysis reveals a consistently strong association between compositional mental health factors and census tract-level death rates from drug overdose.

Keywords: Drug overdose deaths; compositional and contextual factors; mental health; opioid; spatial regression; substance abuse.