Mortality trends, 2018 to 2024

The national overdose death rate was 21.521.5 deaths per 100,000 residentsEstimandnational crude drug overdose death rate: the sum of the 51 state counts over the sum of state populations; interval from the countInterval95% CI 21.4 to 21.7n70,630 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2019SourceCDC WONDER underlying cause of death deaths per hundred thousand residents in 2019. It reached 32.432.4 deaths per 100,000 residentsEstimandnational crude drug overdose death rate: the sum of the 51 state counts over the sum of state populations; interval from the countInterval95% CI 32.2 to 32.6n107,941 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2022SourceCDC WONDER underlying cause of death in 2022 and fell in 2024. These are crude ratesCrude rateDeaths or births divided by the population, with no adjustment for age. A place with older residents has a higher crude death rate even if health at each age is the same. from the death records in CDC WONDER, which count every drug poisoning whatever its intent. Alcohol-induced deaths and suicide moved on other schedules over the same years.

Overdose peaked in 2022 and alcohol-induced deaths in 2021

In WONDER the 2022 overdose rate was 50.5%50.5% percent above the 2019 rateEstimandnational crude drug overdose death rate divided by the 2019 rate, minus 1; normal interval on the log ratio of the two death countsInterval95% CI 49.1% to 51.9%n107,941 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2022 against 2019SourceCDC WONDER underlying cause of death above the 2019 rate, and the 2024 rate was 8.5%8.5% percent above the 2019 rateEstimandnational crude drug overdose death rate divided by the 2019 rate, minus 1; normal interval on the log ratio of the two death countsInterval95% CI 7.4% to 9.6%n79,384 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2024 against 2019SourceCDC WONDER underlying cause of death above it. The rise had begun before 2020, since the 2018 rate was below the 2019 rate. The alcohol-induced rate peaked a year earlier, in 2021, and it was still 15.5% (95% CI 13.9% to 17.0%)15.5% percent above the 2019 rateEstimandnational crude alcohol-induced death rate divided by the 2019 rate, minus 1; normal interval on the log ratio of the two death countsInterval95% CI 13.9% to 17.0%n46,714 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2024 against 2019SourceCDC WONDER underlying cause of death above its 2019 level in 2024. The suicide rate stayed within 3.6%3.6% percent of the 2019 rateEstimandlargest absolute difference of the national crude suicide rate from its 2019 rateWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2018 to 2024 against 2019SourceCDC WONDER underlying cause of death of its 2019 level in every year from 2018 to 2024.

Each national rate sums the state counts and divides by the summed state populations. No state row has a withheldSuppressionThe withholding of a number because the count behind it is too small to publish without risking the identification of a person. A suppressed value is missing, not zero. cell, so the national series is complete. A drug poisoning recorded as a suicide is in both the overdose and the suicide counts.[1]

How we know

The national series come from WONDER's underlying-cause-of-death files for 2018 to 2024. WONDER's 2024 counts are final, but its 2024 population estimate comes from a new vintage, so the fall in 2024 is a little overstated by the denominator. North Carolina amended many 2023 overdose death certificates after WONDER's final 2023 file, so the national 2023 overdose point is low. For counties the chapter adds a second source, the county file of CDC's injury and violence dashboard, called the panel here. Its modeledModeled estimateA figure produced by a statistical model instead of a direct count or measurement, usually for small areas where direct data are thin, borrowing strength from surveys, neighboring areas or other data. Neighboring areas can share errors, so single extremes call for caution. rates cover nearly every county from 2019 to 2024, Connecticut's excepted, and its 2024 values are provisional. WONDER withholds a county's count in any year when it is above zero and below 1010 deaths in a county-yearEstimanddefinition: WONDER withholds a county-year count above zero and below this numberWeightsnone (definition)Populationcounty-years in CDC WONDERPerioddeaths in 2018 to 2024SourceCDC WONDER underlying cause of death deaths. Its county series therefore use complete countiesComplete countyA county whose death count is published in every year of a window, possibly as zero, so its rate over the window is exact. Counties that are complete are selected by their counts, so as a group they are not typical of counties their size., those published in every year from 2018 to 2024. There are 889889 countiesEstimandcount of counties whose drug overdose count is published in every year and that have a population in every yearWeightsnone (full count)Populationcounties and county equivalents in CDC WONDERPeriod2018 to 2024SourceCDC WONDER underlying cause of death of them for overdose. Complete counties are selected on the outcome as well as on size (Chapter 10.3, Suppressed counties in death data). The data do not include COVID deaths, so the line at 2020 on the charts marks a date and not a measured cause. The report gives every estimate with its interval and sample size.

