Chapter 6.4 · Last call
Mortality trends, 2018 to 2024
The national overdose death rate peaked in 2022 at 50.5% above its 2019 level and was 8.5% above it in 2024, the alcohol-induced rate was still 15.5% above its 2019 level in 2024, and CDC's modeled county panel puts the overdose rise at 54.7%, a difference that tracks a roughly constant number of deaths the panel does not count.
The national overdose death rate was 21.5 (95% CI 21.4 to 21.7)21.5 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 per hundred thousand residents in 2019, 32.4 (95% CI 32.2 to 32.6)32.4 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 23.3 (95% CI 23.2 to 23.5)23.3 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 23.2 to 23.5n79,384 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2024SourceCDC WONDER underlying cause of death in 2024. The 2022 rate is 50.5% (95% CI 49.1% to 51.9%)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 is 8.5% (95% CI 7.4% to 9.6%)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. These are crude rates from CDC WONDER, which counts every drug poisoning whatever its intent. CDC's modeled injury panel, which counts unintentional and undetermined-intent drug overdoses in 3,1353,135 countiesEstimandcount of counties in the fileWeightsnone (full count)Populationcounties in CDC's county file (Connecticut's eight counties are absent)Period2019 to 2024SourceCDC injury and violence mapping counties, puts the rise to 2022 at 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, 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. Neither number is wrong. The two sources count different sets of deaths, and the section on them below finds that the difference tracks a roughly constant number of deaths added to two different bases, which fits the way the panel defines overdose but cannot be proved from the files used here.
Alcohol-induced deaths and suicide moved on other schedules. The alcohol-induced rate peaked a year before overdose, at 16.316.3 deaths per 100,000 residentsEstimandnational crude alcohol-induced death rate: the sum of the 51 state counts over the sum of state populations; interval from the countInterval95% CI 16.2 to 16.5n54,258 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2021SourceCDC WONDER underlying cause of death in 2021 (37.4% (95% CI 35.7% to 39.2%)37.4% 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 35.7% to 39.2%n54,258 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2021 against 2019SourceCDC WONDER underlying cause of death above 2019), and 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. Homicide, which only the panel measures, peaked in 2021 at 35.2% (95% CI 31.2% to 39.1%)35.2% percent above the 2019 rateEstimandweighted mean of county homicide rates in the year divided by the 2019 value, minus 1; bootstrap over counties with shared drawsInterval95% CI 31.2% to 39.1%n3,051 countiesWeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled homicide rate that yearPeriod2021 against 2019SourceCDC injury and violence mapping above 2019 and was back within the interval of its 2019 level in 2024. Case and Deaton group suicide, drug overdose and alcoholic liver disease as deaths of despair;[1] Chapter 6.3, Overdose, alcohol and suicide asks whether they share an address, and the paths in this chapter show that they do not share a clock.
The chapter follows the paths from 2018 to 2024 and asks which counties they reached. National figures sum counties, and the county figures split them by deprivation. The panel's 2024 values are provisional and WONDER's are final. The data used here do not include COVID deaths, so the marker for 2020 on the charts is a date and not a measured cause.
