Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011–2016

December 12, 2018

Questions for Lead Author Holly Hedegaard, M.D., M.S.P.H., Health Statistician, and author of “Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011–2016.”

Q: Is there a specific finding in this report that surprised you?

HH: During the six years of the study, the relative ranking of the drugs most frequently involved in drug overdose deaths changed. In 2011, the drug most frequently involved in drug overdose deaths was oxycodone, in 2012-2015 was heroin and in 2016 was fentanyl. In 2016, fentanyl was involved in nearly 30% of the drug overdose deaths in the United States.

The drugs most frequently involved in drug overdose deaths also varied by the intent of the death. In 2016, the drugs most frequently involved in unintentional (accidental) drug overdose deaths were fentanyl, heroin and cocaine, while the drugs most frequently mentioned in suicides by drug overdose were oxycodone, diphenhydramine, hydrocodone, and alprazolam.


Q: How is the data in this report different from the recently released drug overdose data brief and provisional drug overdose numbers produced by NCHS?

HH: The drug overdose data brief and the provisional drug overdose numbers produced by NCHS involve analysis of death certificate data coded using the International Classification of Diseases, Tenth Revision (ICD-10). One limitation of this classification system is that, with a few exceptions, ICD–10 codes reflect broad categories of drugs rather than unique specific drugs.

In the National Vital Statistics Report, NCHS uses data from the literal text on death certificates to identify the specific drugs involved in the death. Using this method, we can look at the number of deaths involving specific drugs, such as oxycodone, hydrocodone, or fentanyl, for example, rather than be limited to the broader categories found with ICD-10 coded data, such as natural and semi-synthetic opioids or synthetic opioids other than methadone.


Q: What did your report find on the percentage of drug overdose deaths mentioning at least one specific drug or substance?

HH: Using the literal text to identify the specific drugs involved is dependent on whether or not the specific drugs are reported on the death certificate. The specificity of reporting has improved in recent years. In 2011, the specific drugs or drug classes involved were reported for 78% of drug overdose deaths; in 2016, the reporting increased to nearly 88% of drug overdose deaths.


Q: Do you have data that goes further back than 2011?

HH:  A previous report looked at the drugs most frequently involved in drug overdose deaths in 2010-2014. That report is available at https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_10.pdf


Q: Do you have data on drugs most frequently involved in drug overdose deaths that goes up to 2017?  If not, when do you expect that will be available?

NCHS does not currently have information on the drugs most frequently involved in drug overdose deaths in 2017. NCHS is currently preparing the data files for analysis. The results for 2017 will be available in 2019.


Q: What is the take home message for this report?

HH: The patterns in the specific drugs most frequently involved in drug overdose deaths can change from year to year. Complete and accurate reporting in the literal text on death certificates of the specific drugs involved provides critical information needed for understanding and preventing drug overdose deaths.

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Early Release of Selected Estimates Based on Data From January-June 2018 National Health Interview Survey

December 6, 2018

Questions for Lead Author Tainya C. Clarke, Ph.D., M.P.H., Health Statistician, of “Early Release of Selected Estimates Based on Data From January-June 2018 National Health Interview Survey.”

Q: What are some of the findings that you would highlight in this early release report?

TC:  Diabetes and obesity continue to increase among U.S. adults.  The prevalence of diagnosed diabetes among adults aged 18 and over increased from 7.8% in 2006 to 10.2% in January–June 2018.  During the same period the prevalence of obesity among U.S. adults aged 20 and over increased from 26.4%  to 31.7%.


Q: What do the findings in this report tell us about the health of the country overall?

TC:  The health of our nation is multifaceted and quite complex. While we make improvements in some areas, such as increased leisure time physical activity and declining smoking rates, other areas leave a lot to be desired. The prevalence of diabetes and obesity continue to rise.


Q: Are there any trends in this report that Americans should be concerned about?

