Report Analysis

Urban–Rural Differences in Drug Overdose Death Rates, 2020

Demographics
Overdose
  • Published by: US Department of Health and Human Services/Centers for Disease Control and Prevention
  • Published Date: July 2022
  • Link: Click here to read full report

Part One

Report Summary

This report, by the U.S. Department of Health and Human Services/Centers for Disease Control and Prevention, provides a detailed analysis of drug overdose deaths in the United States in 2020, categorized by urban and rural differences, sex, race and Hispanic origin, and types of drugs. 

In 2020, significant disparities in drug overdose death rates were observed in the United States, depending on demographic factors and geographical location, according to a recent report from the National Vital Statistics System. The report reveals a decade-long increase in overdose rates, with some stark differences between urban and rural counties. Urban counties demonstrated a higher overall drug overdose death rate, recorded at 28.6 per 100,000 standard population, compared to 26.2 in rural counties. 

However, when broken down by gender, an interesting contrast appeared: the overdose death rate for males was 18% higher in urban counties than in rural ones, whereas the rate for females was 5% lower in urban counties. This indicates a more pronounced impact of drug overdose on males, particularly in urban settings. 

The disparity extended to different ethnic and racial groups as well. Non-Hispanic Black, Hispanic, and non-Hispanic White people experienced higher drug overdose death rates in urban counties than in rural ones. The highest rates of drug overdose deaths were found among non-Hispanic American Indian or Alaska Native (AIAN) people in both urban and rural settings, whereas non-Hispanic Asian people demonstrated the lowest rates. 

When it came to specific types of drugs, a higher rate of deaths involving cocaine, heroin, and synthetic opioids, excluding methadone, was observed in urban counties. In contrast, rural counties saw a higher rate of deaths associated with psychostimulants with abuse potential and natural and semisynthetic opioids. 

Statewise, urban counties had higher rates of drug overdose deaths than rural counties in 23 states, while 8 states exhibited the opposite pattern. The report reveals a worrying rise in drug overdose death rates and highlights the disparities present depending on geographical location, gender, and race. It calls for comprehensive and inclusive solutions to address the complex and pervasive issue of drug overdose in the United States.

Part Two

Key Findings

  1. In 2020, drug overdose death rates were higher in urban counties compared to rural counties. The rate was 28.6 per 100,000 standard population in urban areas, while rural areas reported a rate of 26.2.

  2. A gender discrepancy was observed. In urban counties, male drug overdose death rates were 18% higher than those in rural counties. On the contrary, urban counties reported a 5% lower rate for females compared to rural counties.

  3. Males were found to be twice as likely to die from a drug overdose as females in both urban and rural settings.

  4. Among different racial and ethnic groups, non-Hispanic American Indian or Alaska Native (AIAN) people reported the highest rates of drug overdose deaths in both urban (44.3 per 100,000) and rural (39.8 per 100,000) counties. Conversely, non-Hispanic Asian people had the lowest rates in both settings.

  5. Urban counties reported higher rates of overdose deaths involving cocaine, heroin, and synthetic opioids other than methadone compared to rural counties. However, the rate of deaths involving psychostimulants with abuse potential was 31% higher in rural counties compared to urban counties.

  6. Among the 50 states, 23 states reported higher rates of drug overdose deaths in urban counties compared to rural counties. Eight states reported the opposite trend, and 16 states reported similar rates in both urban and rural areas.

Part Three

Statistical Data Categorized

  • Overall Drug Overdose Rates:
    • The rate of drug overdose deaths was higher in urban counties (28.6 per 100,000 standard population) than in rural counties (26.2 per 100,000 standard population).
  • Gender-Specific Rates:
    • The drug overdose death rate for males was 18% higher in urban counties (40.4 per 100,000) than in rural counties (34.1 per 100,000).
    • The drug overdose death rate for females was 5% lower in urban counties (17.0 per 100,000) than in rural counties (17.9 per 100,000).
    • Rates for males were about twice as high as rates for females in both urban and rural counties.
  • Race and Ethnicity-Specific Rates:
    • Non-Hispanic American Indian or Alaska Native (AIAN) people had the highest rates of drug overdose deaths in both urban (44.3 per 100,000) and rural (39.8 per 100,000) counties.
    • Non-Hispanic Asian people had the lowest rates in both urban (4.6 per 100,000) and rural (4.5 per 100,000) counties.
    • Rates were higher in urban counties than in rural counties among non-Hispanic Black (37.4 urban vs. 18.9 rural), Hispanic (17.9 urban vs. 13.7 rural), and non-Hispanic White (33.9 urban vs. 28.8 rural) people.
  • Drug-Type Specific Rates:
    • The rate of drug overdose deaths involving cocaine was more than double in urban counties (6.4 per 100,000) compared to rural counties (3.0 per 100,000).
    • The rate of deaths involving heroin was 31% higher in urban counties (4.2 per 100,000) than in rural counties (3.2 per 100,000).
    • The rate of deaths involving synthetic opioids other than methadone was 28% higher in urban counties (18.3 per 100,000) than in rural counties (14.3 per 100,000).
    • The rate of deaths involving psychostimulants with abuse potential was 31% higher in rural counties (9.4 per 100,000) than in urban counties (7.2 per 100,000).
    • The rate of deaths involving natural and semisynthetic opioids was nearly 13% higher in rural counties (4.5 per 100,000) than in urban counties (4.0 per 100,000).
  • State-Specific Rates:
    • Rates of drug overdose deaths were higher in urban counties than in rural counties in 23 states.
    • Eight states had drug overdose death rates that were higher in rural counties than in urban counties.
    • Urban and rural rates were similar in 16 states.

