Unintentional Injury Death Rates in Rural and Urban Areas: United States, 1999–2017

July 16, 2019

Questions for Lead Author Henry Olaisen, EIS Fellow, of “Unintentional Injury Death Rates in Rural and Urban Areas: United States, 1999–2017.”

Q: Can you define what an unintentional injury death is?  Is there a difference in the term accidental death?

HO: Unintentional injury deaths consist of those deaths involving injuries for which there are no evidence of predetermined intent, meaning intention of harm to self or others. In 2017, the leading causes of unintentional deaths in the U.S. were drug overdose, motor vehicle crashes, and falls.

Unintentional injury deaths are a subset of injury deaths, and exclude those that are intentional (e.g. where there is intent to harm) and those where intent is unknown. Among drug overdose deaths, unintentional drug deaths comprise 87% of all deaths due to overdose.


Q: Do you have data that directly corresponds with this report that goes back further than 1999?

HO: We here at the CDC’s National Center for Health Statistics have data dating back to 1959. Given our focus on unintentional injury and the changing patterns of where people live and work in the U.S., we focused on the most recent 18 years, as they are trend patterns that not only tell an important story, but can guide decision-makers and inform new policies to avoid these types of preventable deaths in the near future.


Q: Was there a specific finding in your report that surprised you?

HO: We were surprised that drug overdose death rates are not only growing fastest in the last three years in suburban counties (“large fringe counties”), but that the rate of drug overdose deaths is now (in 2017) highest in small metro and suburban counties(“large fringe counties), and lowest in rural counties.


Q: Why do you think there is a difference in unintentional injury deaths from rural and urban areas?

HO: We observed differences in trends and patterns of unintentional injury deaths using mortality data from the   National Center for Health Statistics. Determining the reasons for the difference is a really important next step, and not something we looked at in this report. We at the National Center for Health Statistics encourage scientists to use these data to help us understand the underlying causes for these observed trends and patterns.


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

HO: Unintentional injury death rates – which are preventable deaths, are on the rise, with a steeper increase since 2014. Between 2014 and 2017, large fringe metro counties had the largest increase in unintentional drug overdose rates; small metro had the largest increase in motor vehicle death rates; and rural counties had the largest increase in death rates due to unintentional falls. While motor vehicle deaths have historically been the leading cause of unintentional deaths for several decades, in 2013 unintentional overdose deaths became the leading cause of unintentional deaths.


2017 Final Deaths, Leading Causes of Death and Life Tables Reports Released

June 24, 2019

NCHS released a report that presents the final 2017 data on U.S. deaths, death rates, life expectancy, infant mortality, and trends, by selected characteristics such as age, sex, Hispanic origin and race, state of residence, and cause of death.

Key Findings:

  • In 2017, a total of 2,813,503 deaths were reported in the United States.
  • The age-adjusted death rate was 731.9 deaths per 100,000 U.S. standard population, an increase of 0.4% from the 2016 rate.
  • Life expectancy at birth was 78.6 years, a decrease of 0.1 year from the 2016 rate.
  • Life expectancy decreased from 2016 to 2017 for non-Hispanic white males (0.1 year) and non-Hispanic black males (0.1), and increased for non-Hispanic black females (0.1).
  • Age-specific death rates increased in 2017 from 2016 for age groups 25–34, 35–44, and 85 and over, and decreased for age groups under 1 and 45–54.
  • The 15 leading causes of death in 2017 remained the same as in 2016 although, two causes exchanged ranks.
  • Chronic liver disease and cirrhosis, the 12th leading cause of death in 2016, became the 11th leading cause of death in 2017, while Septicemia, the 11th leading cause of death in 2016, became the 12th leading cause of death in 2017.
  • The infant mortality rate, 5.79 infant deaths per 1,000 live births in 2017, did not change significantly from the rate of 5.87 in 2016.

NCHS also released the 2017 U.S. Life Tables and Leading Causes of Death Reports.


