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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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.


“Births: Final Data for 2017” Released

November 7, 2018

The comprehensive report on final births data for the United States was released on November 7, 2018, documenting a total of 3,855,500 births registered in the United States, down 2% from 2016. Compared with rates in 2016, the general fertility rate declined to 60.3 births per 1,000 women aged 15–44. The birth rate for females aged 15–19 fell 7% in 2017. Birth rates declined for women in their 20s and 30s but increased for women in their early 40s. The total fertility rate declined to 1,765.5 births per 1,000 women in 2017. Birth rates for both married and unmarried women declined from 2016 to 2017, and the percentage of babies born to unmarried women (39.8) did not change between 2016 and 2017.  Many of these findings were documented in a May 2018 provisional release of 2017 data.

The final data are contained in the new publication “Births: Final Data for 2017.”

Some new data for 2017 are included for the first time in the new report:

  • The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.3% in 2017.
  • The percentage of all women who smoked during pregnancy declined to 6.9%. Percentages dropped for all race/ethnic groups from 2016 to 2017 except for Hispanic mothers (no change) and Native Hawaiian or Other Pacific Islander mothers (a 0.1 percentage point increase).
  • Medicaid was the source of payment for 43.0% of all births in 2017, up 1% from 2016.
  • Twin and triplet and higher-order multiple birth rates were essentially stable in 2017.
  • The average age of U.S. mothers at first birth in 2017 was 26.8 years, an increase from 26.6 years in 2016 – and a new all-time high.

Fact or Fiction: Do women who live in rural counties in the U.S. give birth at an earlier age than women in large metropolitan counties?

October 17, 2018

Source: National Vital Statistics System, 2017

https://www.cdc.gov/nchs/data/databriefs/db323-h.pdf


Trends in Liver Cancer Mortality Among Adults Aged 25 and Over in the United States, 2000-2016

July 17, 2018

Jiaquan Xu, M.D., NCHS Epidemiologist

Questions for Lead Author Jiaquan Xu, M.D., Epidemiologist, and Author of “Trends in Liver Cancer Mortality Among Adults Aged 25 and Over in the United States, 2000-2016

Q: What made you decide to focus on liver cancer deaths for this study?

JX: It was the dramatic rise in the death rate for liver cancer that caused me to want to look more deeply into various aspects of this marked change and produce this new report. I also wanted to offer state-by-state data for liver cancer mortality, so that the U.S. Public Health Community might have information that will help them in their important work throughout America. While we have seen decreases in death rates from many major causes — such as heart disease, cancer (all cancer combined), and stroke recently – liver cancer deaths stand out far away from the decreasing trends of these causes of death. To elaborate, the age-adjusted death rates for all cancer combined, have declined since 1990. Also, for the top six cancer death causes in 2016 (lung cancer, colorectal cancer, pancreatic cancer, breast cancer, prostate cancer, and liver cancer), the age-adjusted death rates decreased for four of them (lung, colorectal, breast, and prostate) and increased for two (liver cancer and pancreatic cancer) — with the liver cancer death rate increasing much faster than the pancreatic cancer death rate, since 2000.


Q: Was there a finding in your new report that you hadn’t expected and that really surprised you?

JX:  There actually are quite a few interesting results in this new analysis that surprised me. While there are some reports out there that show the increase of liver cancer mortality, we also know that the liver cancer death rate demonstrates a trend of continued rate increase during the period from 2000 through 2016 – which is the time span this report analyzed. The surprise is that the liver cancer death rate for men is between 2 and 2.5 times the rate for women aged 25 and over, during the period of 2000–2016. Within the four race/ethnic groups analyzed, the only decrease trend in liver cancer mortality observed, is for the non-Hispanic Asian or Pacific Islander (API) group. The rate increased for non-Hispanic white, non-Hispanic black, and Hispanic persons. Also the liver cancer death rates varied quite a bit by state, which is another surprising finding.


Q: What made you decide to focus on the age group of adults 25 years old and older?