Part Four

Trends and Observations

  1. Urban vs Rural Rates: Overall, urban areas have a higher rate of drug overdose deaths compared to rural areas, which suggests that urbanization might be associated with higher drug use or access to drugs.

  2. Gender Disparity: Across both urban and rural areas, males have consistently higher rates of drug overdose deaths compared to females. This could indicate gender differences in drug use behaviors or access to drugs, and it could also hint towards different risk-taking behaviors between genders.

  3. Ethnic Differences: There are notable ethnic disparities in drug overdose deaths. Non-Hispanic American Indian or Alaska Native (AIAN) people had the highest rates in both urban and rural areas. Conversely, Non-Hispanic Asian people had the lowest rates. There are also marked differences among Non-Hispanic Black, Hispanic, and Non-Hispanic White populations, with higher rates in urban areas compared to rural ones. These disparities might reflect socioeconomic, cultural, or healthcare access differences among these groups.

  4. Variations by Drug Type: The type of drug involved in overdoses also varied by urban and rural locations. Overdoses involving cocaine, heroin, and synthetic opioids other than methadone were more prevalent in urban areas, whereas overdoses involving psychostimulants with abuse potential and natural and semisynthetic opioids were more common in rural areas. This could be reflective of the types of drugs more accessible or preferred in these different environments.

  5. State-Level Differences: There are state-level differences in urban and rural overdose rates, indicating geographic disparities in drug overdose deaths. Some states have higher rates in urban counties, some have higher rates in rural counties, and others have similar rates across both. These differences might be influenced by various factors such as state-specific drug policies, availability of substances, social-economic factors, or healthcare infrastructure differences.

These trends suggest that public health efforts to address drug overdoses need to consider the geographic, demographic, and drug-type specific nuances of this issue.

Part Five

Possible Prevention Strategies

  1. Targeted Interventions: Develop and implement interventions targeting the highest-risk groups. For instance, interventions could be designed for males, non-Hispanic AIAN people, and individuals living in urban areas who appear to be at a higher risk of drug overdose.

  2. Addressing Ethnic Disparities: Efforts could be made to reduce ethnic disparities in drug overdose deaths. This might involve culturally sensitive educational initiatives, increasing access to healthcare, and addressing underlying socio-economic factors.

  3. Drug-specific Strategies: Strategies could be developed based on the type of drug most associated with overdoses in different regions. For instance, interventions in urban areas could focus on cocaine, heroin, and synthetic opioids, while rural areas might require a focus on psychostimulants and natural and semisynthetic opioids.

  4. State-Level Initiatives: The data suggests that drug overdose rates vary by state and urban versus rural areas. State-level initiatives could therefore be developed to address these specific trends.

  5. Research: More research could be conducted to understand the underlying causes of the observed trends. For instance, why are drug overdose rates higher among males? What factors contribute to higher rates of drug overdoses in urban areas? Understanding these dynamics could help in developing more effective interventions.

Please note that these recommendations are based on the data provided, but they might not represent the full picture or the complexities involved in addressing such a multifaceted issue. The report authors or experts in the field may have additional or alternative recommendations based on other data or research. Specific strategies and interventions should be developed and implemented in consultation with healthcare providers, public health officials, and policymakers.

Citation: U.S. Department of Health and Human Services/Centers for Disease Control and Prevention. (2022, July). Urban–Rural Differences in Drug Overdose Death Rates, 2020. Retrieved May 17, 2023, from https://www.cdc.gov/nchs/data/databriefs/db440.pdf.