With US life expectancy declining for 4 straight years from so-called “deaths of despair,” experts have searched for possible explanations as to why Americans are dying from drug and alcohol abuse, suicide, and diseases caused by poor nutrition and a lack of exercise. Chronic stress, social isolation, income inequality, and a decline of the country’s manufacturing sector have all been cited as possible reasons.
This week, researchers pinpointed the effects of shuttered automobile factories, releasing results in JAMA Internal Medicine that show plant closures from 1999 to 2016 were associated with increases in deaths from opioid overdoses. According to the estimates from the difference-in-difference analysis, opioid overdose mortality rates were 85% higher than anticipated in counties that saw a plant closure, compared with unaffected counties.
Non-Hispanic white men between 18-34 years old, followed by non-Hispanic white men in the next age group—35-65—were the 2 groups with the highest rate of death after a plant closed.
The 17-year study period (1999-2016) covered 112 manufacturing counties near major automotive manufacturing plants located in 30 commuting zones with at least 1 operational automotive assembly plant as of 1999. Twenty-nine of the counties experienced an automotive assembly plant closure during the study period.
The majority of the counties studied were located in the Midwest and South, where the automobile industry has played a large role in local economies and culture.
Researchers, from the Perelman School of Medicine at the University of Pennsylvania, the Massachusetts General Hospital, Yale University, and Harvard Medical School, said the findings, while not definitive, highlight “the importance of declining economic opportunity as an underlying factor associated with the opioid overdose crisis. In particular, our findings, combined with a growing body of research demonstrating adverse associations between trade-related industrial decline and drug overdose mortality, lend support to the view that the current opioid overdose crisis may be associated in part with the same structural changes to the US economy that have been responsible for worsening overall mortality among less-educated adults since the 1980s.”
Automakers are aware of the problem, according to a November 2019 report in an industry trade publication, which said that Ford had agreed to spend up to $250,000 for addiction treatment. In addition, Ford and the UAW created an education and awareness initiative.
The researchers pointed out that other factors are involved in opioid misuse and death, including exaggerated prescription rates of opioids by providers, which was seen at the beginning of the first wave of deaths in the early 2000s.
However, prescribing rates have fallen, and synthetic or illicit opioids now make up the majority of deaths.
In their study, researchers did not find much difference in the pattern of deaths caused by prescription opioids and illicit ones.
Still, regions of the country struggling this type of fallout from economic loss will need a variety of strategies if they want to improve population health in the South and the Midwest, the authors wrote. Since the decline in manufacturing is expected to continue, social policies to address these disparities will be required, and community organizations and health systems need to focus on social determinants of health, they said.
“Our findings confirm the general intuition that declining economic opportunity may have played a significant role in driving the opioid crisis,” said
Atheendar Venkataramani, MD, PhD, an assistant professor of Medical Ethics and Health Policy and lead author of the study, which was funded by The Robert Wood Johnson Foundation Evidence for Action program.
“Until we can achieve structural change to address the fundamental drivers of the crisis, there are some health care system and health policy changes that can be implemented immediately,” said senior author and co-study lead Alexander Tsai, MD, an associate professor of psychiatry at the Massachusetts General Hospital and Harvard Medical School. “There is an urgent need to rapidly lower the threshold for accessing evidence-based treatment for substance use disorders, for example, at the level of state Medicaid policy and private payor utilization management.”
Venkataramani AS, Bair EF, O’Brien RL, et al. Association between automotive assembly plant closures and opioid overdose mortality in the United States: A difference-in-differences analysis [published online December 30, 2019]. JAMA Intern Med. doi: 10.1001/jamainternmed.2019.5686.