Racial and Ethnic Minority Population, Unemployment Linked to COVID-19, Opioid Overdose Mortality

Investigators sought to identify social determinants of health for rural and urban US counties with high COVID-19 and opioid overdose mortality rates.

COVID-19 mortality risk and opioid overdoses were more common in rural American counties with high proportions of racial and ethnic minorities and urban American counties with high unemployment rates. The study findings were published in the Journal of Addiction Medicine.

Researchers from the University of California, Los Angeles, evaluated counties in the United States (US) for COVID-19-related mortality between January and May 2020 and opioid overdose mortality between 2014 and 2018. Counties were subdivided into rural (n=1976) and urban (n=1166) locations and assessed for features associated with mortality risks.

For the COVID-19 regression analysis, significant factors for rural counties included population, ethnicity, and socioeconomic characteristics; for urban counties, population density, ethnicity, age, education levels, and socioeconomic and health care characteristics.

For the opioid regression analysis, significant factors included ethnicity, gender, age, socioeconomic and health care characteristics for both rural and urban counties.

In rural counties, risk for COVID-19-related and opioid overdose mortality was associated with 2 or more races (adjusted odds ratio [aOR], 1.34; 95% CI, 1.13-1.60; P <.001), population (aOR, 1.17; 95% CI, 1.03-1.33; P <.05), population aged 65 years or older (aOR, 1.12; 95% CI, 1.02-1.23; P <.05), American Indian or Alaskan Native population (aOR, 1.07; 95% CI, 1.02-1.13; P <.01), and Black population (aOR, 1.04; 95% CI, 1.01-1.07; P <.05).

For urban counties, risk was associated with the proportion of unemployed individuals (aOR, 1.23; 95% CI, 1.07-1.41; P <.01) and population density (aOR, 1.12; 95% CI, 1.04-1.22; P <.01). COVID-19-related and opioid overdose mortality risk was decreased in counties populated by Native Hawaiian or Pacific Islanders (aOR, 0.00; 95% CI, 0.00-0.10; P <.05) and other races (aOR, 95% CI, 0.03-0.90; P <.05).

Study limitations included using county-wide data and not accounting for in-county variation.

The study found that ethnic diversity in counties and unemployment rates were upstream factors contributing to mortality in rural and urban counties in the US.

“Society needs to consider that the unintended consequences of strategies to reduce COVID-19 impacts may further exacerbate the opioid overdose crisis through increased social and economic marginalization,” the study authors noted. “The study findings could encourage policymakers and program leaders to take geographic needs into consideration when developing practical responses to combat these public health crises.”

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Zhu Y, Fei Z, Mooney LJ, Huang K, Hser Y-I. Social determinants of mortality of COVID-19 and opioid overdose in American rural and urban counties. J Addict Med. 2022;16(1):e52-e55. doi:10.1097/ADM.0000000000000834