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This article is the authors' final version prior to publication in Preventive Medicine, Volume 153, December 2021, Article number 106785.

The published version is available at Copyright © Duan & Hand


Educational attainment may be an indicator of disparities in the ongoing opioid-overdose crisis. To understand the association between educational attainment and fatal opioid overdose, death records in the mortality files published by the Centers for Disease Control and Prevention (CDC) from 2010 - 2019 were analyzed. Proportionate mortality due to opioid overdose, PMOD, was used, as age-adjusted death rates suffer dual data-source errors caused by differences in educational data reported in death records and in population surveys. From 2013 to 2019, PMOD increased by 120% for the “less-than-high-school-diploma” (< HS) education group, whereas the increase was 60% and 30% for groups with bachelor’s and graduate-level educations, respectively. Educational gradient was observed for both males and females, with PMOD for males higher than females. From 2013 to 2019, males and females with < HS education experienced 142% and 85% increases in PMOD, respectively, compared with the 94% and 26% increases for males and females, respectively, with BS education. The PMOD increase was primarily driven by synthetic opioids (ICD-10 code T40.4). From 2013 to 2019, for males with < HS education, PMOD related to T40.4 opioids increased by 19-fold, whereas the increase was more than 100-fold for adult Black males with < HS education. These results suggest that the impact of lower educational attainment may be getting worse and furthering inequities in health. Responses to the opioid-overdose epidemic should consider the large educational gradient. Extra attention to the most vulnerable groups is necessary.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

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