JX: I had a number of reasons to focus on the liver cancer death rate for adults aged 25 and over. More than 99% of all deaths with liver cancer reported on the death certificate are for adults 25 years of age and over. It made sense to focus this analysis on the majority age group that dies from this cancer cause. We also know that age is a leading risk factor for the development of many types of cancer. Aging increases cancer risk. This is exactly what we see here in this new report. And the liver cancer death rate for older age groups is significantly higher than the rate for younger age groups throughout the period examined in this analysis.


Q: What differences or similarities did you see between or among various demographic groups in this analysis?

JX:  The differences among demographic groups is also what I found most surprising in this report. The liver cancer death rate for men aged 25 and over is between 2 and 2.5 times the rate for women. The liver cancer death rate varies by race/ethnic groups. The Non-Hispanic Asian or Pacific Islander (API) group have the highest liver cancer death rate among the four race/ethnic groups analyzed during 2000–2014. The rate for Hispanic adults surpassed the rate for non-Hispanic API and became the highest in 2016. The liver cancer death rate for non-Hispanic white adults was the lowest among the race/ethnic groups throughout the period (2000–2016).


Q: Why do you think there is such a vast difference among the states in death rates from liver cancer?

JX: The mortality data we analyzed does not provide any evidence itself to show the reason or reasons that could contribute to the variation of liver cancer death rates by state. In general, the majority of the liver cancer in the United States is often attributed to some potential risk factors such as metabolic disorders (including obesity, diabetes, and nonalcoholic fatty liver disease), chronic Hepatitis C (HCV) infection, excessive consumption of alcohol, smoking, and chronic Hepatitis B (HBV) infection. If the number of people affected by those potential risk factors is different from one state to another, the liver cancer incidence rate and death rate would vary.


Q: What do you think is the reason for the growing increase in deaths from liver cancer in the United States?

JX: The mortality data we analyzed does not provide any evidence itself to show the reason or reasons that could contribute to the rising of the liver cancer death rate in this country. Some risk factors might contribute to the increase in liver cancer incidence rate and death rate. For example, some attribute the baby boomer generation’s higher hepatitis C virus infection rate than other adult age groups. Some have identified an increase in the obesity rate as another reason. Unfortunately, we can’t answer this question with our data, though it is an important question.


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

JX: I think the real take-home message of this Data Brief is what it can offer to the Public Health Community to learn about liver cancer mortality variance among different groups. The report shows that liver cancer mortality varies by sex, age, race/ethnic groups, and by state. Although the overall liver cancer death rate increased from 2000 to 2016, the rate for non-Hispanic Asian or Pacific Islander (API) decreased. The rate for adults aged 45–54 has decreased since 2012.


Describing the Increase in Preterm Births in the United States, 2014–2016

June 13, 2018

Questions for Joyce Martin, Statistician, and Lead Author of “Describing the Increase in Preterm Births in the United States, 2014–2016

Q: What did you think was the most interesting finding in your report?

JM: Two things – that the rate has increased for three straight years following several years of decline, and that the increase generally occurred among babies born late preterm.


Q: Why are total preterm birth rates increasing?

JM: The reasons for the rise are not well understood, but appear to be largely among births occurring at the highest end of the preterm/late range, that is, at 36 weeks.  That said, it is important to note that early preterm births, those at the greatest risk of poor outcome increased among non-Hispanic black births.


Q: Why did you decide to examine preterm birth rates?

JM: The preterm birth rate is a basic indicator of the maternal and infant health of a nation and, accordingly, changes in the preterm rate have important implications for the public health. Babies born prior to 37 weeks of gestation are more likely to die within the first year of life and more likely to suffer life-long morbidities than those born later in pregnancy.


Q: How did preterm birth rates vary among U.S. states from 2014-2016?

JM: Preterm rates rose significantly in 23 states and the District of Columbia and non-significant increased were seen in an additional 22 states.  In short, rates are trending upward for the vast majority of states.


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

JM: The incidence of infants born too soon is on the rise in the US, appears to be largely among late preterm births and the rise does not appear to be limited to any specific maternal race, age or geographic group.