Identifying Counties at Higher Risk for Mortality from COVID-19 and Opioid Overdose

July 2022
CTN Dissemination Library

Key points:

• COVID-19 may have worsened the opioid crisis as protective health measures increased isolation and reduced access to care.
• Knowing which populations are at higher risk from a public health crisis could help policymakers better tailor protective responses.
• This study looked at social determinants of health to identify what factors might make a county high-risk for deaths from COVID-19 and opioid overdose.
• Rural counties with high proportions of racial/ethnic minorities and urban counties with high unemployment rates were found to be the most at-risk for both COVID-19 and opioid-related deaths.

The U.S. is still combatting both the COVID-19 pandemic and the opioid crisis, and COVID-19 seems to have contributed to an increase in fatal overdoses, possibly due to pandemic-related health policies like shelter-in-place, which pushed people into isolation and reduced access to care. 

Though federal and state policies made quick adjustments to try to allow for easier access to medication treatment for opioid use disorder, socio-economic conditions and healthcare infrastructure are often slower to change.

Knowing which populations are at higher risk for death from a pandemic illness and opioid overdoses could help policymakers and program leaders better tailor responses to current and future public health crises. 

Examining social determinants of health, conditions in the environment that impact people’s health risks and outcomes, might be one useful way to try to determine what factors make a population more vulnerable to death from COVID-19 and opioids. 

Researchers in this study looked at rural and urban county-level data on COVID-19 mortality from January 1 to May 31, 2020, and at opioid overdose mortality during 2014-2018. They identified “high-risk counties” – those that had high mortality rates for both COVID-19 and opioid overdose – and then examined social determinants of health associated with those counties.

They found that deaths from COVID-19 were higher in rural and urban counties with larger population size, a higher proportion of racial/ethnic minorities, and a higher median household income (possibly due to international and vacation travel early in the pandemic).

Deaths from opioid overdose, on the other hand, were higher in rural and urban counties with lower proportions of racial/ethnic minorities, as well as a higher proportion of females and lower median household income.

Rural counties with high mortality rates for both COVID-19 and opioid overdose had higher proportions of Black people, American Indians and Alaska Natives, and people of two or more races. High-risk urban counties had larger population density and higher unemployment rates during the COVID-19 pandemic.

Conclusions: Rural counties with high proportions of racial/ethnic minorities and urban counties with high unemployment rates are at high mortality risk for COVID-19 and opioid overdose. It’s important that policy- and other decision-makers take social and economic factors like these into consideration when developing strategies to combat one public health crisis so they don’t accidentally exacerbate the effects of another.