Trends in mortality from alcohol, opioid, and combined alcohol and opioid poisonings by sex, educational attainment and race and ethnicity for the United States 2000-2018.

Drug and alcohol poisonings are strongly related to socioeconomic status, with the highest mortality rates and increases over time reported for White Americans with low education. It is unclear whether other groups experienced similar increases, and how different substances contributed to this. This study aimed to quantify disparities over time between educational, and racial and ethnic groups in sex-specific mortality rates for opioid, alcohol, and combined alcohol and opioid poisonings in the United States.

Multiple Cause of Death Files from the National Vital Statistics System (NVSS) comprising mortality data from individual death records for 2000-2018 were used alongside population counts from the Current Population Survey (CPS). Alcohol, opioid, and combined alcohol and opioid poisonings were assigned using ICD-10 codes. Sex-stratified Generalized Least Square (GLS) regression models were estimated to quantify differences in mortality between educational and race and ethnicity groups.

The highest mortality rates were observed for opioid only poisonings in White and Black men and women with low education. The largest relative inequalities between educational groups were observed for opioid poisonings with White men and women having 7.5 [95% CI 7.3, 7.8] and 7.8 [95% CI 5.5, 10.1] times as many poisoning deaths in low compared to high education groups. For combined alcohol and opioid poisonings, relative socioeconomic inequalities were larger in Black men and women with 8.9 [95% CI 7.4, 10.5] and 10.4 [95% CI 6.5, 14.3] times as many poisonings in low compared to high education groups. Most educational inequalities increased over time, particularly for combined alcohol and opioid poisonings in Black men.

Educational inequalities in poisoning deaths from alcohol, opioids, and alcohol and opioids in combination are large and have increased over time in multiple groups. This study highlights diverse population sub-groups who might benefit from targeted interventions to reduce mortality from poisonings in the US.