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Observational Study
. 2013 Dec;45(6):e19-25.
doi: 10.1016/j.amepre.2013.07.012.

Trends and geographic patterns in drug-poisoning death rates in the U.S., 1999-2009

Lauren M Rossen  1 , Diba Khan, Margaret Warner
Affiliations
Observational Study

Trends and geographic patterns in drug-poisoning death rates in the U.S., 1999-2009

Lauren M Rossen et al. Am J Prev Med. 2013 Dec.

Abstract

Background: Drug poisoning mortality has increased substantially in the U.S. over the past 3 decades. Previous studies have described state-level variation and urban-rural differences in drug-poisoning deaths, but variation at the county level has largely not been explored in part because crude county-level death rates are often highly unstable.

Purpose: The goal of the study was to use small-area estimation techniques to produce stable county-level estimates of age-adjusted death rates (AADR) associated with drug poisoning for the U.S., 1999-2009, in order to examine geographic and temporal variation.

Methods: Population-based observational study using data on 304,087 drug-poisoning deaths in the U.S. from the 1999-2009 National Vital Statistics Multiple Cause of Death Files (analyzed in 2012). Because of the zero-inflated and right-skewed distribution of drug-poisoning death rates, a two-stage modeling procedure was used in which the first stage modeled the probability of observing a death for a given county and year, and the second stage modeled the log-transformed drug-poisoning death rate given that a death occurred. Empirical Bayes estimates of county-level drug-poisoning death rates were mapped to explore temporal and geographic variation.

Results: Only 3% of counties had drug-poisoning AADRs greater than ten per 100,000 per year in 1999-2000, compared to 54% in 2008-2009. Drug-poisoning AADRs grew by 394% in rural areas compared to 279% for large central metropolitan counties, but the highest drug-poisoning AADRs were observed in central metropolitan areas from 1999 to 2009.

Conclusions: There was substantial geographic variation in drug-poisoning mortality across the U.S.

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Figures

Figure 1
Figure 1
Annual change in age-adjusted death rate due to drug poisoning by urban/rural status *Significant differences between groups, adjusted for multiple comparisons using Scheffe’s test AADR, age-adjusted death rate
Figure 2
Figure 2
Age-adjusted death rates due to drug poisoning in the U.S. by level of urbanization, 1999–2009
Figure 3
Figure 3
Age-adjusted death rates due to drug poisoning in the U.S. by region of the country, 1999–2009
Figure 4
Figure 4
Maps of predicted age-adjusted death rates due to drug poisoning (per 100,000), 1999–2000, 2004–2005, 2008–2009
Figure 5
Figure 5
Age-adjusted death rates due to drug poisoning, given that a death was observed, by level of urbanization, 1999–2009
See this image and copyright information in PMC

References

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