Q and As on “Mortality in the United States, 2016” and “Drug Overdose Deaths in the United States, 1999-2016”

December 21, 2017

Questions for Bob Anderson, Chief of the Mortality Statistics Branch, on the following reports, “Mortality in the United States, 2016” and “Drug Overdose Deaths in the United States, 1999-2016.”

Q: How significant is it that life expectancy¹ in the U.S. has declined two years in a row?

A:  This is the first time life expectancy for the U.S. as a whole has declined two years in a row since 1962 and 1963, years in which there were severe flu outbreaks – and an increase in deaths from flu and pneumonia – in the U.S.


Q:  Since this is very rare, do we have any idea why this decline in life expectancy has happened again?

A:  We first have to look at the leading causes of death and see what is happening there.  For 7 out of the 10 leading causes of death in the U.S., mortality actually declined between 2015 and 2016.  But mortality from 3 causes of deaths increased.  Suicide rates increased 1.5% in 2016, and mortality from Alzheimer’s disease increased 3.1%.  However, mortality from accidents/unintentional injuries increased at a rate over three times that the increase of Alzheimer’s disease mortality – a 9.7% increase between 2015 and 2016.   And many of these accidental/unintentional deaths were from drug overdoses.


Q: How many deaths in 2016 were attributed to opioids?

A: In 2016, 42,249 drug overdose deaths mentioned involvement of any type of opioid, including heroin and illicit opioids.


Q: Why is the 63,632 number of overdose deaths smaller than what CDC has previously reported for 2016?

A: The 63,632 number is a final, official number of overdose deaths among U.S. residents for 2016 whereas the previously reported (and slightly higher) numbers were provisional estimates.

BACKGROUND:  In August of this year, 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 2016 number of 63,632 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: In comparing the 2016 numbers with 2015 and past years, is the crisis of drug overdose deaths growing or about the same?

A: From 2015 to 2016, the number of drug overdose deaths increased from 52,404 deaths to 63,632 deaths, a 21% increase.  Over a longer period of time, from 1999 through 2016, 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 18% per year from 2014 to 2016.  So this is a continuing, disturbing upward trend.


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, doubled in one year, from 3.1 per 100,000 in 2015 to 6.2 per 100,000 in 2016. In 2016, 30% of all drug overdose deaths mentioned involvement of a synthetic opioid other than methadone.


Q: Has fentanyl overtaken heroin as a 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, doubled between 2015 and 2016. In 2016, the rate of drug overdose deaths involving synthetic opioids other than methadone was 6.2 per 100,000 and the rate of drug overdose deaths involving heroin was 4.9 per 100,000.


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

A: As mentioned, mortality from 7 out of the 10 leading causes of death in the U.S. declined in 2016; in fact, the overall mortality rate for the U.S. actually dropped despite the decline in life expectancy.  As for drug overdose deaths, the rate of increase in drug overdose deaths involving natural and semi-synthetic opioids, such as oxycodone and hydrocodone, is slowing. From 1999 to 2009, the rate increased on average by 13% per year but from 2009 to 2016, the rate increased by 3% per year.  And from 2006 to 2016, the rate of drug overdose deaths involving methadone decreased from 1.8 per 100,000 to 1.0 per 100,000.

The 2015 life expectancy estimate was revised to 78.7 years, down from 78.8 years, which was reported a year ago.

¹BACKGROUND: As a routine matter, for the highest degree of accuracy we blend Medicare data for people ages 66 and over with our vital statistics data to get a final, official estimate of life expectancy.  However, the two data sets are released on different schedules and occasionally, as with the 2015 estimates, the Medicare data for that year isn’t available at the time we release our final mortality statistics.


Drug Overdose Deaths Among Adolescents Aged 15-19 in the United States: 1999-2015

August 16, 2017

Questions for Sally Curtin, Statistician and author of “Drug Overdose Deaths Among Adolescents Aged 15-19 in the United States: 1999-2015

Q:  Do trends in overdose deaths among teens reflect the trends of older adults in the U.S.?

SC: There are some similarities, but also differences.  Both teens and older adults experienced the sharp increases from 1999 through the mid-2000s.  But unlike older adults, whose rates continued to increase, teenagers actually had a decline in drug overdose death rates through 2014, before an upturn in 2015.  All of this decline was for males as the rates for females stabilized from 2004-2013 before increasing again.


 

Q: Do we know why trends for teens dropped during the first several years of the millennium?  And why they increased sharply in 2015?

