Drug-related charges and their association with social determinants of health

Abstract

Objective

Drug-related arrests persist at high levels despite the negative health consequences of incarceration, particularly for those with a substance use disorder. To understand community-level factors potentially contributing to high rates of drug-related arrests, we conducted an ecological study estimating associations between county-level social determinants of health and rates of drug-related charges in North Carolina from 2016 to 2019.

Method

Allowing a one-year lag between variables, we regressed the county-level rates of drug-related charges on each county-level social determinant of health variable. County-level rates of drug-related charges were the number of drug-related charges per 1000 residents. The county-level social determinant of health variables describe the percent of the population experiencing poverty, unemployment, evictions, food insecurity, or uninsured status. We accounted for spatial dependence of the social determinants of health variables and spatial correlation of the errors. We report direct effects, which measure the effect of a given social determinant of health in a given county on rates of drug-related charges in that same county.

Results

Poverty, evictions, and food insecurity were not associated with county-level rates of drug-related charges. There was a positive association between both unemployment and drug-related charges and between lack of health insurance and drug-related charges. A one percentage point increase in county-level unemployment was associated with a 3.27 (95 % CI: 1.28, 5.26) percent increase in the rate of next year drug-related charges per 1000 adults. A one percentage point increase in county-level lack of health insurance was associated with a 110.50 (95 % CI: 52.81, 168.18) percent increase in drug-related charges per 1000 adults the following year.

Conclusion

In this descriptive analysis, we found that a higher percentage of the population unemployed and uninsured were associated with higher rates of drug-related charges in the subsequent year. Areas with high unemployment and a high percentage of the population uninsured may benefit from diversion programs for individuals with substance use disorders.