TC: Yes, the observed increase in the prevalence of diabetes and obesity, suggests that Americans need to work towards achieving a healthy balance between dietary intake and exercise.


Q: Why did you decide to only look back to 2006?  Previous NHIS Early Release reports went back to 1997?

TC: The Early Release Key Health Indicators report transitioned from static quarterly reports to a dynamic report back in June 2018. In the previous format, we included estimates back to 1997, but the trend results were getting unwieldy to produce and interpret on a quarterly basis.  Thus, we made the decision to start the trends at 2006 for the newer format.  Readers can still go back and view the static reports and combined with the dynamic report, they can construct the longer trend.


Q: What is the take home message for this report?

TC: Americans are making significant improvement is some aspects of health, but are falling short in others.


Mortality in the United States, 2017

November 29, 2018

Questions and Answers from the authors of the recently released 2017 mortality data.  The data can be found in the following reports, “Mortality in the United States, 2017, ” “Drug Overdose Deaths in the United States, 1999–2017, ” and “Suicide Mortality in the United States, 1999–2017.”

Q: Why did life expectancy decline in 2017?

A: Mortality rates increased for 7 out of the 10 leading causes of death in the U.S., including a 5.9% increase in the flu/pneumonia death rate, a 4.2% increase in the accidental/unintentional injury death rate, and 3.7% in the suicide rate. Many of the accidental/unintentional deaths were from drug overdoses, which continued to increase in 2017.


Q: Isn’t this the third straight year that life expectancy declined?

A: Estimated life expectancy at birth in 2017 was 0.3 years lower than in 2014 and 0.1 years lower than in 2016. The 2016 life expectancy estimate was revised to 78.7 years, up from an estimated 78.6 years, which was reported a year ago. This means that the 2016 life expectancy estimate is the same as the 2015 estimate, which also was revised to 78.7 years, down from an estimated 78.8 years, originally reported two years ago. As a routine matter, for the highest degree of accuracy, NCHS blends Medicare data for people ages 66 and over with our vital statistics data to estimate life expectancy. However, the two data sets are released on different schedules. When Medicare data for a year aren’t available at the time we release our final mortality statistics, we use the most recent Medicare data available at the time. We later revise life expectancy estimates when updated Medicare data become available.


Q: How many deaths in 2017 were attributed to opioids?

A: In 2017, 47,600 drug overdose deaths mentioned involvement of any type of opioid, including heroin and illicit opioids, representing over two-thirds of all overdose deaths (68%).


Q: Why is the 70,237 number of overdose deaths smaller than what CDC has previously reported for 2017?

A: The 70,237 number is a final, official number of overdose deaths among U.S. residents for 2017 whereas the previously reported (and slightly higher) numbers were provisional estimates. In August of 2017, CDC began calculating monthly provisional data on counts of drug overdose deaths as a rapid response to this public health crisis, in order to provide a more accurate, closer to “real-time” look at what is happening both nationally and at the state level. These monthly totals are provisional counts, and they include all deaths occurring in the U.S. – which include deaths among non-residents (i.e., visitors here on business or leisure, students from abroad, etc). These counts also do not include deaths that are still under investigation. As a result, the monthly numbers are provisional or very preliminary, and the final 2017 number of 70,237 deaths is an official number that only include deaths among U.S. residents and account for any previously unresolved deaths that were under investigation.


Q: Does this mean that the 70,237 total does not include deaths to undocumented immigrants here in the U.S.?

A: We don’t get immigration status off the death certificates, so we wouldn’t know how many of the deaths were to undocumented immigrants.


Q: In comparing the 2017 numbers with 2016 and past years, is the crisis of drug overdose deaths growing or about the same?