SC: There are many public health initiatives to combat the rising drug overdose death rates.  While we do not know the exact reason for the decline, we know the specific drugs that were involved—opioids, cocaine, and benzodiazepines.  For the opioids, it was the frequently prescribed drugs—methadone and natural and semisynthetic (oxycodone, morphine) that had declines for teens since the mid 2000s.  Other opioids such as heroin and synthetic opioids (including fentanyl) fluctuated but generally increased over the 1999-2915 study period.  The continued rise in drug overdose deaths involving heroin and synthetic opioids from 2014 to 2015 contributed to the uptick between those years.


 

Q: What are the differences in overdose deaths by gender and race?

SC: We did not examine race in this report because the numbers were too small for some groups.  By gender, the drug overdose death rate for males was higher for females for every year of the 1999-2015 period and was 70% higher in 2015.  While males had a greater increase in drug overdose death rates than females between 1999 and the mid-2000s, they also declined by about a third between 2007 and 2014 before increasing again.  The rate in 2015 was still lower than the 2007 peak.  Females had an increase, albeit smaller than for males, and then their rate stabilized between 2004-2013 before increasing again.


 

Q:  What type of drugs are killing these teens?

SC: As for the population at large, the majority of drug overdose deaths involve opioids.  When we examined the specific type of opioid involved, heroin is the leading drug involved and rose fairly steadily throughout the study period.  Synthetic opioids (including fentanyl) were lower than other opioid drugs through the early years of the period, but then doubled between 2014 and 2015.  This large increase for synthetic opioids has also been observed for the population at large.

We did not look at combinations of drugs.  Often, there is more than one drug involved so the categories we show are not mutually exclusive.


Stat of the Day – May 17, 2017

May 17, 2017


Drug Poisoning Mortality: United States, 1999-2015

April 19, 2017

The CDC’s National Center for Health Statistics (NCHS) has released a new data visualization storyboard that presents drug poisoning deaths from 1999 to 2015 at the national, state, and county levels.

The first two dashboards depict U.S. and state trends in age-adjusted death rates for drug poisoning from 1999 to 2015 by selected demographic characteristics, and the third dashboard presents a series of heat maps of model-based county estimates for drug poisoning mortality from 1999 to 2015.

https://www.cdc.gov/nchs/data-visualization/drug-poisoning-mortality/


Has the death rate from drug overdoses in the U.S. increased most rapidly among young people over the last decade and a half?

February 24, 2017

Source: National Vital Statistics System

https://www.cdc.gov/nchs/data/databriefs/db273.pdf


QuickStats: Rates of Drug Overdose Deaths Involving Heroin by Selected Age Groups — United States, 2006–2015

January 9, 2017

The rate of drug overdose deaths involving heroin increased slightly during 2006–2010 but more than tripled during 2010–2015 for all age groups shown.

During 2010–2015, the rates increased from 1.2 to 3.8 per 100,000 for persons aged 15–24 years, from 2.2 to 9.7 for persons aged 25–34 years, from 1.6 to 7.4 for persons aged 35–44 years, from 1.4 to 5.6 for persons aged 45–54 years, and from 0.7 to 3.4 for persons aged 55–64 years.

In 2015, the rate of drug overdose deaths involving heroin was highest for persons aged 25–34.

Source: https://www.cdc.gov/mmwr/volumes/65/wr/mm6552a12.htm


Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2010–2014

December 20, 2016
Dr. Margaret Warner, Senior Epidemiologist

Dr. Margaret Warner, Senior Epidemiologist

Questions for Margaret Warner, Senior Epidemiologist  and Lead Author on “Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2010–2014.”

Q: Why did you decide to do a report on drugs most frequently involved in drug overdose deaths?

MW: From our routine mortality statistics, we know that drug overdose death rates are increasing, and we have some insight into the classes of drugs involved. This report presents findings from a new method we developed to identify the specific drugs involved in drug overdose deaths, which gives us a more complete and granular understanding of the problem.


Q: Do you have 2015 data on drug overdose deaths? If not, when do you anticipate this being released?

MW: NCHS just released the 2015 mortality data at the beginning of December. CDC released an MMWR last week describing drug overdose deaths in 2015 and some of the drug classes involved. NCHS is currently analyzing the 2015 literal text data using the new method to report on the specific drugs, and plan to have those results available soon.


Q: How has the number of drug overdose deaths changed from 2010 to 2014?

MW: From 2010 through 2014, the number of drug overdose deaths per year increased 23%. During this 5-year period, the age-adjusted rate of drug overdose deaths involving heroin more than tripled, and the rate of drug overdose deaths involving methamphetamine more than doubled.

The rate of drug overdose deaths involving fentanyl more than doubled in a single year (from 2013 to 2014). Fentanyl went from the 9th most common drug involved in overdose deaths in 2013 to the 5th most common in 2014.


