County-level predictors of US drug overdose mortality: A systematic review

Manuel Cano; Sehun Oh; Preston Osborn; Samson A Olowolaju; Armando Sanchez; Yeonwoo Kim; Alberto Cano Moreno

doi:10.1016/j.drugalcdep.2022.109714

County-level predictors of US drug overdose mortality: A systematic review

Drug Alcohol Depend. 2023 Jan 1:242:109714. doi: 10.1016/j.drugalcdep.2022.109714. Epub 2022 Nov 24.

Authors

Manuel Cano¹, Sehun Oh², Preston Osborn², Samson A Olowolaju³, Armando Sanchez⁴, Yeonwoo Kim⁵, Alberto Cano Moreno⁶

Affiliations

¹ School of Social Work, Arizona State University, USA. Electronic address: m.cano@asu.edu.
² College of Social Work, The Ohio State University, USA.
³ Department of Demography, University of Texas at San Antonio, USA.
⁴ Department of Social Work, University of Texas at San Antonio, USA.
⁵ Department of Kinesiology, University of Texas at Arlington, USA; School of Social Work, University of Texas at Arlington, USA.
⁶ Department of Public Policy, Universidad Autónoma del Estado de Hidalgo, México.

PMID: 36463764
DOI: 10.1016/j.drugalcdep.2022.109714

Abstract

Background: This systematic review summarized published literature on county-level predictors of drug overdose mortality in the United States (US).

Methods: Peer-reviewed studies and doctoral dissertations published in English between 1990 and July 19, 2022 were identified from PubMed, Web of Science, ProQuest Dissertations & Theses, PsycINFO, CINAHL, and EconLit. Eligible studies examined at least one county-level predictor of drug overdose mortality in US counties. Two reviewers independently completed screening, quality assessment (with an adapted National Institutes of Health Quality Assessment Tool), and data extraction. Results were qualitatively summarized and grouped by predictor categories.

Results: Of 56 studies included, 42.9% were subnational, and 53.6% were limited to opioid overdose. In multiple studies, measures related to opioid prescribing, illness/disability, economic distress, mining employment, incarceration, family distress, and single-parent families were positively associated with drug overdose mortality outcomes, while measures related to cannabis dispensaries, substance use treatment, social capital, and family households were negatively associated with drug overdose mortality outcomes. Both positive and negative associations were documented for smoking, uninsurance, healthcare professional shortage status, physicians per capita, unemployment, income, poverty, educational attainment, racial composition, and rurality. Findings within studies also differed by subpopulation (by race/ethnicity, gender, age, or rurality) and the type of drugs involved in overdose.

Conclusions: The findings of this review provide relatively mixed evidence regarding many county-level predictors of overdose mortality, several of which also vary between subpopulations, supporting the importance of additional research to elucidate pathways through which the county context may shape risk of fatal overdose.

Keywords: County-level; Drug overdose; Mortality; Opioid; Systematic review.

Publication types

Systematic Review
Review

MeSH terms

Analgesics, Opioid
Drug Overdose*
Ethnicity
Humans
Practice Patterns, Physicians'
Substance-Related Disorders*
United States

Substances

Analgesics, Opioid