Theme: Epidemiology & Public Health Research Year: 2024
Background: Drug-related death is a significant public health challenge in the United States (U.S). While social capital has emerged as a macro-social construct of interest in understanding the predictors of drug overdose, most research examined this construct at the individual and neighborhood level. Recognizing the geographic mobility of people who use drugs beyond their neighborhoods, this research aims to investigate the association between county-level social capital and drug overdose mortality across 15 U.S. states and the District of Columbia.
Methods: County-level social capital, as measured by a social capital index (SCI), was obtained from the U.S. Congress’ Social Capital Project. The SCI incorporates indicators related to family structure stability, confidence and trust in institutions, community cohesion, social network structure and volunteerism. County drug overdose mortality data from 2017-2019 was obtained from the Agency for Healthcare Research and Quality. Multilevel negative-binomial regression models assessed the association between county-level social capital and drug overdose mortality.
Results: Across 546 counties analyzed, SCI ranged from 3.51 standard deviation (SD) below and 1.49 SD above the average SCI across all counties. A one standard deviation increase in SCI was associated with a 15% decrease in drug overdose death rate (IRR: 0.85; 95% CI: 0.77, 0.94). After adjusting for county characteristics, a one standard deviation increase in SCI was associated with a 17% decrease in drug overdose death rate (adjusted IRR: 0.83; 95% CI: 0.76, 0.91).
Conclusion: In this study, counties with high social capital had significantly lower rates of drug overdose deaths than counties with low social capital. Strong social networks, which build social capital, may provide protective influences, such as sharing knowledge of harm reduction services, that could prevent or reduce risky drug use. Our findings emphasize the need for interventions aimed at fostering social cohesion, trust, and community engagement to reduce overdose deaths.