Updated Provisional Drug Overdose Death Data: 12-Month Ending from November 2017- November 2018

June 12, 2019

Link: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm


Updated Provisional Drug Overdose Death Data: 12-Month Ending from October 2017- October 2018

May 15, 2019

Link: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm


Drug Overdose Deaths Involving Fentanyl, 2011–2016

March 21, 2019

Questions for Lead Author Merianne Spencer, M.P.H., Health Statistician, of “Drug Overdose Deaths Involving Fentanyl, 2011-2016.”

Q: Why did you decide to do a report specifically on drug overdose deaths involving fentanyl?

MS: Fentanyl, a synthetic opioid, is of interest to public health officials because of its increased involvement in drug overdose deaths and contributing role in the opioid epidemic. Understanding trends in drug overdose deaths involving fentanyl by demographic and regional characteristics can provide insights to better target interventions for populations at risk and to inform agencies working to combat this public health problem.


Q: Do you have any data that is more recent than 2016? 

MS: Mortality data for deaths occurring in 2017 are currently available for research use.  However, these data were not available at the time of the analysis for this study, and the text analyses required for preparing this report are time intensive.


Q: How did drug overdose deaths involving fentanyl vary by age, sex and race?

MS: The rates for drug overdose deaths involving fentanyl varied by age with the largest rates among adults aged 25-34 and 35-44. Exponential increases occurred in all age groups, with the greatest increases per year among adults aged 35-44, 25-34 and 15-24.

The rates for males and females were similar in 2011, 2012 and 2013.  In 2013, the rates for males and females began to diverge such that by 2016, the rate for males (8.6 per 100,000) was roughly 2.8 times the rate for females (3.1).

For race/ethnicity, non-Hispanic whites had higher rates than non-Hispanic blacks and Hispanics for the entire study period.  However, the annual percentage changes were greater among non-Hispanic blacks and Hispanics.


Q: Was there a specific finding in your report that surprised you?

MS: I was surprised to see how high the average annual percentage change in rates was for teenagers and young adults aged 15-24. While the death rate for this age group was not as high as the rates for persons aged 25-34 and 35-44, the average annual percentage increase in the rate was among the greatest, increasing an average of almost 94% each year from 2011 through 2016.


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

MS: The rise in drug overdose deaths involving fentanyl was noticeable in certain subpopulations and regions.  Overall, death rates, which were stable in 2011 and 2012, significantly increased from 2013 through 2016.

Death rates for males and females were similar in 2011 and 2012, but then diverged, with rates for males increasing faster than the rate for females starting in 2013. Non-Hispanic whites had the highest death rates; however, the rates for non-Hispanic blacks and Hispanics increased at a greater pace than those for non-Hispanic whites.  All age groups had increasing rates, but the greatest increases were among those aged 15-24, 25-34 and 35-44.  There were also regional differences, with the highest rates and greatest increase in rates occurring in the East Coast and Upper Midwest regions.


Updated Provisional Drug Overdose Death Data: 12-Month Ending from August 2017-August 2018

March 13, 2019

Link: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm


Updated Provisional Drug Overdose Death Data: 12-Month Ending from July 2017-July 2018

February 13, 2019

Link: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm


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.


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.


QuickStats: Age-Adjusted Death Rates for Drug Overdose by Race/Ethnicity — National Vital Statistics System, United States, 2015–2016

April 2, 2018

During 2015–2016, the age-adjusted death rates from drug overdose for the total population increased from 16.3 per 100,000 standard population to 19.8 (21.5%).

The rate increased from 21.1 to 25.3 (19.9%) for non-Hispanic whites, from 12.2 to 17.1 (40.2%) for non-Hispanic blacks, and from 7.7 to 9.5 (23.4%) for Hispanics.

Source: National Vital Statistics System, Underlying cause of death data, 1999–2016. https://wonder.cdc.gov/ucd-icd10.html.

https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a9.htm