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Background  Understanding relationships between individual-level demographic, socioeconomic status (SES) and U.S. opioid fatalities can inform interventions in response to this crisis.    Methods  The Mortality Disparities in American Community Study (MDAC) links nearly 4 million 2008 American Community Survey responses to the 2008–2015 National Death Index. Univariate and multivariable models were used to estimate opioid overdose fatality hazard ratios (HR) and 95% confidence intervals (CI).    Results  Opioid overdose was an overrepresented cause of death among people 10 to 59 years of age. In multivariable analysis, compared to Hispanics, Whites and American Indians/Alaska Natives had elevated risk (HR = 2.52, CI:2.21–2.88) and (HR = 1.88, CI:1.35–2.62), respectively. Compared to women, men were at-risk (HR = 1.61, CI:1.50–1.72). People who were disabled were at higher risk than those who were not (HR = 2.80, CI:2.59–3.03). Risk was higher among widowed than married (HR = 2.44, CI:2.03–2.95) and unemployed than employed individuals (HR = 2.46, CI:2.17–2.79). Compared to adults with graduate degrees, those with high school only were at-risk (HR = 2.48, CI:2.00–3.06). Citizens were more likely than noncitizens to die from this cause (HR = 4.62, CI:3.48–6.14). Compared to people who owned homes with mortgages, those who rented had higher HRs (HR = 1.36, CI:1.25–1.48). Non-rural residents had higher risk than rural residents (HR = 1.46, CI:1.34, 1.59). Compared to respective referent groups, people without health insurance (HR = 1.30, CI:1.20–1.41) and people who were incarcerated were more likely to die from opioid overdoses (HR = 2.70, CI:1.91–3.81). Compared to people living in households at least five-times above the poverty line, people who lived in poverty were more likely to die from this cause (HR = 1.36, CI:1.20–1.54). Compared to people living in West North Central states, HRs were highest among those in South Atlantic (HR = 1.29, CI:1.11, 1.50) and Mountain states (HR = 1.58, CI:1.33, 1.88).    Discussion  Opioid fatality was associated with indicators of low SES. The findings may help to target prevention, treatment and rehabilitation efforts to vulnerable groups.

plos one

Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the Mortality Disparities in American Communities Study (MDAC)