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Incarceration, economic hardship tied to drug-related deaths

Data published in The Lancet Public Health revealed that lower household income and high incarceration rates were strongly associated with mortality from drug use disorders.

“More than half a million drug-related deaths have occurred in the USA in the past three and half decades, however, no studies have investigated the association between these deaths and the expansion of the incarcerated population, which began in the mid-1970s,” Elias Nosrati, PhD, from the University of Oxford, England, and colleagues wrote.

At the county level, researchers evaluated the connections between economic hardship, incarceration rates and age-standardized mortality from drug use disorders in their observational analysis.

Nosrati and colleagues examined mortality data from the U.S. National Vital Statistics System and the Institute for Health Metrics and Evaluation, household income data from the U.S. Census Bureau and county-level incarceration data from the Vera Institute of Justice for more than 2,600 U.S. counties between 1983 and 2014. They also assessed data on county-level control variables from the U.S. Census Bureau, the National Center for Health Statistics and the CDC.

The investigators found that an increase of 1 standard deviation (SD) in admissions rates to local jail (mean 7,018 per 100,000 population) and prison (mean 254.6 per 100,000 population) was linked to a 1.5% (95% CI, 1-2) and 2.6% (95% CI, 2.1–3.1) increased rate of drug-related deaths, respectively. Furthermore, each 1 standard deviation (SD) drop in median household income was linked to an 12.8% increase (95% CI, 11-14·6) in drug-related deaths.

The findings showed that high rates of incarceration were tied to a more than 50% rise in drug-related mortality between counties. Also, the connections between drug-related death, income and incarceration remained even after controlling for local opioid prescription rates, according to the results.

“The rapid expansion of the prison and jail population over the past few decades might have made a substantial contribution to the increasing number of deaths from drug use disorders,” Nosrati and colleagues wrote. “Future research and policy should focus on the impacts of incarceration, or more broadly, of punitive social policy, on population health.”

The findings have important public health–related implications, but further research is needed; for example, future studies should examine the effects arrest and sentencing policies and racial/ethnic biases in incarceration have on drug-related mortality, James LePage, PhD, of the VA North Texas Health Care System, wrote in a related commentary. – by Savannah Demko

Disclosure: The authors and LePage report no relevant financial disclosures.