Key findings

  • Drug-related deaths disproportionately affected males, those aged 16–44 years, and residents in urban (particularly Greater Belfast) and in the most deprived areas.

After accounting for other factors (such as age and area deprivation):

  • Poor mental health was associated with higher mortality risk for both sexes.

  • For males, living alone, or being a lone parent in a household, was associated with higher mortality risk.
    For females, being single, divorced or separated was associated with higher mortality risk.

  • For males, increased risk was associated with having no qualifications and with unemployment. For females, economic inactivity was associated with increased risk.

Background

Drug-related deaths are a major public health challenge in Northern Ireland, with profound impacts on individuals, families and communities. Based on registration data (all ages), mortality rates have risen sharply over the last decade, with males and those under 45 years disproportionately affected. Drug-related deaths increased by 47.0% from 115 in 2013 to 169 in 2023 (see reference 1). Among those aged 15-49 years, drug-related deaths ranked as the second leading cause of death – behind suicide for males and behind cancer for females (see main report, Annex 3, Figure 4B).

This study examined personal, household and area characteristics associated with drug-related deaths, providing insights beyond Accredited Official Statistics (see reference 1). This brief is part of a series alongside suicide and alcohol-specific deaths. The full report is available on the NISRA-led research website.

Data source

Analysis used the Northern Ireland Mortality study, linking 2011 Census records to registered deaths from April 2011 to September 2022. The dataset includes 1,094 drug-related deaths (61.7% of all registered drug-related deaths).

Key strengths of NIMS include:

  1. Nationally representative data enabling comparisons of characteristics between those that died and the general population.
  2. Sufficient sample sizes for detailed subgroup analyses.
  3. Supports modelling to quantify mortality risk across diverse groups.

Characteristics

Characteristics of those who died from a drug-related death compared with the general population:

Age and sex:

  • Males accounted for 70.8% of drug-related deaths among 16-64 year-olds (but comprised 48.9% of the general population aged 16-64 years).
  • Males aged 16-44 years: 90.2% of drug-related deaths (but comprised 61.0% of the male population aged 16-64 years).

Marital status:

  • Single individuals: 72.2% of deaths (41.1% of the population).
  • Divorced or separated: 15.5% of deaths (10.2% of the population).

Education and employment:

  • No qualifications: 40.3% of deaths (21.4% of the population).
  • Economically inactive: 53.1% of deaths (27.8% of the population).
  • Unemployed: 14.7% of deaths (5.5% of the population).

Health factors:

  • Self-reported poor mental health: 32.7% of deaths (7.7% of the population).
  • Self-reported disability: 41.9% of deaths (17.2% of the population).

Housing and living arrangements:

  • Social housing residents: 39.3% of deaths (12.8% of the population).
  • Living alone: 27.4% of deaths (10.6% of the population).
  • Children living in lone parent households: 17.0% of deaths (7.2% of the population).

Geographic patterns:

  • Greater Belfast: 45.8% of deaths (34.0% of the population).
  • Urban areas: 83.4% of deaths (63.8% of the population).
  • 31.4% of deaths were in the 20% most deprived areas.

Who faces the highest risk?

Figure 1 shows Hazard Ratios for drug-related deaths by sex, comparing each characteristic with its specific reference group (e.g. married, employed, no disability). Full modelling details are in the main report available at NISRA-led research.

Key modelling insights

Health factors:

  • Self-reported poor mental health was strongly associated with mortality risk, with males (HR: 2.73 when reported alone; HR: 2.44 when reported with other conditions) and females (HR: 1.97 alone; HR: 2.54 with other conditions).
  • Self-reported disability was also associated with increased risk for females (HR: 2.47).

Marital status:

  • Being divorced or separated (vs married) tripled the risk for females (HR 3.05) and nearly doubled the risk for males (HR 1.92).
  • Being single (vs married) was associated with greater risk for females (HR: 2.73).

Housing and living arrangements:

  • Living alone (compared with living as part of a couple household) was associated with increased mortality risk for males (HR: 2.16).
  • For males, being a lone parent in a household was also associated with increased mortality risk (HR: 2.09).
  • Living in social-rented accommodation (vs owner-occupied) was associated with increased risk for females (58%).

Education and employment:

  • For males, having no qualifications (compared to being degree-qualified) was associated with increased mortality risk (HR: 2.82).
  • Unemployed males (vs employed) had over twice the risk (HR 2.10); while economically inactive females (vs employed) had 72% increased risk.

Urban residence:

  • Living in an urban area (compared with rural) was associated with increased risk: 94% for males and 68% for females.

Note: all reference groups are shown in Figure 1.

Discussion

This study confirms known patterns: drug-related deaths are more prevalent among males, younger age groups and urban residents. Beyond this, the analysis uncovers new insights:

  • There are strong links between self-reported poor mental health and drug-related deaths, with notable differences between sexes.
  • Socio-economic and health factors differed by sex: for males, no qualifications and unemployment were associated with increased mortality risk. For females, having a disability, economic inactivity and social-renting increased mortality risk.

Living alone or being a lone parent in a household was associated with increased mortality risk for males while being single, divorced or separated was linked to increased risk for females. However, not all individuals in these groups experience loneliness or social isolation. Rather these characteristics point to areas where targeted support may be beneficial.

Policy context

Northern Ireland’s strategies addressing substance use, mental health and inequalities include:

This research highlights the importance of addressing mental health issues, social isolation, and socio-economic inequalities. Collaboration is ongoing with stakeholders in the Department of Health and in the Public Health Agency to maximise the policy impact of this work.

Further information

Definitions:

  • Economic inactivity: not working or seeking work due to reasons such as long-term illness or caring responsibilities.
  • Unemployment: not working but actively seeking employment.
  • Disability: self-reported health problems or disabilities lasting, or expected to last, at least 12 months and which limit daily activities.
  • Poor mental health: self-reported emotional, psychological or mental health condition (such as depression or schizophrenia).
  • Greater Belfast includes residents of the Belfast, Antrim and Newtownabbey, and Lisburn and Castlereagh Local Government Districts (see reference 2) at the baseline in 2011.

Note: see the main report for full definitions.

Acknowledgements

The help provided by the staff of the Northern Ireland Mortality Study (NIMS) and the NILS Research Support Unit is acknowledged. The NIMS is funded by the Health and Social Care Research and Development Division of the Public Health Agency (HSC R&D Division) and NISRA. The NILS-RSU is funded by the Economic & Social Research Council and the Northern Ireland Government. We also thank colleagues in NISRA, the Department of Health and the Public Health Agency who contributed to the development of this brief.

Contact details

Research team John Hughes, Brian Foley, Jana Ross, Carmel Colohan, and Deborah Lyness (all Administrative Research Unit, NISRA)

For further information on this research, please contact

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