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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Health, United States, 2017

September 20, 2018

Renee Gindi, Ph.D., Chief, Analytic Studies Branch, Office of Analysis and Epidemiology

Questions for Renee Gindi, Ph.D., Chief, Analytic Studies Branch, Office of Analysis and Epidemiology, who led production of “Health, United States, 2017”

Q: Why did you produce this report?

RG: We produced this report for a number of reasons. Health, United States, 2017 with Special Feature on Mortality is the 41st edition of the Congressionally-mandated annual report on the health of the nation from the Secretary of the Department of Health and Human Services to the President of the United States and to Congress.

This report benefits the public health community and the general public by bringing key national health data from different sources into one location. In this wide-ranging report, users can find graphs, tables, and descriptions of trends and current information on selected measures of health and disease. The Special Feature section of the report more closely examines a topic of public health interest and policy relevance.

Q: What made you decide to focus on deaths in the United States as the Special Feature for this study?

RG: It was the recent decrease in life expectancy at birth that caused us to want to look more deeply into what groups were most affected by this marked change. Life expectancy at birth decreased for the first time since 1993 by 0.2 years between 2014 and 2015 and then decreased another 0.1 years between 2015 and 2016. We found that between 2000 and 2016, death rates for 5 of the 12 leading causes of death increased: unintentional injuries, Alzheimer’s disease, suicide, chronic liver disease, and septicemia.

Q: Was there a finding in this edition of “Health, United States” that you hadn’t expected and that really surprised you?

RG: In addition to the decrease in life expectancy at birth, we found several trends that were particularly noteworthy. Here are a few of them:

  • The increases (and acceleration of those increases) in death rates for specific causes of death in specific age groups:
    • In particular, drug overdose death rates among men aged 25–34 increased by an average of 26.7% per year during 2014-2016. For women aged 15-24, drug overdose death rates increased by an average of 19.4% per year during 2014-2016.
    • The suicide rate among children and young adults aged 15-24 has been increasing since 2006, with a recent increase of 7.0% per year during 2014-2016.
    • The rate of deaths from Alzheimer’s among adults aged 65 and older has also been increasing, by an average of 6.9% per year during 2013-2016.
  • Current cigarette smoking has been decreasing among adults (18+), with declines observed in every age group in recent years.
  • Among adolescents, cigarette smoking in the past 30 days has decreased between 2011 and 2016, but e-cigarette use in the past 30 days has increased more than seven-fold, from 1.5% in 2011 to 11.3% in 2016.
  • The rate of births to teen mothers has been decreasing in recent years among all races and ethnic groups examined.

Q: What is new in the report this year?

RG: There are a couple of new items worth highlighting from this year’s edition of Health, United States. The Special Feature on mortality, with its look at when, why, and where individuals are dying in the United States, is a new focus this year.

Also new this year is the examination of trends in disability and functional limitation using a new data source, the Washington Group Short Set on Functioning (WG-SS). These questions are considered the international standard and replace the questions used to describe disability in previous editions of Health, United States.

Health, United States, 2017 includes information on the functional status of civilian noninstitutionalized adults. Level of difficulty in six basic, universal domains—seeing, hearing, mobility, communication, cognition (remembering or concentrating), and self-care—identify the population with disability, namely those at greater risk than the general population for participation restrictions due to these, if appropriate accommodations are not made. Functional status is summarized using three mutually exclusive categories: “a lot of difficulty” or “cannot do at all/unable to do” in at least one domain; “some difficulty” in at least one domain but no higher level of difficulty in any domain;  and those with “no difficulty” in all domains.

Q: What does this publication tell us about the health of our nation?

RG: This year’s Health, United States publication tells us a lot about the health of our nation. The overall age-adjusted death rate has decreased between 2006 and 2016 by 8%, from 791.8 to 728.8 deaths per 100,000 resident population. However, the majority of deaths (73%) are among persons aged 65 and older. The death rates for nearly all of the leading causes of death in this age group have been decreasing since 2006, including heart disease and cancer, the two leading causes of death in this age group.

However, the death rates in other age groups paint a different picture. Among persons aged 15-24, 25-44 and 45-64, death rates for several causes have been increasing in recent years—including unintentional injuries, suicide, homicide, and chronic liver disease.

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2015 Restricted-Use Linked Mortality Files

February 21, 2018

NCHS survey data have been linked to the National Death Index data containing information on mortality status, date of death, and cause of death.  These data can be accessed in the NCHS Research Data Center (RDC) or at a federal statistical RDC managed by the U.S. Census Bureau.

The restricted-use Linked Mortality File (LMF) has been updated with mortality follow-up data through December 31, 2015  https://go.usa.gov/xnMTW

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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.

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Stat of the Day – November 7, 2017

November 7, 2017

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Mortality in the United States, 2015

December 8, 2016

Questions for Jiaquan Xu, Epidemiologist and Lead Author on “Mortality in the United States, 2015.”

Q: Is it true that death rates in the U.S. have been increasing over the past few years?