A: From 2016 to 2017, the number of drug overdose deaths increased from 63,632 deaths to 70,237, a 10% increase, which is a smaller increase compared to the 21% increase from 2015 to 2016, when the number of drug overdose deaths increased from 52,404 deaths to 63,632 deaths. Over a longer period of time, from 1999 through 2017, the age-adjusted rate of drug overdose deaths increased on average by 10% per year from 1999 to 2006, by 3% per year from 2006 to 2014, and by 16% per year from 2014 to 2017. So the trend is continuing, although the increase in 2017 was not as large as in previous years.


Q: Are there any other trends of significance when looking at the types of drugs attributed to overdose deaths?

A: The rate of drug overdose deaths involving synthetic opioids other than methadone, which include drugs such as fentanyl, fentanyl analogs, and tramadol, increased 45% in one year, from 6.2 per 100,000 in 2016 to 9.0 per 100,000 in 2017. In 2017, 40%(?) of all drug overdose deaths mentioned involvement of a synthetic opioid other than methadone.


Q: Has fentanyl overtaken heroin as the major cause of overdose death?

A: The data brief on drug overdose deaths does not specifically address fentanyl. However the rate of drug overdose deaths involving synthetic opioids other than methadone, which includes fentanyl, increased 45% 2016 and 2017 whereas the overdose death rate from heroin did not change (4.9 deaths per 100,000).


Q: There is a lot of stark news in these three reports. Are there any positives to report?

A: The cancer mortality rate declined between 2016 and 2017, and although estimated life expectancy declined in 2017, life expectancy for people at age 65 actually increased. Also, regarding drug overdose deaths, the rate of increase in drug overdose deaths slowed between 2016 and 2017, although the increases that occurred were still very significant.


Infant Mortality by Age at Death in the United States, 2016

November 16, 2018

Questions for Danielle Ely, Ph.D., Health Statistician and Author of “Infant Mortality by Age at Death in the United States, 2016

Q:  What made you decide to focus on the age when infants die in this new analysis of infant mortality in the United States?

DE:  We focused this study on the age when infants die for a number for reasons. Age at death is an important factor in the risk of infant mortality. One important statistic is that infants are more likely to die before 28 days of age (neonatal deaths) than infants who live to 28 days and older (postneonatal deaths.) By presenting infant mortality rates by age at death, we show the differences in the likelihood of death between these two infant groups — information that can help inform the U.S. Public Health Community, families, and physicians on this critical age factor in infant lives and deaths.


Q:  What sort of trend data do you have for the demographics and the cause of death data in your new study on infant mortality at the age of death?

DE:  We have interesting trend data here in this report, as well as other public-use resources that are available for further research and data. Our new report looks at the overall trends in infant, neonatal and postneonatal mortality rates from 2007 (the most recent peak in infant mortality) through 2016. For 2016, we looked at infant mortality rates by mother’s race and Hispanic origin and age and cause of death.


Q:  Was there a result in your study’s analysis of infant mortality at the age of death that you hadn’t expected and that really surprised you?

DE:  An important finding in this study is the lack of improvements to infant mortality. Since infant mortality had been on the decline in the United States for much of the last two decades, it was surprising that the infant mortality rate did not show significant declines from 2011-2016. Another recent report also showed a similar lack of improvement in fetal/perinatal mortality rates from 2014 through 2016.


Q:  What differences, if any, did you see in infant mortality among race and ethnic groups, or any other demographics?

DE:  The sometimes substantial differences among race and Hispanic origin groups in this report on infant mortality are noteworthy. We found that infants of non-Hispanic black mothers continue to have total, neonatal, and postneonatal mortality rates that were more than two times as high as infants of non-Hispanic white, Asian or Pacific Islander, or Hispanic mothers. Infants of American Indian or Alaska Native mothers had the next highest rates and had postneonatal mortality rates that were similar to infants of non-Hispanic black mothers.


Q:  What would you say is the take-home message of this report?

