Community Economic Changes and Drug Mortality in the United States: Evidence from the Great Recession

Background/Purpose: The Great Recession is one of the most extensive economic downturns with lasting impact on many communities in U.S. history. Evidence suggests that the communities, hit hardest by employment and housing crisis, are at greater risks of drug mortality, also known as “the disease of despair.” Reductions in tax revenues limit the availability of substance misuse prevention funding. Also, adverse economic conditions disrupt social cohesion and support within communities, raising drug mortality risks. Despite the extant literature, less is clear about how differential magnitudes of economic impacts have lasting impacts on drug mortality at the county-level. Therefore, we examine how county-level economic changes since the Great Recession have affected drug mortality trajectories and whether these effects are equally distributed across sociodemographic subgroups.

Methods: The Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (2003-2019), combined with the Census data, provided data for 1,865 counties on drug-related mortality rates (per 100,000 people) and economic changes since the late 2000s when the recession occurred. We pooled data for 4-year periods to minimize suppression of data intended for privacy protection. Our independent variables are the changes in two county-level economic indicators (percentage of vacant housing units and unemployment rates) before and during the Recession. Using a multilevel mixed-effects binomial regression analysis, the effects of county-level economic changes on drug-related mortality were estimated while accounting for pre-recession county-level economic conditions, drug mortality, sociodemographic factors and opioid prescription rates.

Results: County-level drug mortality rates increased from 15.9% in 2008-2011 to 23.0% in 2016-2019, indicating a 44.7% increase among the total population. Since the Great Recession, the increase was particularly notable among Black (by 122.8%), Hispanic (by 81.5%), ages 15-34 (by 64.2%), and males (by 55.7%). Of county-level economic conditions, the changes in the percent of vacant housing units (IRR=1.03, 95% CI=1.01-1.06) and unemployment rates (IRR=1.05, 95% CI=1.03-1.07) were associated with higher drug mortality. That is, 1 SD increase in county-level percent of vacant housing units and unemployment rates was associated with a 3% and 5% increase in drug mortality, respectively. Also, the significant cross-level interactions between time and changes in unemployment rates imply that the counties experiencing greater increases in unemployment rates during the recession had a more rapid increase in drug mortality over time than their counterpart counties with smaller changes in unemployment rates.

Conclusions/Implications: Findings suggest that county-level economic changes since the Great Recession left long-term adverse impacts on drug mortality in disadvantaged communities. As we observe the lingering effects of the Great Recession, reinforced by the COVID-19 pandemic recession, special attention is needed for disparities in county-level economic conditions in alleviating drug mortality. In particular, better understanding perpetual effects of economic recession on community housing and labor markets can be critical to create economically viable and health-promoting communities.