Observational studyThe Lancet. Public health2019
Economic decline, incarceration, and mortality from drug use disorders in the USA between 1983 and 2014: an observational analysis.
Observational study in The Lancet. Public health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
19 citing papers in PubMed, 53 citations in OpenAlex.
- Multifactor Risk Stratification for Post-Transplant Alcohol Relapse Using Abstinence, Psychosocial, and Socioeconomic Factors.Annals of gastroenterological surgery · 2026Article
- Individual- and Area-Level Incarceration and Mortality.JAMA network open · 2025Article
- Association of federal poverty level with healthcare expenditures among opioids users in the United States (2008-2019): a serial cross-sectional study.International journal for equity in health · 2025Article
- Global burden of disease among adolescents and young adults with drug use disorders, 1990-2021: based on GBD 2021.Frontiers in public health · 2025Article
- Does Pain Explain Trends in Disability? An Analysis of Middle-Aged and Older U.S. Adults, 2002-2018.The journals of gerontology. Series B, Psychological sciences and social sciences · 2024Article
- The Distribution of Carceral Harm: County-Level Jail Incarceration and Mortality by Race, Sex, and Age.Demography · 2024Article
- Impact of County-level health infrastructure on participation in a reform effort to reduce the use of jail for individuals with mental health disorders.Health & justice · 2023Article
- County-Level Economic Changes and Drug Mortality in the United States: Evidence from the Great Recession.International journal of environmental research and public health · 2022Article
- The relationship between community public health, behavioral health service accessibility, and mass incarceration.BMC health services research · 2022Article
- Mortality among people who inject drugs: a prospective cohort followed over three decades in Baltimore, MD, USA.Addiction (Abingdon, England) · 2022Article
- Application of Distributed Agent-based Modeling to Investigate Opioid Use Outcomes in Justice Involved Populations.IEEE International Symposium on Parallel & Distributed Processing, Workshops and Phd Forum : [proceedings]. IEEE International Symposium on Parallel & Distributed Processing, Workshops and Phd Forum · 2021Article
- A Critical Review of the Social and Behavioral Contributions to the Overdose Epidemic.Annual review of public health · 2021Review
- Association between county jail incarceration and cause-specific county mortality in the USA, 1987-2017: a retrospective, longitudinal study.The Lancet. Public health · 2021Article
- The Geography of Opioid Use Disorder: A Data Triangulation Approach.Infectious disease clinics of North America · 2020Review
- The Relative Economy and Drug Overdose Deaths.Epidemiology (Cambridge, Mass.) · 2020Article
- Article
- County Jail Incarceration Rates and County Mortality Rates in the United States, 1987-2016.American journal of public health · 2020Article
- The American Opioid Epidemic in Special Populations: Five Examples.NAM perspectives · 2020Review
- Persistence and Pervasiveness : Early Wave Opioid Overdose Death Rates Associated With Subsequent Overdose Death Rates.Public health reports (Washington, D.C. : 1974)Article
Corrections and comments
- Commented on by
- Commented on by
Authors and funding
6 authors at 5 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDrug use disorders are an increasing cause of disability and early death in the USA, with substantial geographical variation. We aimed to investigate the associations between economic decline, incarceration rates, and age-standardised mortality from drug use disorders at the county level in the USA.
methodsIn this observational analysis, we examined age-standardised mortality data from the US National Vital Statistics System and the Institute for Health Metrics and Evaluation, household income data from the US Census Bureau, and county-level jail and prison incarceration data from the Vera Institute of Justice for 2640 US counties between 1983 and 2014. We also extracted data on county-level control variables from the US Census Bureau, the National Center for Health Statistics, and the US Centers for Disease Control and Prevention. We used a two-way fixed-effects panel regression to examine the association between reduced household income, incarceration, and mortality from drug use disorders within counties over time. To assess between-county variation, we used coarsened exact matching and a simulation-based modelling approach.
findingsAfter adjusting for key confounders, each 1 SD decrease in median household income was associated with an increase of 12·8% (95% CI 11·0-14·6; p<0·0001) in drug-related deaths within counties. Each 1 SD increase in jail and prison incarceration rates was associated with an increase of 1·5% (95% CI 1·0-2·0; p<0·0001) and 2·6% (2·1-3·1; p<0·0001) in drug-related mortality, respectively. The association between drug-related mortality and income and incarceration persisted after controlling for local opioid prescription rates. Our model accounts for a large proportion of within-county variation in mortality from drug use disorders (R
interpretationReduced household income and high incarceration rates are associated with poor health. The rapid expansion of the prison and jail population in the USA over the past four decades might have contributed to the increasing number of deaths from drug use disorders.
fundingNone.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.