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Trends and Geographic Patterns in Drug-Poisoning Death Rates in the U.S., 1999–2009

Filetype[PDF-353.34 KB]


  • English
    • Details Supporting Files You May Also Like

    Details:

    • Alternative Title:
      Am J Prev Med
    • Personal Author:
    • Description:
      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.

    • Subjects:
    • Source:
      Am J Prev Med. 45(6):e19-e25.
    • Pubmed ID:
      24237925
    • Pubmed Central ID:
      PMC4659504
    • Document Type:
      Journal Article
    • Funding:
      CC999999/Intramural CDC HHS/United States
    • Place as Subject:
      United States
    • Collection(s):
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