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Mortality rates due to substance use, intentional injuries vary widely in US

Mortality rates varied substantially among counties in the United States from 1980 to 2014, increasing by 618.3% for drug use disorders and decreasing by 8.1% for alcohol use disorders, 6% for self-harm and 44.9% for interpersonal violence, according to research published in JAMA.

“Existing studies of spatial patterns in mortality from self-harm and interpersonal violence are primarily from the 1980s and 1990s, and more timely data on local-level trends are unavailable,” Laura Dwyer-Lindgren, PhD, Institute for Health Metrics and Evaluation, University of Washington, and colleagues wrote. “Additionally, studies of drug poisoning have failed to distinguish between accidental and intentional overdoses (ie, overdoses intended to self-inflict harm or to harm others), despite important differences in the underlying etiology of unintentional and intentional overdoses.”

Using a small-area estimation method, researchers examined age-standardized mortality rates by U.S. county due to substance use disorders — including alcohol use disorders and drug use disorders — and intentional injuries — including self-harm and interpersonal violence — from 1980 to 2014. They applied the estimation models to deidentified death records from the National Center for Health Statistics and population counts to estimate county-level mortality rates. The investigators measured deaths by county, age group, sex, year and underlying cause.

Over the 34-year span, substance use disorders and intentional injuries accounted for 2,848,768 deaths in the U.S. Alcohol use disorders accounted for 256,432 deaths, drug use disorders for 542,501, self-harm for 1,289,086 and interpersonal violence for 760,749. By county, the mortality rates varied substantially.

While the national age-standardized mortality rate from alcohol use disorders lessened by 8.1% between 1980 and 2014, more counties saw growing mortality rates (65.4%) than declining. Counties with the highest increases were mainly in the Northern and Western U.S. whereas those with considerable decreases were in South Carolina, North Carolina, Virginia, Georgia, Florida and Alaska.

The national rate of drug use-related deaths increased 618.3% between 1980 and 2014, “largely due to increasing numbers of deaths from both prescription and nonprescription opioid overdoses,” according to Dwyer-Lindgren and colleagues. These rates increased in every county, though the scale of this growth varied regionally, with counties located in Kentucky, West Virginia, Ohio, Indiana and eastern Oklahoma seeing the largest increases.

For self-harm, mortality rates dropped by 6% nationally; however, most counties (74.6%) saw an increase in self-harm mortality, particularly in Alaska, Utah, Arkansas, Montana, North Dakota, Oklahoma, Tennessee, Colorado, Indiana, Kentucky, Maryland, Michigan, South Dakota and Texas. For interpersonal violence, the national mortality rate dropped by 44.9% between 1980 and 2014. Most counties also experienced a decrease — with the largest decreases seen in Virginia, Georgia, Florida, Texas, California and New York — but those in northern Midwestern and Atlantic states saw increases.

“The findings in this study may help clinicians, local health authorities and policymakers address the burden of substance use disorders and intentional injuries in their communities,” the authors wrote. “There are important opportunities to more closely examine counties and communities with notably high or low mortality rates or particularly substantial increases or decreases in the mortality rate over time. Such research could facilitate identifying potential solutions to these problems that might include social, cultural, legal, policy or health service–related approaches.” – by Savannah Demko

Disclosures: The authors report no relevant financial disclosures.