Geographic Trends in Opioid Overdoses in the US From 1999 to 2020

Abstract

This cross-sectional study examines changes in rates of opioid-involved overdose deaths from 1999 to 2020 in US counties categorized from most urban to most rural.

Figure 1.. Opioid Overdose Deaths by Urbanicity From 1999 to 2020

Numbers of opioid overdose deaths were generated from the Centers for Disease Control and Prevention’s WONDER Multiple Cause of Death file and were classified using ICD-10 codes for primary underlying cause of death (X40-44, X60-64, X85, and Y10-14) and for the following: T40.0 (opium), T40.1 (heroin), T40.2 (other opioids), T40.3 (methadone), T40.4 (other synthetic narcotics), or T40.6 (other and unspecified narcotics). Large central metro indicates counties in metropolitan statistical areas (MSAs) with a population ≥1 000 000 that contain all or part of a principal city of the area; large fringe metro, the remaining counties (similar to suburbs) of MSAs with ≥1 000 000 population; medium metro, counties in MSAs with populations of 250 000 to 999 999; small metro, counties in MSAs with populations <250 000; micropolitan, nonmetropolitan counties belonging to a micropolitan statistical area; and noncore, the remaining nonmetropolitan counties. Large central metro is the most urban category and noncore the most rural.

Figure 2.. Acceleration Rates of Opioid Overdose Deaths by Urbanicity

Large central metro indicates counties in metropolitan statistical areas (MSAs) with a population ≥1 000 000 that contain all or part of a principal city of the area; large fringe metro, the remaining counties (similar to suburbs) of MSAs with ≥1 000 000 population; medium metro, counties in MSAs with populations of 250 000 to 999 999; small metro, counties in MSAs with populations <250 000; micropolitan, nonmetropolitan counties belonging to a micropolitan statistical area; and noncore, the remaining nonmetropolitan counties. Large central metro is the most urban category and noncore the most rural.