JX: Not exactly. The age-adjusted death rate for total US population increased 1.2% from 724.6 per 100,000 standard population in 2014 to 733.1 in 2015. This was the first significant increase since 1999. We have seen the decrease in mortality for most race/ethnic groups in most of years since 2006. Especially the rates decreased significantly for all male, all female, non-Hispanic white male, non-Hispanic white female, non-Hispanic black male, non-Hispanic black female, Hispanic male, and Hispanic female in 2014 from 2013.

Q: What are some of the reasons why the death rate increased between 2014 and 2015?

JX: We don’t know exactly what caused the increase in mortality in the United States from 2014 to 2015. The results have shown that the age-adjusted death rates increased for 8 (heart disease, chronic lower respiratory, unintentional injuries, stroke, Alzheimer’s disease, diabetes, kidney disease, and suicide) of the 10 leading causes of death. Only decrease in mortality among 10 leading causes of death in 2015 from 2014 was for cancer. Death rates increased significantly for 20 states and decreased for 1. The change for the rest of states were not significant.

Q: Do your findings for 2015 suggest we have reached a peak as far as increases in life expectancy goes?

JX: We don’t think we have reached a peak in life expectancy. Many people died of non-age-related causes because they have aged. Those deaths are preventable. For example, there are 146,571 deaths caused by accidents which accounted for 5.4% of total deaths in 2015. About 65% of deaths from these unintentional injuries were those aged under 65. Among accidental deaths, unintentional poisoning accounted for 32.4 % and motor vehicle traffic accidents accounted for 24.5%. We also don’t know if the increase in mortality in 2015 will continue in 2016. But preliminary data have shown that the mortality for most of the 10 leading causes of death in 2015 went down in second quarter from first quarter, 2016 (http://www.cdc.gov/nchs/products/vsrr/mortality-dashboard.htm#trends). But it is too early to say that the mortality in 2016 will go down or continue going up. We will see what happens when the 2016 final file is available.

Q: What accounts for the decline in life expectancy at birth in 2015 from 2014?

JX: For the total US population, life expectancy decreased 0.1 year from 78.9 years in 2014 to 78.8 in 2015, mainly because of increases in mortality from the 13 causes of death among the 15 leading causes of death, such as heart disease, chronic lower respiratory disease, unintentional injuries, stroke, Alzheimer’s disease, diabetes, kidney disease, suicide, septicemia, , chronic liver disease, hypertension, Parkinson’s disease, and pneumonitis due to solids and liquids. From 2014 to 2015, life expectancy decreased 0.1 year for females largely because of increases in mortality from 12 of 15 leading causes of death such as heart disease, chronic lower respiratory disease, stroke, Alzheimer’s disease, unintentional injuries, influenza and pneumonia, septicemia, hypertension, chronic liver disease, Parkinson’s disease, suicide, and pneumonitis due solids and liquids. The deaths from those 12 leading causes of death accounted for 52.9% of total female deaths.

Life expectancy declined 0.2 year for males largely because of increases in mortality from 11 of 15 leading causes of death such as unintentional injuries, chronic lower respiratory disease, stroke, diabetes, suicide, Alzheimer’s disease, chronic liver disease, septicemia, Parkinson’s disease, Homicide, and hypertension. And about 65% of accidental deaths were under 65 years old, while 81% of suicides were aged 15-64, and 95% of homicides were under 65 years. More young people dying from preventable causes drags life expectancy down.

Q: Is it unusual that mortality rates for so many leading causes of death increased in 2015?

JX: We haven’t seen the increase in mortality from so many leading causes of death for a long time. The age-adjusted death rates increased significantly for 3 of 10 leading causes of death in 2014, 2 in 2013, 1 in 2012, and 5 in 2011. It is an unusual year. Again we don’t know why.

Q: Does the increase in mortality among white females suggest another drop in life expectancy for that group?

JX: We don’t have life expectancy numbers for white females yet. It is possible that the life expectancy numbers in 2015 for white women will drop again in 2015 since the life expectancy decreased 0.1 year for all females in 2015 from 2014 and mortality from 12 of 15 leading causes of death for white females increased significantly in 2015 from 2014 (heart disease, chronic lower respiratory diseases, Alzheimer’s disease, stroke, unintentional injuries, diabetes, influenza and pneumonia, hypertension, chronic liver disease, Parkinson’s disease, suicide, pneumonitis due to solids and liquids).

 

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Injury Mortality: United States, 1999–2014

October 21, 2016

NCHS has released new data visualization that depicts injury mortality in the United States from 1999 through 2014.

This storyboard allows the user to select subcategories of injury deaths based on intent and mechanism of injury.

Numbers and rates are provided for the subcategory selected by the user.

The storyboard includes six dashboards. Deaths can be grouped or separated by mechanism of injury, intent of injury, and selected demographics (sex, age group, race and Hispanic origin).

Drop-down boxes across the top of the dashboard control the display of the entire visualization. The dashboards feature:

Rates: Line charts displaying trends for injury death rates. Both fixed and dynamic scale line charts are provided. The fixed scale line chart allows the user to see changes in rates relative to a predefined y-axis, while the dynamic scale line chart adjusts to maximize the visualization of the trend for the options selected. A dialog box on the left of the dashboard allows the user to select among several options for the range of y-axis values used in the fixed scale line chart.

Numbers of deaths: A table describes numbers of injury deaths for selections made at the top of the visualization.

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