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Editor's Comment
Social Determinants of Health
February 19, 2020

Linking the Loss of Automotive Manufacturing Jobs With the Rise of Opioid-Related Mortality

Author Affiliations
  • 1Editor, JAMA Health Forum
JAMA Health Forum. 2020;1(2):e200122. doi:10.1001/jamahealthforum.2020.0122

A recent study by Venkataramani and colleagues1 published in JAMA Internal Medicine reports a concerning potential connection between the closure of automotive assembly plants and rising mortality from opioid overdoses in the US during 1999 through 2016. Using a rigorous difference-in-differences analysis, this study focused on counties that are highly reliant on manufacturing jobs and compared opioid deaths in 29 counties that experienced closures of automotive assembly plants with 83 demographically similar counties that did not face such manufacturing losses.

In counties with automotive plant closures, the study found that mortality rates 5 years after the closures had increased by 8.6 opioid overdose deaths per 100 000 individuals, an 85% relative increase in mortality from opioid overdoses compared with unaffected counties. This significant mortality difference became evident about 3 years after a plant closure, was concentrated among non-Hispanic white men, and was noted for overdoses from both prescription and illicit opioids in this subgroup. In an informative commentary about this study presented as a Twitter thread, the study’s lead author described how clinical observations of economic hardship in his primary care practice prompted a journey of discovery that led to his research team’s analysis and findings.

The study by Venkataramani et al1 adds an important socioeconomic link to the growing literature on the declining life expectancy of younger and middle-aged adults without a college degree in the US.2,3 This troubling decline has been attributed to rising deaths from drug overdoses, alcohol-related complications such as cirrhosis, and suicide—collectively characterized as “deaths of despair.”4 Venkataramani and colleagues1 shed light on abrupt changes in local employment opportunities as a potentially important social determinant of these adverse health outcomes over the past 20 years, adding to the broader literature on the socioeconomic effects of manufacturing plant closures and community responses to them.5

Along with careful analyses of population-level data that illuminate the potential connections between economic disruption and adverse health outcomes, it is important to understand how individual workers, their families, and communities are affected when major manufacturing plants close, as reflected in recent news reports of automotive plant closures.6,7 It is also essential for physicians and other health care professionals in areas affected by the loss of manufacturing plants to avoid excessive or inappropriate opioid prescribing to vulnerable patients who have been affected directly or indirectly by plant closures, while offering supportive counseling and medication-assisted treatment to those who have developed opioid use disorders.

The loss of well-paid manufacturing jobs and the scourge of the opioid epidemic were both important influences on US voters in the 2016 presidential election, especially in midwestern swing states, such as Michigan, Ohio, and Wisconsin, that have experienced both of these challenges. For candidates in the 2020 presidential election, the election outcome may hinge on their ability to address these challenges for voters and chart a path from despair to better economic and health prospects.

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Article Information

Open Access: This is an open access article distributed under the terms of the CC-BY License.

Venkataramani  AS, Bair  EF, O’Brien  RL, Tsai  AC.  Association between automotive assembly plant closures and opioid overdose mortality in the United States: a difference-in-differences analysis.   JAMA Intern Med. 2019;180(2):254-262. doi:10.1001/jamainternmed.2019.5686PubMedGoogle ScholarCrossref
Case  A, Deaton  A.  Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century.   Proc Natl Acad Sci U S A. 2015;112(49):15078-15083. doi:10.1073/pnas.1518393112PubMedGoogle ScholarCrossref
Woolf  SH, Schoomaker  H.  Life expectancy and mortality rates in the United States, 1959-2017.   JAMA. 2019;322(20):1996-2016. doi:10.1001/jama.2019.16932PubMedGoogle ScholarCrossref
Case  A, Deaton  A.  Mortality and morbidity in the 21st century.   Brookings Pap Econ Act. 2017;2017:397-476. doi:10.1353/eca.2017.0005PubMedGoogle ScholarCrossref
Beer  A, Weller  S, Barnes  T,  et al.  The urban and regional impacts of plant closures: new methods and perspectives.   Reg Stud Reg Sci. 2019;6(1):380-394. doi:10.1080/21681376.2019.1622440Google Scholar
Andres  T, Samuelson  T. How the closings of two auto plants changed Hamtramck and Detroit’s Poletown. Accessed January 29, 2020. https://www.marketplace.org/2019/08/14/how-the-closings-of-two-auto-plants-changed-hamtramck-and-detroits-poletown/
Kaufman  D. What happens to a factory town when the factory shuts down? New York Times Magazine. Published May 1, 2019. Accessed January 29, 2020. https://www.nytimes.com/interactive/2019/05/01/magazine/lordstown-general-motors-plant.html
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