Macro-Level Sources of Illegal Drug Overdose Deaths across U.S. Communities

University Of Cincinnati Main Campus, Cincinnati OH

Investigators

Abstract

Between 1999 and 2016, the United States experienced a three-fold increase in illegal drug overdose deaths, with many communities facing epidemic levels of overdoses. As a result, overdose deaths now claim three to four times more American lives each year than homicide and more deaths annually than the AIDS epidemic did at its peak. Although the drug overdose crisis has affected people across all locations and walks of life, research shows that this illegal drug epidemic is concentrated in some communities and demographic groups but not others. Little research has been conducted, however, on why some places and populations are more vulnerable to experiencing drug overdoses. In addition, little is known about whether the community sources of fatal drug overdoses are the same as those that shape homicide and suicide rates. This project will address these questions by identifying the community characteristics that contribute to drug overdose death concentrations across locales, time, and demographic groups, both alone and compared to the community sources of homicide and suicide. In so doing, this project provides one of the most comprehensive, nationwide analyses examining the community-level sources of drug overdose deaths to date. It also will equip researchers and policy makers with information that can be used to combat the drug overdose epidemic by targeting community-level conditions for intervention and assisting those places and groups that are most susceptible to drug overdose concentrations. This project will compile a unique database using approximately 25 years of nationally-representative mortality data on overdose deaths, homicides, and suicides drawn from the Center for Disease Control Restricted-Access Multiple Cause of Death Mortality data from 1990 to 2016. These data will be aggregated and combined with measures of community social, economic, and health indicators drawn from multiple databases including: the U.S. Census Bureau, Center for Disease Control prescription data, and Institute for Health Metrics and Evaluation community health data. Using fixed effects change-score models, these combined data will be used to identify the community sources of overdose death rates across: (1) aggregate study units (e.g., county, metropolitan areas); (2) time (1990-2016); (3) substance type (heroin, natural and semi-synthetic opioids, synthetic opioids, cocaine, psychostimulants); and (4) demographic groups (race/ethnicity, age, gender). These analyses will be replicated for both homicide and suicide to identify whether the community-level determinants of death are unique for each form of mortality, or whether there are common factors that similarly predict overdose, homicide, and suicide death rates. Hybrid time series models will also be used to address limitations of fixed effects modeling. Findings from this project will contribute to greater understanding of ecological theories of crime by testing relevant hypotheses using dependent variables reflecting drug overdose, homicide, and suicide rates, which include outcomes previously understudied within this theoretical framework. This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.