Trends and Patterns of Geographic Variation in Mortality From Substance Use Disorders and Intentional Injuries Among US Counties, 1980-2014 (Excerpt)
March 13, 2018
Laura Dwyer-Lindgren, PhD1; Amelia Bertozzi-Villa, MPH1; Rebecca W. Stubbs, MA1; et al Chloe Morozoff, MPH1; Shreya Shirude, MPH1; Jürgen Unützer, MD2; Mohsen Naghavi, MD, PhD1; Ali H. Mokdad, PhD1; Christopher J. L. Murray, MD, DPhil1
Author Affiliations Article Information
JAMA. 2018;319(10):1013-1023. doi:10.1001/jama.2018.0900
Key Points
Question What are the spatial and temporal trends in mortality due to alcohol use disorders, drug use disorders, self-harm, and interpersonal violence among US counties from 1980 to 2014?
Findings In this study of 2 848 768 deaths in the United States from 1980 to 2014, mortality rates varied widely among counties and increased by 618.3% for drug use disorders but decreased by 8.1% for alcohol use disorders, 6.0% for self-harm, and 44.9% for interpersonal violence. Mortality rates due to drug use disorders increased in every county, while mortality rates due to alcohol use disorders, self-harm, and interpersonal violence increased in some counties and decreased in others.
Meaning Between 1980 and 2014, there were important differences among US counties in the level and trend in mortality rates due to alcohol use disorders, drug use disorders, self-harm, and interpersonal violence.
Abstract
Importance Substance use disorders, including alcohol use disorders and drug use disorders, and intentional injuries, including self-harm and interpersonal violence, are important causes of early death and disability in the United States.
Objective To estimate age-standardized mortality rates by county from alcohol use disorders, drug use disorders, self-harm, and interpersonal violence in the United States.
Design and Setting Validated small-area estimation models were applied to deidentified death records from the National Center for Health Statistics (NCHS) and population counts from the US Census Bureau, NCHS, and the Human Mortality Database to estimate county-level mortality rates from 1980 to 2014 for alcohol use disorders, drug use disorders, self-harm, and interpersonal violence.
Exposures County of residence.
Main Outcomes and Measures Age-standardized mortality rates by US county (N = 3110), year, sex, and cause.
Results Between 1980 and 2014, there were 2 848 768 deaths due to substance use disorders and intentional injuries recorded in the United States. Mortality rates from alcohol use disorders (n = 256 432), drug use disorders (n = 542 501), self-harm (n = 1 289 086), and interpersonal violence (n = 760 749) varied widely among counties. Mortality rates decreased for alcohol use disorders, self-harm, and interpersonal violence at the national level between 1980 and 2014; however, over the same period, the percentage of counties in which mortality rates increased for these causes was 65.4% for alcohol use disorders, 74.6% for self-harm, and 6.6% for interpersonal violence. Mortality rates from drug use disorders increased nationally and in every county between 1980 and 2014, but the relative increase varied from 8.2% to 8369.7%. Relative and absolute geographic inequalities in mortality, as measured by comparing the 90th and 10th percentile among counties, decreased for alcohol use disorders and interpersonal violence but increased substantially for drug use disorders and self-harm between 1980 and 2014.
Conclusions and Relevance Mortality due to alcohol use disorders, drug use disorders, self-harm, and interpersonal violence varied widely among US counties, both in terms of levels of mortality and trends. These estimates may be useful to inform efforts to target prevention, diagnosis, and treatment to improve health and reduce inequalities.