Social determinants of health, substance use, and drug overdose prevention

Fatal drug overdoses, now primarily driven by illicit opioids like fentanyl, continue to increase in the United States, reflecting a growing need for prevention and treatment strategies. Preventive interventions have primarily focused on curbing opioid prescribing, and treatment strategies target individuals. However, little is known about the broader social context surrounding these individuals.

This study examines the association between drug overdose mortality and social determinants of health (SDOH) across different levels of influence in the social-ecological model.

Data on drug overdose death and SDOH were collected at the county level for most mid-Atlantic states in 2019. Association between each characteristic and drug overdose mortality was measured through a bivariate analysis. Furthermore, a multivariate analysis was performed to detect risk factors of drug overdose death while adjusting for multiple comparisons. All statistical analyses were performed with SAS version 9.4.

SDOH, including violent crime (P < 0.001), access to the Internet (P < 0.001), per capita income (P < 0.001), social vulnerability index (P = 0.001), and access to health care (P < 0.001), demonstrated a statistically significant positive association with drug overdose death. In contrast, vacancy rate was negatively associated with drug overdose mortality (P < 0.001). The association between drug overdose deaths and opioid prescription rates was not statistically significant (P = 0.412).

Factors such as violent crime and social vulnerability demonstrated a statistically significant impact on drug overdose mortality. To address drug overdose crisis, health care system, community leaders, and policy makers' strategies should focus on socially vulnerable populations.