Mortality From Overdose, Alcohol and Firearms Varies Regionally Interview with:

Dr. Laura Dwyer-Lindgren PhD Assistant Professor at IHME Institute for Health Metrics and Evaluation 

Dr. Dwyer-Lindgren

Dr. Laura Dwyer-Lindgren PhD
Assistant Professor at IHME
Institute for Health Metrics and Evaluation What is the background for this study? What are the main findings?

 Response: This study in the latest in a series of studies IHME has conducted on health and disease on the county level in the United States. We analyzed data provided by the National Center for Health Statistics, the U.S. Census Bureau, and other sources. Main findings include:

  • Nearly 550,000 deaths were attributed to drug use over the 35 years. Nationally, the age-standardized death date increased 238% between 1980 and 2000, and 112% between 2000 and 2014. The death rate from drug use disorders increased in every county, but some counties in Kentucky, West Virginia, Ohio, Indiana, and eastern Oklahoma has increases exceeding 5000%.
  • There were more than a quarter million deaths in the U.S. due to alcohol use; Western counties generally has higher levels than those in other parts of area of the nation, with especially high death rates in Wisconsin, North Dakota, South Dakota, Nebraska, Montana, New Mexico, Arizona, Utah, and Alaska.
  • Neatly 1.3 million suicides were recorded, with especially high rates in Alaska, Nevada, South Dakota, Utah, New Mexico, Arizona, Montana, North Dakota, Oregon, Wyoming and one county in Maryland. While the national death rate due to suicide decreased between 1980 and 2014, there was an increase in the death rate due to suicide in most counties.
  • More than three quarters of a million deaths by homicide occurred in the US between 1980 and 2015. Nationally, the age-standardized death rate due to homicide decreased by about 35% between 1980 and 2000, and by nearly 16% between 2000 and 2014. Counties with the largest decreases were found in Virginia, Florida, Texas, California and New York. What should readers take away from your report?

Response: National trends can mask important regional differences. While mortality due to drug use disorders has increased in any every county, mirroring the national trend, the size of that increase varies massively. A the same time, while mortality due to alcohol use disorders, suicide, and homicide declined nationally between 1980 and 2014, there were individual counties where the mortality rates due to these causes actually increased. What recommendations do you have for future research as a result of this work? 

Response: More in-depth and up-to-date analyses on deaths from these four causes and ways to prevent such deaths. Is there anything else you would like to add?

Response: To our knowledge, this study is the first at the county level to consider drug use disorders and distinguish between intentional and unintentional overdoses. No disclosures. 


Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, Morozoff C, Shirude S, Unützer J, Naghavi M, Mokdad AH, Murray CJL. Trends and Patterns of Geographic Variation in Mortality From Substance Use Disorders and Intentional Injuries Among US Counties, 1980-2014. JAMA. 2018;319(10):1013–1023. doi:10.1001/jama.2018.0900

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Last Updated on March 14, 2018 by Marie Benz MD FAAD