Lindenfeld Zoe, Mauri Amanda I, Chang Ji E
Author Affiliations: Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, New York.
J Public Health Manag Pract. 2025;31(1):20-28. doi: 10.1097/PHH.0000000000001983. Epub 2024 Sep 13.
Prior studies have examined the social determinants of health (SDOH) characteristics of counties with elevated rates of overdose deaths. However, this research often ignores variation in upstream governmental investment in these SDOH categories.
To examine the association of local governmental investments in SDOH with drug overdose mortality at the county level, controlling for demographic and socioeconomic characteristics.
Longitudinal analysis from 2017 to 2020.
United States counties.
3126 counties.
The primary study outcome was county overdose death rates per 100 000 population taken from the Centers for Disease Control and Prevention. The main predictor of interest was the per capita average of local governmental expenditures in public health, social service, and education drawn from the US Census of Governments, categorized into quartiles. Covariates included county-level socioeconomic and demographic characteristics as well as county-level SUD services from the AHRQ SDOH Database.
In longitudinal multivariate linear regression models with state and year fixed effects, counties in the highest 3 quartiles of SDOH spending had significantly lower rates of overdose deaths compared with counties in the lowest quartile of SDOH spending; in particular, counties in quartile 2 had an average of 9.09 fewer overdose deaths per 100 000 population (95% CI: -12.58, -5.60), counties in quartile 3 had an average of 13.18 fewer deaths per 100 000 population (95% CI: -17.56; -8.80), and counties in quartile 4 had an average of 13.92 deaths per 100 000 population (95% CI: -19.16, -8.68).
Our findings demonstrate that higher levels of local governmental investments in SDOH were associated with significantly lower rates of overdose death in US counties after controlling for socioeconomic and demographic characteristics. Going forward, research should focus on determining causality in this relationship, the mechanisms through which this relationship occurs, as well as assess the impact of local public health expenditures allocated toward SUD prevention and treatment specifically on substance use outcomes at the local level.
先前的研究考察了药物过量死亡发生率较高的县的健康的社会决定因素（SDOH）特征。然而，这项研究往往忽视了政府在这些SDOH类别上的上游投资差异。
在控制人口和社会经济特征的情况下，研究县级政府在SDOH方面的投资与药物过量死亡率之间的关联。
2017年至2020年的纵向分析。
美国各县。
3126个县。
主要研究结局是每10万人口中的县药物过量死亡率，数据来自疾病控制和预防中心。主要的预测指标是根据美国政府普查得出的地方政府在公共卫生、社会服务和教育方面的人均支出平均值，分为四分位数。协变量包括县级社会经济和人口特征以及来自美国医疗保健研究与质量局SDOH数据库的县级物质使用障碍服务。
在具有州和年份固定效应的纵向多变量线性回归模型中，与SDOH支出处于最低四分位数的县相比，SDOH支出处于最高3个四分位数的县的药物过量死亡率显著更低；具体而言，处于第二四分位数的县每10万人口中的药物过量死亡平均少9.09例（95%置信区间：-12.58，-5.60），处于第三四分位数的县每10万人口中的死亡平均少13.18例（95%置信区间：-17.56；-8.80），处于第四四分位数的县每10万人口中的死亡平均少13.92例（95%置信区间：-19.16，-8.68）。
我们的研究结果表明，在控制社会经济和人口特征后，地方政府在SDOH方面的较高投资水平与美国各县较低的药物过量死亡率相关。未来，研究应侧重于确定这种关系中的因果关系、这种关系发生的机制，以及评估专门用于物质使用障碍预防和治疗的地方公共卫生支出对地方层面物质使用结果的影响。
