A Comparative Analysis of Deaths Due to Drug‐Related Causes Between Rural and Urban Areas in the United Kingdom, 1997–2026
Emmert Roberts, Jürgen Rehm, Caroline CopelandABSTRACT
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.