METHODS: We used an ecological study design linking county level demographics from the United States Census American Community Survey and the 2008-2012 national mortality file obtained from the National Center for Health Statistics (NCHS). Using four multivariable logistic regression models, we analyzed the impact of three county-level demographic variables on the drug overdose death rate among American Indians in the county: 1) the percent of AIAN persons living in a county, 2) the percent of persons living on tribal lands, 3) and classification as an Indian Health Service Area, and 4) all three variables together.
RESULTS: After adjustment for social and economic factors including poverty, educational attainment and Gini index, we found that percent of self-identified AIANs living within the county, percent of county population living on tribal lands were both associated with a reduction in the log transformed county level AIAN drug overdose death rates.
CONCLUSIONS: The three measures we used to describe the types of counties that AIAN individuals live in are likely proxy measures for conditions in these communities. We believe that these measures may be proxies for community resilience, or community cohesiveness, which are things we are unable to measure with this type of study design. These proxies of social structure In AIAN communities (percent of AIAN living in a county and percent of county population living on tribal lands) were shown to be protective against drug overdose death. These results suggests that there may be factors in American Indian communities that may be protective from drug overdose. Further research is needed into the identification and bolstering of the protective factors intrinsic in AIAN communities.