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Research Summary

Geography, Sociodemographic Factors, and the Risk of Substance Use Disorders

Few studies have compared the sociodemographic factors associated with drug use among people in urban, rural, and metropolitan areas. To examine whether residence in these areas modifies the relationship between sociodemographic factors and substance use disorders, researchers employed a nationally representative survey of 8098 adults in the United States aged 15–54 years.

  • African Americans were significantly protected against substance use disorders in rural (odds ratios, OR, from 0.2 to 0.3) and urban (ORs from 0.2 to 0.3), but not metropolitan, areas.
  • Workers in services (ORs from 2.2 to 4.4) and craft (ORs from 2.3 to 3.7) occupations, compared with those not in the labor force, were significantly more likely to have a substance use disorder in most geographic areas (borderline significant increased odds of drug abuse and dependence for rural service workers).
  • Metropolitan residents in all occupations (compared with those not in the labor force) and people with no health insurance in all geographic areas (compared with those with private insurance) were also significantly more likely to have a substance use disorder.


This study suggests that geographic context and occupation type may impact risk of substance use disorders for some people. The relationship between these two variables is complex (certain occupations increased odds regardless of geographic context, while residents in one geographic area had higher odds regardless of occupation). However, the relationship between geography, insurance status, and the likelihood of a substance use disorder appears clear—those without health insurance had higher odds no matter where they lived.

Peter D. Friedmann, MD, MPH


Diala CC, Muntaner C, Walrath C. Gender, occupational, and socioeconomic correlates of alcohol and drug abuse among U.S. rural, metropolitan, and urban residents. Am J Drug Alcohol Abuse. 2004;30(2):409–428.
(view abstract)