Beyond social determinants: Fiscal determinants of overdose death in U.S counties, 2017–2020

Zoe Lindenfeld, Diana Silver, Amanda I. Mauri and Michah W. Rothbart

Social Science & Medicine, 2025, vol. 364, issue C

Abstract: A large body of research has been dedicated to understanding the relationship between social determinants of health (SDOH) and overdose death across counties in the United States (U.S). However, this literature has so far focused on demographic and socioeconomic characteristics of counties and has largely overlooked the ways in which county fiscal constraints may be associated with responses to the opioid epidemic. To address this gap, this longitudinal study uses data from the U.S Census of Governments to examine the associations between county governments’ revenues and expenditures, commonly used measures of SDOH, and overdose deaths in U.S counties from 2017 to 2020. We find that along with SDOH, higher per capita police spending, but not health expenditures, was associated with overdose deaths in U.S counties. Furthermore, we find that the link between police spending and overdose mortality depends on the amount of revenue generated through fines and forfeitures, suggesting it is a particular form of expenditures on policing – those linked to extractive practices– that is associated with overdose. This study heightens understanding on how the strategies counties undertake in generating and utilizing public resources impact overdose outcomes. Future studies should focus on measuring the causal impact of policies that significantly alter local revenue sources and expenditures on overdose deaths at the county level.

Keywords: Substance use disorders; Social determinants of health; Local governments; Policing (search for similar items in EconPapers)
Date: 2025
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
http://www.sciencedirect.com/science/article/pii/S0277953624009833
Full text for ScienceDirect subscribers only

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:eee:socmed:v:364:y:2025:i:c:s0277953624009833

Ordering information: This journal article can be ordered from
http://www.elsevier.com/wps/find/supportfaq.cws_home/regional
http://www.elsevier. ... _01_ooc_1&version=01

DOI: 10.1016/j.socscimed.2024.117529

Access Statistics for this article

Social Science & Medicine is currently edited by Ichiro (I.) Kawachi and S.V. (S.V.) Subramanian

More articles in Social Science & Medicine from Elsevier
Bibliographic data for series maintained by Catherine Liu ().