Drug overdose mortality rates by educational attainment and sex for adults aged 25–64 in the United States before and during the COVID-19 pandemic, 2015–2021

• Published in: Drug and alcohol dependence 2024-02, Vol.255, p.111014-111014, Article 111014
• Main Authors: Xu, Jay J., Seamans, Marissa J., Friedman, Joseph R.
• Format: Article
• Language: English
• Subjects: Adult; Analgesics, Opioid; COVID-19 - epidemiology; COVID-19 pandemic; Drug Overdose - epidemiology; Drug overdose deaths; Educational attainment; Educational Status; Fentanyl; Humans; Male; Pandemics; Synthetic opioids; United States - epidemiology
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2023.111014

Dramatic increases in U.S. drug overdose deaths involving synthetic opioids, especially fentanyl, beginning around 2014 have driven a marked progression in overall drug overdose deaths in the U.S., which sharply rose to unprecedented levels amid the COVID-19 pandemic. Disparities in drug overdose deaths by educational attainment (EA) during the fentanyl era of the drug overdose epidemic and its intersection with the COVID-19 pandemic have not been widely scrutinized. Utilizing restricted-use mortality data from the National Vital Statistics System and population estimates from the American Community Survey, we estimated annual national age-adjusted mortality rates (AAMRs) from drug overdoses jointly stratified by EA and sex for adults aged 25–64 from 2015 to 2021. State-level AAMRs in 2015 and 2021 were also estimated to examine the geographic variation in the cumulative evolution of EA-related disparities over the course of the analysis period. Nationally, AAMRs rose fastest among persons with at most a high school-level education, whereas little to no change was observed for bachelor’s degree holders, widening pre-existing disparities. During the analysis period, the difference in national AAMRs between persons with at most a high school-level education and bachelor’s degree holders increased from less than 8-fold (2015) to approximately 13-fold (2021). The national widening of EA-related disparities accelerated amid the COVID-19 pandemic, and they widened in nearly every state. Among non-bachelor’s degree holders, national AAMRs increased markedly faster for males. The widening disparities in drug overdose deaths by EA are a likely indicator of a rapidly increasing socioeconomic divide in drug overdose mortality more broadly. Policy strategies should address upstream socioeconomic drivers of drug use and overdose, particularly among males. •Disparities in drug overdose mortality by educational attainment have been understudied.•From 2015 to 2021, these disparities widened substantially among adults aged 25–64.•The widening of these disparities occurred most rapidly during the COVID-19 pandemic.•Males experienced greater increases in age-adjusted mortality rates within educational attainment categories.•Beginning in 2020, over 50% of all drug overdose deaths among adults aged 25–64 are estimated to have occurred among males with at most a high school-level education.