Urban–Rural Disparities in Deaths of Despair: A County-Level Analysis 2004–2016 in the U.S

The purpose of this study is to examine nationwide disparities in drug, alcohol, and suicide mortality; evaluate the association between county-level characteristics and these mortality rates; and illustrate spatial patterns of mortality risk to identify areas with elevated risk. The authors applied a Bayesian spatial regression technique to investigate the association between U.S. county-level characteristics and drug, alcohol, and suicide mortality rates for 2004–2016, accounting for spatial correlation that occurs among counties. Mortality risks from drug, alcohol, and suicide were positively associated with the degree of rurality, the proportion of vacant housing units, the population with a disability, the unemployed population, the population with low access to grocery stores, and the population with no health insurance. Conversely, risks were negatively associated with Hispanic population, non-Hispanic Black population, and population with a bachelor's degree or higher. Spatial disparities in drug, alcohol, and suicide mortality exist at the county level across the U.S. social determinants of health; educational attainment, degree of rurality, ethnicity, disability, unemployment, and health insurance status are important factors associated with these mortality rates. A comprehensive strategy that includes downstream interventions providing equitable access to healthcare services and upstream efforts in addressing socioeconomic conditions is warranted to effectively reduce these mortality burdens.