County-Level Economic Changes and Drug Mortality in the United States: Evidence from the Great Recession.

We aimed at examining whether county-level economic changes were associated with changes in county-level drug mortality rates since the Great Recession and whether the association is equally distributed across major sociodemographic subgroups. Using the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (2004-2019), combined with census data, we conducted fixed effects analyses by including county-level economic changes as primary exposures and county-level drug-related mortality rates (per 100,000 people) from 2004-2007 (i.e., prior to the recession) to 2008-2011, 2012-2015, and 2016-2019 as an outcome variable based on 1833 counties. Our findings showed that drug mortality rates increased from 13.9 (2004-2007) to 16.0 (2008-2011), 18.0 (2012-2015), and 23.0 (2016-2019). Counties experiencing smaller median household income growth during and/or after the recession were associated with greater increase in drug mortality than counties experiencing larger median household income growth among the total population and all sociodemographic subgroups. Counties experiencing larger increases in unemployment rates and percentage of vacant housing units were associated with greater increase in drug mortality than counties experiencing smaller or no increase in unemployment rates and percentage of vacant housing units among certain sociodemographic subgroups. Findings suggest the importance of local economic contexts in understanding drug mortality risk since the recession. Drug overdose prevention polices need to be formulated by taking local economic changes following a major recession into consideration.