Two sources count different sets of overdose deaths

The panel counts unintentional and undetermined-intent drug overdoses, where WONDER counts poisonings of every intent. On the panel's measure the national overdose rate rose 54.7% (95% CI 50.0% to 59.7%)54.7% percent above the 2019 rateEstimandweighted mean of county drug overdose rates in the year divided by the 2019 value, minus 1; bootstrap over counties with shared drawsInterval95% CI 50.0% to 59.7%n3,040 countiesWeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled drug overdose rate that yearPeriod2022 against 2019SourceCDC injury and violence mapping between 2019 and 2022, which is 4.24.2 percentage pointsEstimandthe panel's percent rise in the overdose rate minus WONDER's, 2019 to 2022Weightssee the two seriesPopulationresidents of the United StatesPeriod2022 against 2019SourceCDC injury and violence mapping points more than WONDER's rise over the same years. Neither number is wrong. Poisonings recorded as suicide or homicide are in WONDER and not in the panel, and the panel also leaves out Connecticut and the county-years CDC marks unstable.

Figure 2 follows the difference in deaths rather than rates. The panel's implied deaths, each county's modeled rate times WONDER's county population, fall short of WONDER's count outside Connecticut by 4,9054,905 drug overdose deathsEstimandWONDER count outside Connecticut minus the panel's implied deathsWeightssee the two seriesPopulationresidents of the 50 states and DC outside ConnecticutPeriod2019SourceCDC WONDER underlying cause of death deaths in 2019 and 4,8174,817 drug overdose deathsEstimandWONDER count outside Connecticut minus the panel's implied deathsWeightssee the two seriesPopulationresidents of the 50 states and DC outside ConnecticutPeriod2022SourceCDC WONDER underlying cause of death in 2022. Both series add about the same number of deaths between 2019 and 2022, so the panel's smaller base turns the same increase into a larger percentage. Adding the 2019 gap back to the panel's deaths in every year brings its rise close to WONDER's rise outside Connecticut. The gap fits the way the panel defines overdose, but the files used here do not record intent, so the chapter cannot prove that intent accounts for it.

In complete counties, the overdose rise was alike by deprivation

The county comparison ranks counties by the Area Deprivation IndexArea Deprivation Index (ADI)A score that ranks neighborhoods by income, education, employment and housing conditions drawn from the American Community Survey. In this book a higher national percentile means a more deprived neighborhood. of their residents and cuts them into thirds with equal numbers of counties.The index understates deprivation in high-cost cities (Chapter 1.1, What the deprivation index measures). In complete counties the most deprived third had higher rates than the least deprived third in every year, for overdose, alcohol-induced deaths and suicide. The overdose rise from 2019 to 2022 was about the same proportion in both outer thirds, 48.4% (95% CI 40.7% to 56.0%)48.4% percent above the 2019 rateEstimandpooled drug overdose rate of the least deprived third of counties in the year over its 2019 rate, minus 1; bootstrap over counties with shared drawsInterval95% CI 40.7% to 56.0%n294 countiesWeightsnone (crude rates from counts)Populationresidents of the least deprived third of counties whose count is published in every year (drug overdose)Period2022 against 2019SourceCDC WONDER underlying cause of death in the least deprived and 50.3% (95% CI 41.8% to 62.1%)50.3% percent above the 2019 rateEstimandpooled drug overdose rate of the most deprived third of counties in the year over its 2019 rate, minus 1; bootstrap over counties with shared drawsInterval95% CI 41.8% to 62.1%n293 countiesWeightsnone (crude rates from counts)Populationresidents of the most deprived third of counties whose count is published in every year (drug overdose)Period2022 against 2019SourceCDC WONDER underlying cause of death in the most deprived, and the two intervals overlap. Dropping the complete counties with no deaths in every year from 2018 to 2024 and cutting the thirds again leaves that result in place.

