A Comparative Analysis of Deaths Due to Drug-Related Causes Between Rural and Urban Areas in the United Kingdom, 1997-2026.
10 affiliations
- 1National Addiction Centre, King's College London, London, UK.
- 2South London and the Maudsley NHS Foundation Trust, London, UK.
- 3Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.
- 4Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.
- 5Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- 6Department of Psychiatry, University of Toronto, Toronto, Canada.
- 7Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.
- 8Centre for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
- 9Program on Substance Abuse and World Health Organization Collaborating Centre, Public Health Agency of Catalonia, Barcelona, Spain.
- 10Faculty of Life Sciences & Medicine, King's College London, London, UK.
Abstract
Introduction
Multiple jurisdictions report disproportionately elevated rates of drug-related harm in urban settings, alongside unique treatment needs in rural populations. We examined differences in case characteristics, circumstances of death and implicated drugs among individuals dying from drug-related causes, stratified by rural or urban setting, and determined changes in the proportion of deaths between settings over time.Methods
Retrospective registry-based analysis of coronial records of individuals who died from drug-related causes, submitted to the National Programme on Substance Use Mortality in the UK, 1997-2026. UK Government Rural-Urban Classification methodology dichotomised cases using postcode at date of death.Results
Overall, 39,975 decedents died, 36,350 (90.9%) in urban settings. The urban percentage decreased significantly over the study period from 96.6% in 1999 to 92.3% in 2025 (AAPC -0.34%, 95% CI -0.47% to -0.15%, p = 0.002). Accidental poisoning was the most common direct cause of death in both rural (45.5%) and urban (54.8%) settings, while intentional self-poisoning was more common rurally (17.3% vs. 9.5%). Opioids were the most frequently implicated drug group in both rural (61.1%) and urban (65.4%) settings. The median number of drugs implicated did not differ significantly between settings (both 2, IQR 1-3), but rural decedents had a significantly higher median number of prescribed implicated drugs (1, IQR 0-2 vs. 0, IQR 0-2).Discussion and conclusions
Over three decades, approximately one in 11 UK drug-related deaths occurred rurally. Intentional self-poisoning was substantially more common in rural fatalities, and opioids were the leading implicated drug group across both settings.
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BibTeX
@article{roberts2026comparative,
title = {{A Comparative Analysis of Deaths Due to Drug-Related Causes Between Rural and Urban Areas in the United Kingdom, 1997-2026.}},
author = {Emmert Roberts and Jürgen Rehm and Caroline Copeland},
journal = {Drug and alcohol review},
year = {2026},
month = oct,
doi = {10.1111/dar.70285},
url = {https://europepmc.org/article/MED/42950888},
note = {CC BY},
}
RIS
TY - JOUR
TI - A Comparative Analysis of Deaths Due to Drug-Related Causes Between Rural and Urban Areas in the United Kingdom, 1997-2026.
AU - Emmert Roberts
AU - Jürgen Rehm
AU - Caroline Copeland
PY - 2026
DA - 2026/10/28
JO - Drug and alcohol review
DO - 10.1111/dar.70285
UR - https://europepmc.org/article/MED/42950888
AB - Introduction Multiple jurisdictions report disproportionately elevated rates of drug-related harm in urban settings, alongside unique treatment needs in rural populations. We examined differences in case characteristics, circumstances of death and implicated drugs among individuals dying from drug-related causes, stratified by rural or urban setting, and determined changes in the proportion of deaths between settings over time.Methods Retrospective registry-based analysis of coronial records of individuals who died from drug-related causes, submitted to the National Programme on Substance Use Mortality in the UK, 1997-2026. UK Government Rural-Urban Classification methodology dichotomised cases using postcode at date of death.Results Overall, 39,975 decedents died, 36,350 (90.9%) in urban settings. The urban percentage decreased significantly over the study period from 96.6% in 1999 to 92.3% in 2025 (AAPC -0.34%, 95% CI -0.47% to -0.15%, p = 0.002). Accidental poisoning was the most common direct cause of death in both rural (45.5%) and urban (54.8%) settings, while intentional self-poisoning was more common rurally (17.3% vs. 9.5%). Opioids were the most frequently implicated drug group in both rural (61.1%) and urban (65.4%) settings. The median number of drugs implicated did not differ significantly between settings (both 2, IQR 1-3), but rural decedents had a significantly higher median number of prescribed implicated drugs (1, IQR 0-2 vs. 0, IQR 0-2).Discussion and conclusions Over three decades, approximately one in 11 UK drug-related deaths occurred rurally. Intentional self-poisoning was substantially more common in rural fatalities, and opioids were the leading implicated drug group across both settings.
SN - 0959-5236
SN - 1465-3362
ER -