Substance Use
Drug overdose mortality in North Carolina among publicly and privately insured people: 2006-2022 Raana Zakeri* Raana Zakeri Shabbar I Ranapurwala Brian W. Pence Hillary Mortensen Grace Yeboah-Kodie
Background: The drug overdose epidemic costs the US about $1 trillion annually. We aimed to compare the overdose death rates among publicly and privately insured individuals in North Carolina (NC) between 2006-2022.
Methods: Records from Medicaid and privately insured NC individuals were linked to NC State Center for Health Statistics death certificate data, by fuzzy match linkage method using last and first names, date of birth, and sex. Overdoses from all drugs, opioids, and polydrugs were identified using primary cause of death International Classification of Disease Version 10 (ICD-10) codes. Indirect standardization with the NC general population as the reference group, was used to report adjusted rate and standardized mortality ratios (SMRs) adjusted for age and sex per calendar year between 2006-2022.
Results: Between 2013-2022, the adjusted rate and SMR for all drugs, opioids, polydrug overdose deaths among Medicaid population was 67.1, 50.2, and 43.2 per 100,000 person-years (PY), with respective SMRs of 1.6, 2.6, and 1.8 relative to the general population. In contrast, among privately insured population the rates for all drug, opioids, and polydrug overdose deaths were 15.1, 11.3, and 7.9 per 100,000 PY, with respective SMRs of 0.29, 0.49, and 0.32, relative to the general population. The rates for all drug, opioids, and polydrug overdose deaths among Medicaid population peaked in 2013, and then decreased thereafter, while still remaining higher than the general population. However, the rates for the privately insured population remained about a third of the general population throughout the follow up.
Conclusion: People with Medicaid insurance experienced higher overdose rates compared to those with private health insurance. This highlights significant disparities between individuals of different socioeconomic statuses, which must be addressed in any prevention strategies.
Keywords: overdoses, drugs, opioids, polydrugs, Medicaid, health insurance