@article{ref1,
title="Urban-rural disparities in deaths of despair: a county-level analysis 2004-2016 in the U.S",
journal="American journal of preventive medicine",
year="2023",
author="Lee, Jong Hyung and Wheeler, David C. and Zimmerman, Emily B. and Hines, Anika L. and Chapman, Derek A.",
volume="64",
number="2",
pages="149-156",
abstract="INTRODUCTION: The purpose of this study is to examine nationwide disparities in drug, alcohol, and suicide mortality; evaluate the association between county-level characteristics and these mortality rates; and illustrate spatial patterns of mortality risk to identify areas with elevated risk. <br><br>METHODS: The authors applied a Bayesian spatial regression technique to investigate the association between U.S. county-level characteristics and drug, alcohol, and suicide mortality rates for 2004-2016, accounting for spatial correlation that occurs among counties. <br><br>RESULTS: Mortality risks from drug, alcohol, and suicide were positively associated with the degree of rurality, the proportion of vacant housing units, the population with a disability, the unemployed population, the population with low access to grocery stores, and the population with no health insurance. Conversely, risks were negatively associated with Hispanic population, non-Hispanic Black population, and population with a bachelor's degree or higher. <br><br>CONCLUSIONS: Spatial disparities in drug, alcohol, and suicide mortality exist at the county level across the U.S. social determinants of health; educational attainment, degree of rurality, ethnicity, disability, unemployment, and health insurance status are important factors associated with these mortality rates. A comprehensive strategy that includes downstream interventions providing equitable access to healthcare services and upstream efforts in addressing socioeconomic conditions is warranted to effectively reduce these mortality burdens.<p /> <p>Language: en</p>",
language="en",
issn="0749-3797",
doi="10.1016/j.amepre.2022.08.022",
url="http://dx.doi.org/10.1016/j.amepre.2022.08.022"
}