Q: What are the most prevalent drugs involved in drug overdose deaths?

MW: The 10 drugs most frequently involved in overdose deaths included the following opioids: heroin, oxycodone, fentanyl, morphine, methadone, and hydrocodone; the following benzodiazepines: alprazolam and diazepam; and the following stimulants: cocaine and methamphetamine.


Q: Were there any findings that surprised you?

MW: We suspected that multidrug toxicity played a role in drug overdose deaths, and this analysis revealed that nearly half of these deaths where at least one drug was mentioned on the death certificate, involved more than one drug. We were surprised that the top 10 drugs were often mentioned in combination with each other. We were also pleasantly surprised to find that the reporting on specific drugs improved with the percentage of death certificates mentioning at least one specific drug increasing from 67% in 2010 to 78% in 2014.


NCHS Data on Drug Poisoning Deaths

July 23, 2015

Poisoning is the leading cause of injury death in the United States. Drugs—both pharmaceutical and illicit—cause the vast majority of poisoning deaths.

NCHS uses the National Vital Statistics System (NVSS) to monitor deaths due to drug poisoning. NVSS collects and compiles mortality information from death certificates in all 50 states and the District of Columbia. NCHS identifies the number of drug poisoning deaths from the underlying cause of death on death certificates. Multiple causes of death are used to identify the drugs involved. Approximately 23% of drug poisoning deaths lack information on the specific drugs involved.

An NCHS fact sheet highlights trends in drug-poisoning deaths involving opioid analgesics (referred to as opioid-analgesic poisoning deaths).

Recent Findings

  • Since 2000, the age-adjusted drug poisoning death rate more than doubled, from 6.2 per 100,000 in 2000 to 13.8 per 100,000 in 2013.
  • In 2013, 43,982 deaths were due to drug poisoning; 81% of these deaths were unintentional, 12% were suicides, and 6% were of undetermined intent.
  • In 2011, opioid analgesics were involved in 41% of drug poisoning deaths (16,917 deaths); in 2013, that decreased to 37% (16,235 deaths).
  • The age-adjusted rate for deaths involving opioid analgesics more than tripled from 1.5 per 100,000 in 2000 to 5.4 per 100,000 in 2011, then declined to 5.1 per 100,000 in 2012 and 2013.
  • Nearly 70% of the opioid analgesic poisoning deaths in 2013 involved natural and semisynthetic opioid analgesics such as hydrocodone, morphine, and oxycodone

Drug-poisoning Deaths Involving Heroin: United States, 2000–2013

March 4, 2015

Drug poisoning (overdose) is the number one cause of injury-related death in the United States, with 43,982 deaths occurring in 2013. While much attention has been given to deaths involving opioid analgesics, in recent years there has been a steady increase in the number of drug-poisoning deaths involving heroin. A recent study using data from 28 states reported that the death rate for heroin overdose doubled from 2010 through 2012.

Using data from the National Vital Statistics System, a new NCHS report provides a description of trends and demographics for heroin-related drug-poisoning deaths in the United States from 2000 through 2013.

Key Findings from the Report:

  • From 2000 through 2013, the age-adjusted rate for drug-poisoning deaths involving heroin nearly quadrupled from 0.7 deaths per 100,000 in 2000 to 2.7 deaths per 100,000 in 2013. Most of the increase occurred after 2010.
  • The number of drug-poisoning deaths involving heroin was nearly four times higher for men (6,525 deaths) than women (1,732 deaths) in 2013.
  • In 2000, non-Hispanic black persons aged 45–64 had the highest rate for drug-poisoning deaths involving heroin (2.0 per 100,000). In 2013, non-Hispanic white persons aged 18–44 had the highest rate (7.0 per 100,000).
  • From 2000 through 2013, the age-adjusted rate for drug-poisoning deaths involving heroin increased for all regions of the country, with the greatest increase seen in the Midwest.

 


Increase in poisonings from opioid painkillers

October 1, 2009

NCHS recently released the report titled “Increase in Fatal Poisonings Involving Opioid Analgesics in the United States, 1999-2006.” This report shows the explosion of fatal poisonings from opioid painkillers over the past 7 years. For example, from 1999 through 2006, the number of fatal poisonings involving opioid analgesics more than tripled from 4,000 to 13,800 deaths. Opioid analgesics were involved in almost 40% of all poisoning deaths in 2006.The differences among states is also striking:


Age-adjusted death rates for poisonings involving opioid analgesics: Comparison of state and U.S. rates: United Stats, 2006

For more information, visit the report at http://www.cdc.gov/nchs/data/databriefs/db22.htm.