Social determinants of mortality of COVID-19 and opioid overdose in American rural and urban counties.

Both COVID-19 deaths and opioid overdose deaths continue to increase in the United States. Little is known about the characteristics of counties with high rates of mortality for both.

In this study supported by the CTN Greater Southern California Node, researchers analyzed county-level data on COVID-19 mortality from January 1 to May 31, 2020, and on opioid overdose mortality during 2014-2018. The outcome variable, “high-risk county” was a binary indicator of high mortality rates (above 75% quartile) for both COVID-19 and opioid overdose. Geospatial logistic regression models were conducted separately for urban and rural counties to identify social determinants of health associated with being a high-risk county.

After adjusting for other covariates, researchers found that the overall mortality rate of COVID-19 is higher in counties with larger population size and a higher proportion of racial/ethnic minorities, although counties with high rates of opioid overdose mortality have lower proportions of racial/ethnic minorities, a higher proportion of females, and are more economically disadvantaged. Significant predictors of rural counties with high mortality rates for both COVID-19 and opioid overdose include higher proportions of Blacks (Adjusted odds ratio [aOR], 1.04; 95%CI, 1.01-1.07), American Indians and Alaska Natives (aOR, 1.07; 95%CI, 1.02-1.13), and two or more races (aOR, 1.34; 95%CI, 1.13-1.60). Additional predictors for high-risk urban counties include population density (aOR, 1.12; 95%CI, 1.04-1.22) and higher unemployment rates during the COVID-19 pandemic (aOR, 1.23; 95%CI, 1.07-1.41).

Conclusions: Rural counties with high proportions of racial/ethnic minorities and urban counties with high unemployment rates are at high mortality risk for COVID-19 and opioid overdose.