The panel, over its counties with a stable rate in every year, gives a different answer. There the most deprived third rose 71.0%71.0% percent above the 2019 rateEstimandpooled drug overdose rate of the most deprived third of counties in the year over its 2019 rate, minus 1; bootstrap over counties with shared drawsInterval95% CI 62.3% to 80.7%n878 countiesWeightsWONDER county population of the yearPopulationresidents of the most deprived third of counties with a stable modeled rate in every year (drug overdose)Period2022 against 2019SourceCDC injury and violence mapping between 2019 and 2022, against 51.4%51.4% percent above the 2019 rateEstimandpooled drug overdose rate of the least deprived third of counties in the year over its 2019 rate, minus 1; bootstrap over counties with shared drawsInterval95% CI 45.2% to 57.6%n879 countiesWeightsWONDER county population of the yearPopulationresidents of the least deprived third of counties with a stable modeled rate in every year (drug overdose)Period2022 against 2019SourceCDC injury and violence mapping in the least deprived third. The difference between the two sources is a difference between sets of counties. Inside the counties that WONDER publishes in every year, cut into WONDER's thirds, the panel's overdose rate rose 52.3%52.3% percent above the 2019 rateEstimandpooled modeled overdose rate of the third in the year over its 2019 rate, minus 1; bootstrap over counties with shared drawsInterval95% CI 43.9% to 60.5%n294 countiesWeightsWONDER county population of the yearPopulationresidents of the least deprived third of the balanced panel counties that are complete in WONDER's overdose cut, with WONDER's thirdsPeriod2022 against 2019SourceCDC injury and violence mapping in the least deprived third and 52.3%52.3% percent above the 2019 rateEstimandpooled modeled overdose rate of the third in the year over its 2019 rate, minus 1; bootstrap over counties with shared drawsInterval95% CI 43.0% to 64.8%n293 countiesWeightsWONDER county population of the yearPopulationresidents of the most deprived third of the balanced panel counties that are complete in WONDER's overdose cut, with WONDER's thirdsPeriod2022 against 2019SourceCDC injury and violence mapping in the most deprived.

The larger rise in the most deprived third appears only in the counties WONDER withholds in at least one year, where the modeled panel is the only source. Each of those counties has a year with too few deaths for WONDER to publish. Whether their larger rise is real, or the model smoothing small deprived counties toward their neighbors, cannot be tested with these files.

What the paths describe

Pooled over the nation, the overdose and alcohol-induced rates ran above their 2019 levels from 2020 to 2024, on different schedules, and suicide stayed near its 2019 rate. Where WONDER publishes a county's count every year, the overdose rate rose by about the same proportion in the least and most deprived thirds, and the two sources give the same answer there. These are descriptions of places. A county rate is an average over all of its residents, so it cannot say who died, and a pattern across counties need not hold for the people in them (ecological inferenceEcological inferenceDrawing conclusions about individuals from data about places or groups. A pattern across counties need not hold for the people inside them.). The data do not measure mechanisms. They cannot separate deaths from the virus, changes in the supply of drugs and alcohol, disrupted treatment and services, or anything else that changed in the same years.

What these county series cannot tell you

WONDER's withheld counts are not recoverable, so its county series cover only complete counties. The panel models the rates of counties with few deaths, so its rate for a small county is partly its neighbors' rate. Rates are crude, and a county with an older population has a higher rate for the same risk at each age. The panel's 2024 values are provisional, so the size of the fall in overdose deaths in 2024 may change.

Go deeper

• The report: every estimate with its interval and sample size.
• Tables: every figure of the report as a table.

Data sources

• CDC WONDER underlying cause of deathCDC WONDER underlying cause of death: drug poisoning (overdose, any intent), alcohol-induced deaths and suicide; states summed to the nation and counties published in every year, 2018 to 2024Years: 2018-2024 · Weights: none (crude rates from counts); WONDER population of the year · License: Public domain (NCHS, CDC); WONDER data-use restrictions apply
• CDC injury and violence mappingCDC Mapping Injury, Overdose, and Violence county file: modeled overdose, suicide and homicide death rates, annual 2019 to 2024 (2024 provisional)Years: 2019-2024 for counties, 2022-2024 for tracts (data as of 2026-05-14) · Weights: WONDER county population of the year · License: Public domain (CDC, U.S. Department of Health and Human Services)
• Area Deprivation IndexNeighborhood Atlas Area Deprivation Index 2023, tract national rank averaged to countiesYears: 2023 release (version 4.0.1; built on ACS 2019-2023) · Weights: 2019-2023 ACS tract population · License: Free for non-commercial use; cite the Neighborhood Atlas and Kind and Buckingham
• Published estimates from cited studiesShares quoted from NCHS Data Brief 522 and a research letter on alcohol-related deathsYears: as reported in each study · Weights: as reported in each source · License: Quoted from published research for commentary

All data sources

References

1. Garnett, Matthew F.; Minino, Arialdi M. (2024). Drug overdose deaths in the United States, 2003-2023. NCHS Data Brief No. 522, National Center for Health Statistics. doi:10.15620/cdc/170565

How to cite

@misc{singh2026mortalitytrends20182024,
  author = {Singh, Vishal},
  title = {Mortality trends, 2018 to 2024},
  year = {2026},
  url = {https://vishalsingh.org/zipcode/mortality-trends-2018-2024},
  note = {In ZIP Code Destiny. Published 9 October 2026.}
}