Elias Nosrati1, Jacob Kang-Brown2, Michael Ash3, Martin McKee4, Michael Marmot5, Lawrence P King3. 1. Merton College, University of Oxford, Oxford, UK. Electronic address: elias.nosrati@merton.ox.ac.uk. 2. Vera Institute of Justice, New York, NY, USA. 3. Department of Economics, University of Massachusetts, Amherst, MA, USA. 4. London School of Hygiene & Tropical Medicine, London, UK. 5. Department for Epidemiology and Public Health, Institute of Health Equity, University College London, London, UK.
Abstract
BACKGROUND: Drug use disorders are an increasing cause of disability and early death in the USA, with substantial geographical variation. We aimed to investigate the associations between economic decline, incarceration rates, and age-standardised mortality from drug use disorders at the county level in the USA. METHODS: In this observational analysis, we examined age-standardised mortality data from the US National Vital Statistics System and the Institute for Health Metrics and Evaluation, household income data from the US Census Bureau, and county-level jail and prison incarceration data from the Vera Institute of Justice for 2640 US counties between 1983 and 2014. We also extracted data on county-level control variables from the US Census Bureau, the National Center for Health Statistics, and the US Centers for Disease Control and Prevention. We used a two-way fixed-effects panel regression to examine the association between reduced household income, incarceration, and mortality from drug use disorders within counties over time. To assess between-county variation, we used coarsened exact matching and a simulation-based modelling approach. FINDINGS: After adjusting for key confounders, each 1 SD decrease in median household income was associated with an increase of 12·8% (95% CI 11·0-14·6; p<0·0001) in drug-related deaths within counties. Each 1 SD increase in jail and prison incarceration rates was associated with an increase of 1·5% (95% CI 1·0-2·0; p<0·0001) and 2·6% (2·1-3·1; p<0·0001) in drug-related mortality, respectively. The association between drug-related mortality and income and incarceration persisted after controlling for local opioid prescription rates. Our model accounts for a large proportion of within-county variation in mortality from drug use disorders (R2=0·975). Between counties, high rates of incarceration were associated with a more than 50% increase in drug-related deaths. INTERPRETATION: Reduced household income and high incarceration rates are associated with poor health. The rapid expansion of the prison and jail population in the USA over the past four decades might have contributed to the increasing number of deaths from drug use disorders. FUNDING: None.
BACKGROUND:Drug use disorders are an increasing cause of disability and early death in the USA, with substantial geographical variation. We aimed to investigate the associations between economic decline, incarceration rates, and age-standardised mortality from drug use disorders at the county level in the USA. METHODS: In this observational analysis, we examined age-standardised mortality data from the US National Vital Statistics System and the Institute for Health Metrics and Evaluation, household income data from the US Census Bureau, and county-level jail and prison incarceration data from the Vera Institute of Justice for 2640 US counties between 1983 and 2014. We also extracted data on county-level control variables from the US Census Bureau, the National Center for Health Statistics, and the US Centers for Disease Control and Prevention. We used a two-way fixed-effects panel regression to examine the association between reduced household income, incarceration, and mortality from drug use disorders within counties over time. To assess between-county variation, we used coarsened exact matching and a simulation-based modelling approach. FINDINGS: After adjusting for key confounders, each 1 SD decrease in median household income was associated with an increase of 12·8% (95% CI 11·0-14·6; p<0·0001) in drug-related deaths within counties. Each 1 SD increase in jail and prison incarceration rates was associated with an increase of 1·5% (95% CI 1·0-2·0; p<0·0001) and 2·6% (2·1-3·1; p<0·0001) in drug-related mortality, respectively. The association between drug-related mortality and income and incarceration persisted after controlling for local opioid prescription rates. Our model accounts for a large proportion of within-county variation in mortality from drug use disorders (R2=0·975). Between counties, high rates of incarceration were associated with a more than 50% increase in drug-related deaths. INTERPRETATION: Reduced household income and high incarceration rates are associated with poor health. The rapid expansion of the prison and jail population in the USA over the past four decades might have contributed to the increasing number of deaths from drug use disorders. FUNDING: None.
Authors: Sandhya Kajeepeta; Caroline G Rutherford; Katherine M Keyes; Abdulrahman M El-Sayed; Seth J Prins Journal: Am J Public Health Date: 2020-01 Impact factor: 9.308
Authors: Carlos Blanco; Mir M Ali; Aaron Beswick; Karen Drexler; Cheri Hoffman; Christopher M Jones; Tisha R A Wiley; Allan Coukell Journal: NAM Perspect Date: 2020-10-26
Authors: Eric Tatara; John Schneider; Madeline Quasebarth; Nicholson Collier; Harold Pollack; Basmattee Boodram; Sam Friedman; Elizabeth Salisbury-Afshar; Mary Ellen Mackesy-Amiti; Jonathan Ozik Journal: IEEE Int Symp Parallel Distrib Process Workshops Phd Forum Date: 2021-06-24
Authors: Patrick Sean Sullivan; Heather M Bradley; Carlos Del Rio; Eli S Rosenberg Journal: Infect Dis Clin North Am Date: 2020-09 Impact factor: 5.982
Authors: Magdalena Cerdá; Noa Krawczyk; Leah Hamilton; Kara E Rudolph; Samuel R Friedman; Katherine M Keyes Journal: Annu Rev Public Health Date: 2021-11-30 Impact factor: 21.981
Authors: Sandhya Kajeepeta; Pia M Mauro; Katherine M Keyes; Abdulrahman M El-Sayed; Caroline G Rutherford; Seth J Prins Journal: Lancet Public Health Date: 2021-02-23
Authors: Niloofar Ramezani; Alex J Breno; Benjamin J Mackey; Jill Viglione; Alison Evans Cuellar; Jennifer E Johnson; Faye S Taxman Journal: BMC Health Serv Res Date: 2022-07-29 Impact factor: 2.908
Authors: Kara E Rudolph; Elizabeth N Kinnard; Ariadne Rivera Aguirre; Dana E Goin; Jonathan Feelemyer; David Fink; Magdalena Cerda Journal: Epidemiology Date: 2020-07 Impact factor: 4.860