Drug overdose mortality is associated with employment status and occupation in the National Longitudinal Mortality Study

Abstract

ABSTRACT Background Since 1999, over 702,000 people in the US have died of a drug overdose, and the drug overdose death rate has increased from 6.2 to 21.8 per 100,000. Employment status and occupation may be important social determinants of overdose deaths. Objectives Estimate the risk of drug overdose death by employment status and occupation, controlling for other social and demographic factors known to be associated with overdose deaths. Methods Proportional hazard models were used to study US adults in the National Longitudinal Mortality Study with baseline measurements taken in the early 2000s and up to 6 years of follow-up (n = 438,739, 53% female, 47% male). Comparisons were made between adults with different employment statuses (employed, unemployed, disabled, etc.) and occupations (sales, construction, service occupations, etc.). Models were adjusted for age, sex, race/ethnicity, education, income and marital status. Results Adults who were disabled (hazard ratio (HR) = 6.96 (95% CI = 6.81–7.12)), unemployed (HR = 4.20, 95% CI = 4.09–4.32) and retired (HR = 2.94, 95% CI = 2.87–3.00) were at higher risk of overdose death relative to those who were employed. By occupation, those working in service (HR = 2.05, 95% CI = 1.97–2.13); construction and extraction (HR = 1.69, 95% CI = 1.64–1.76); management, business and financial (HR = 1.39, 95% CI = 1.33–1.44); and installation, maintenance and repair (HR = 1.32, 95% CI = 1.25–1.40) occupations displayed higher risk relative to professional occupations. Conclusions In a large national cohort followed prospectively for up to 6 years, several employment statuses and occupations are associated with overdose deaths, independent of a range of other factors. Efforts to prevent overdose deaths may benefit from focusing on these high-risk groups.