ArticlePloS one2024
Examining the relationship between social determinants of health, measures of structural racism and county-level overdose deaths from 2017-2020.
Article in PloS one, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- How do services offered within opioid treatment programs vary based on state methadone policies?Journal of substance use and addiction treatment · 2026Article
- Legal Financial Obligations: An Understudied Public Health Exposure.American journal of preventive medicine · 2026Article
- Understanding the Impact of Structural Racism and Violence Across the Lifespan on Overdose Vulnerability Among Black San Franciscans Experiencing Homelessness.Journal of psychoactive drugs · 2026Article
- Structural stressors, neurocognition in reward-related decision making and substance use risk in Puerto Rican early adolescents at two sites: study design.Frontiers in public health · 2026Observational
- Fatal Opioid Overdoses by Historical and Contemporary Neighborhood-Level Structural Racism.JAMA health forum · 2025Article
- Geography And Fentanyl: Explaining The Disproportionate Rise In Opioid Overdose Deaths Among Black Americans.Health affairs (Project Hope) · 2025Article
- Structural and healthcare predictors of substance use-related death following release from incarceration: A retrospective cohort study in Rhode Island, 2018-2020.The International journal on drug policy · 2025Article
- Overdose as a complex contagion: modelling the community spread of overdose events following law enforcement efforts to disrupt the drug market.Journal of epidemiology and community health · 2025Article
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Authors and funding
5 authors.
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Abstract
introductionDespite being an important determinant of health outcomes, measures of structural racism are lacking in studies examining the relationship between the social determinants of health (SDOH) and overdose deaths. The aim of this study is to examine the association between per capita revenue generated from fines and forfeitures, a novel measure of structural racism, and other SDOH with county-level overdose deaths from 2017-2020.
methodsThis longitudinal analysis of 2,846 counties from 2017-2020 used bivariate and multivariate Generalized Estimating Equations models to estimate associations between county overdose mortality rates and SDOH characteristics, including the fines and forfeitures measure.
resultsIn our multivariate model, higher per capita fine and forfeiture revenue (5.76; CI: 4.76, 6.78), households receiving food stamps (1.15; CI: 0.77, 1.53), residents that are veterans (1.07; CI: 0.52, 1.63), substance use treatment availability (4.69; CI: 3.03, 6.33) and lower population density (-0.002; CI: -0.004, -0.001) and percent of Black residents (-0.7`; CI: -1.01, -0.42) were significantly associated with higher overdose death rates. There was a significant additive interaction between the fines and forfeitures measure (0.10; CI: 0.03, 0.17) and the percent of Black residents.
conclusionsOur findings suggest that structural racism, along with other SDOH, is associated with overdose deaths. Future research should focus on connecting individual-level data on fines and forfeitures to overdose deaths and other health outcomes, include measures of justice-related fines, such as court fees, and assess whether interventions aimed at increasing economic vitality in disadvantaged communities impact overdose deaths in a meaningful way.
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