DE:  The most important message from this data brief is the lack of improvement in total infant mortality rates since 2011. Neonatal infants of all race and Hispanic origin groups we examined have higher mortality rates than postneonatal infants. Further, infants of non-Hispanic black women continue to have a higher risk of mortality than infants of non-Hispanic white, Asian or Pacific Islander, American Indian or Alaska Native, or Hispanic mothers. This information can further our understanding of current infant mortality trends and provide information on where improvements can be made.


Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–June 2018

November 15, 2018

A new report from NCHS presents selected estimates of health insurance coverage for the civilian noninstitutionalized U.S. population based on data from the 2018 National Health Interview Survey, along with comparable estimates from previous calendar years. Estimates for the first 6 months of 2018 are based on data for 39,112 persons.

Key Findings:

  • In the first 6 months of 2018, 28.5 million persons of all ages (8.8%) were uninsured at the time of interview—not significantly different from 2017, but 20.1 million fewer persons than in 2010.
  • In the first 6 months of 2018, among adults aged 18–64, 12.5% were uninsured at the time of interview, 20.0% had public coverage, and 69.2% had private health insurance coverage.
  • In the first 6 months of 2018, among children aged 0–17 years, 4.4% were uninsured, 43.4% had public coverage, and 53.6% had private health insurance coverage.
  • Among adults aged 18–64, 69.2% (137.1 million) were covered by private health insurance plans at the time of interview in the first 6 months of 2018. This includes 4% (7.9 million) covered by private health insurance plans obtained through the Health Insurance Marketplace or state-based exchanges.
  • The percentage of persons under age 65 with private health insurance enrolled in a high-deductible health plan increased, from 43.7% in 2017 to 46.0% in the first 6 months of 2018.

Fact or Fiction: Is yoga is the fastest-growing complementary health approach among children and adults in the United States?

November 8, 2018

 


Use Of Yoga and Meditation Becoming More Popular in U.S.

November 8, 2018

The use of yoga and meditation has increased in the U.S., according to two new reports released by the CDC’s National Center for Health Statistics (NCHS).

The first report “Use of Yoga, Meditation, and Chiropractors Among U.S. Adults Aged 18 and Older” examines changes from 2012 to 2017 in the percentage of U.S. adults that used yoga, meditation and chiropractors in the past 12 months. Of the three complementary health approached presented, yoga was the most commonly among U.S. adults in 2012 (9.5%) and 2017 (14.3%). The use of meditation increased more than threefold from 4.1% in 2012 to 14.2% in 2017.

The second report released today, “Use of Yoga, Meditation and Chiropractors Among U.S. Children Aged 4–17 Years,” reveals that U.S. children aged 4-17 years who used yoga in the past 12 months increased significantly from 3.1% in 2012 to 8.4% in 2017. Further examination of 2017 data showed that girls were more likely than boys to have used yoga in the past 12 months (11.3% vs. 5.6%).

Other findings documented in the reports:

  • In 2017, the use of yoga among U.S. adults aged 18-44 (17.9%) was more than twice that of adults 65 years and older (6.7%).
  • In 2017, non-Hispanic white adults were more likely to use yoga (17.1%) and see a chiropractor (12.7%) in the past 12 months compared with Hispanic (8% and 6.6%, respectively) and non-Hispanic black (9.3% and 5.5%, respectively) adults.
  • The use of yoga, meditation and chiropractors saw a significant increase from 2012 to 2017, among U.S. adults.
  • Use of meditation increased significantly for U.S. children from 0.6% in 2012 to 5.4% in 2017.
  • Older U.S. children aged 12-17 were more likely to have used meditation (6.5%) and a chiropractor (5.1%) than younger children aged 4-11 (4.7% and 2.1% respectively) in 2017.
  • There was no significant difference in the use of a chiropractor for children from 2012 to 2017.

The two reports, “Use of Yoga, Meditation, and Chiropractors Among U.S. Adults Aged 18 and Older” and “Use of Yoga, Meditation and Chiropractors Among U.S. Children Aged 4–17 Years” are available on the NCHS web site at www.cdc.gov/nchs.