Influence of a Pandemic on an Epidemic: A Population-Based Ecological Study of the Association Between COVID-19 Diagnoses and Drug Overdose Deaths in Rhode Island, 2023.

Objectives: In Rhode Island, drug overdose deaths increased by 28% in the first 6 months of the COVID-19 pandemic in 2020 as compared with the previous year (2019), mirroring national trends. We explored how the spatial distribution of overdose deaths overlapped with that of COVID-19 cases to identify levels and increased prevalence of these health issues among census tracts in Rhode Island.

Methods: We used data from the Rhode Island Department of Health and the US Census Bureau to calculate annualized COVID-19 case rates (from March 20, 2020, through December 31, 2021) and unintentional overdose death rates by census tract (from January 1, 2018, through December 31, 2021). We used bivariate cluster analyses to group census tracts into clusters of high-high, low-low, high-low, and low-high overdose deaths and COVID-19 case rates per 100 000 population.

Results: Clusters with high overdose death rates and high COVID-19 case rates were identified in urban census tracts around the capital city of Providence, whereas clusters with low overdose death rates and low COVID-19 case rates were identified in the state's southern census tracts. Structural factors differed among cluster groups: cluster groups with high overdose death rates and high COVID-19 case rates had greater percentages of households with overcrowding (mean [SD] = 1.6% [1.0%]), people living below the federal poverty level (17.5% [7.4%]), and people with a high school degree or less (37.8% [7.8%]) than the other cluster groups.

Conclusions: Targeted investments in community-led and place-based public health interventions can be used to address underlying social and structural determinants of health (eg, overcrowding, poverty, low education levels) in communities with high rates of overdose deaths and COVID-19 cases.