Rurality, Economic Dislocation, and Opioid Mortality Rates in the U.S.

Rural communities in the U.S. are facing emerging challenges reflected in the opioid crisis. CDC data show that since 1999, the age-adjusted opioid-related mortality rate increased by 185% in metro areas, 693% in micropolitan... [ view full abstract ]

Rural communities in the U.S. are facing emerging challenges reflected in the opioid crisis. CDC data show that since 1999, the age-adjusted opioid-related mortality rate increased by 185% in metro areas, 693% in micropolitan areas, and 725% in noncore/rural areas (see Figure 1). Although there have been numerous population-based studies on the opioid epidemic in recent years, national studies obscure what is happening in rural America. Rates of opioid-related mortality are high in some very rural states like Maine, Kentucky, and West Virginia, but rates are among the lowest in other rural states, including Iowa and Nebraska (see Figure 2). Trends in rural economic decline are implicated in and affected by geographic variation in the opioid mortality surge, but empirical research remains far too limited to inform policy and guide community development initiatives. Accordingly, we link conceptual frameworks from the rural sociology economic and farm restructuring literatures with those from the criminology social and physical disorganization literatures to test the general hypothesis that economic restructuring contributed to greater social disorganization, which in turn has driven geographic variation in opioid-related mortality rates. By examining both current economic distress and economic/labor market change, the analyses distinguish between the roles of absolute and relative economic conditions on opioid mortality rates along the rural-urban continuum and between types of rural labor markets. This will help us tease out whether spatial differences in persistent/enduring economic distress, declines in economic conditions relative to previous decades, or both are driving county-level differences in opioid mortality rates. Analyses draw data from county-level mortality rates (1999-2016) and U.S. Census economic and demographic variables and other county-level social indicators including opiate prescribing patterns. Bivariate analysis, exploratory spatial data analysis, and multivariate spatial regression models are used to test hypotheses.