Association Between Automotive Assembly Plant Closures and Opioid Overdose Mortality in the United States: A Difference-in-Differences Analysis
OFH Contributors
Key Takeaways
Manufacturing counties experiencing automotive assembly plant closures experienced significant increases in opioid overdose mortality rates among working-age adults compared with similar counties where plants remained open.
The biggest increases in opioid overdose mortality occurred among non-Hispanic white men, particularly ages 18–34 and 35–65, suggesting demographic differences in vulnerability to economic shocks.
Findings support the idea that the erosion of local economic opportunity may be an important underlying factor in the U.S. opioid overdose epidemic.
Executive Summary
Introduction
Eroding economic opportunities, driven by economic forces such as automation and policy choices such as trade agreements, have been hypothesized to be a major driver of worsening health among working-age adults in the United States. This case study examined how the shutdown of automotive assembly plants — a large, historically and cultural significant industry – affected the opioid crisis in the Industrial Midwest. The case study reflects the fact that, over the last five decades, many U.S. regions that relied on manufacturing jobs have seen economic decline. We wanted to know whether the erosion of such opportunities plays a causal role in shaping population health. To answer this, we collected novel data on automobile plant closures and compared opioid death rates in manufacturing counties where plants closed with similar counties where plants stayed open over the period 1999 and 2016.
Main Findings
- Counties that experienced automotive plant closures had significant increases in opioid overdose deaths compared with counties that did not.
- Five years after a plant closed, opioid overdose death rates were noticeably higher (about 8.6 more deaths per 100,000 people) than expected if the plant had stayed open. That represents an 85% relative increase compared to counties where plants had remained closed. These increases were seen for deaths involving both prescription and illicit opioids.
- The largest increases in overdose mortality were seen among non-Hispanic White men, especially those aged 18–34 and 35–65.
- Counties without major manufacturing jobs, but were in the same labor market area as manufacturing counties with plant closures, did not show the same increase, suggesting the link is tied to the local economic conditions where plant closures occurred.
Conclusion
Our findings indicate that the closure of automotive assembly plants is associated with meaningful increases in opioid overdose mortality in affected communities. These results suggest that large-scale less of economic opportunity and the economic instability and erosion of hope that follows may play an important role in shaping population health outcomes. While opioid misuse has many contributing factors, our analysis highlights economic disruption as a potential upstream driver of overdose deaths. Addressing the opioid crisis may therefore require not only clinical and public health interventions, but also policies that reduce the harmful health consequences of economic decline and support communities experiencing major employment losses.