Overdose deaths peaked in 2022 and alcohol-induced deaths in 2021, while suicide stayed near its 2019 rate
Figure 1 uses three cuts of CDC WONDER's underlying-cause-of-death files: drug poisoning of any intent, which this chapter calls overdose, alcohol-induced deaths and suicide. National counts are the sum of the state rows, none of which 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, and the 2022 suicide count of 49,47649,476 suicide deathsEstimandsum of the 51 state rows of CDC WONDER; equals the count CDC reports for 2022Weightsnone (full count)Populationresidents of the United StatesPeriod2022SourceCDC WONDER underlying cause of death equals the count CDC reports. Rates are crudeCrude 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.. A drug poisoning recorded as a suicide is in both the overdose and the suicide counts.[2]
Figure 1
The national overdose death rate rose from 21.5 per hundred thousand residents in 2019 to 32.4 in 2022 and was 23.3 in 2024, while the suicide rate stayed within 3.6% of its 2019 level
Crude death rates per 100,000 residents for drug poisoning of any intent (overdose), alcohol-induced deaths and suicide, United States, 2018 to 2024
Show data
| cause | conf_high | conf_low | index | index_hi | index_lo | n | rate | year |
|---|---|---|---|---|---|---|---|---|
| Overdose | 20.75 | 20.44 | 95.69 | 96.71 | 94.69 | 67,367 | 20.59 | 2018 |
| Overdose | 21.68 | 21.36 | 100 | n/a | n/a | 70,630 | 21.52 | 2019 |
| Overdose | 28.04 | 27.68 | 129.5 | 130.8 | 128.2 | 91,799 | 27.86 | 2020 |
| Overdose | 32.34 | 31.96 | 149.4 | 150.8 | 148.0 | 106,699 | 32.15 | 2021 |
| Overdose | 32.58 | 32.19 | 150.5 | 151.9 | 149.1 | 107,941 | 32.39 | 2022 |
| Overdose | 31.54 | 31.16 | 145.7 | 147.1 | 144.3 | 105,007 | 31.35 | 2023 |
| Overdose | 23.50 | 23.18 | 108.5 | 109.6 | 107.4 | 79,384 | 23.34 | 2024 |
| Alcohol-induced deaths | 11.53 | 11.29 | 95.92 | 97.29 | 94.57 | 37,329 | 11.41 | 2018 |
| Alcohol-induced deaths | 12.01 | 11.78 | 100 | n/a | n/a | 39,043 | 11.89 | 2019 |
| Alcohol-induced deaths | 15.02 | 14.76 | 125.2 | 126.9 | 123.5 | 49,061 | 14.89 | 2020 |
| Alcohol-induced deaths | 16.49 | 16.21 | 137.4 | 139.2 | 135.7 | 54,258 | 16.35 | 2021 |
| Alcohol-induced deaths | 15.49 | 15.23 | 129.1 | 130.8 | 127.4 | 51,191 | 15.36 | 2022 |
| Alcohol-induced deaths | 14.44 | 14.19 | 120.3 | 122.0 | 118.7 | 47,938 | 14.31 | 2023 |
| Alcohol-induced deaths | 13.86 | 13.61 | 115.5 | 117.0 | 113.9 | 46,714 | 13.73 | 2024 |
| Suicide | 14.91 | 14.64 | 102.1 | 103.4 | 100.8 | 48,344 | 14.78 | 2018 |
| Suicide | 14.60 | 14.34 | 100 | n/a | n/a | 47,511 | 14.47 | 2019 |
| Suicide | 14.08 | 13.83 | 96.41 | 97.65 | 95.18 | 45,979 | 13.95 | 2020 |
| Suicide | 14.65 | 14.39 | 100.3 | 101.6 | 99.03 | 48,183 | 14.52 | 2021 |
| Suicide | 14.98 | 14.71 | 102.6 | 103.9 | 101.3 | 49,476 | 14.84 | 2022 |
| Suicide | 14.85 | 14.60 | 101.7 | 103.0 | 100.5 | 49,316 | 14.72 | 2023 |
| Suicide | 14.48 | 14.23 | 99.18 | 100.4 | 97.93 | 48,824 | 14.36 | 2024 |
The overdose rate rose in 2020 and 2021 and stayed near its peak from 2021 to 2023, at 32.132.1 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 32.0 to 32.3n106,699 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2021SourceCDC WONDER underlying cause of death in 2021, 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 31.431.4 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 31.2 to 31.5n105,007 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2023SourceCDC WONDER underlying cause of death in 2023, before it fell to 23.323.3 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 23.2 to 23.5n79,384 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2024SourceCDC WONDER underlying cause of death in 2024. The rise had begun before 2020: the 2018 rate was 4.3% (95% CI 3.3% to 5.3%)4.3% percent below the 2019 rateEstimand2019 national crude drug overdose death rate minus the 2018 rate, over the 2019 rateInterval95% CI 3.3% to 5.3%n67,367 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2018 against 2019SourceCDC WONDER underlying cause of death below the 2019 rate. The alcohol-induced rate went from 11.911.9 deaths per 100,000 residentsEstimandnational crude alcohol-induced death rate: the sum of the 51 state counts over the sum of state populations; interval from the countInterval95% CI 11.8 to 12.0n39,043 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2019SourceCDC WONDER underlying cause of death in 2019 to 14.914.9 deaths per 100,000 residentsEstimandnational crude alcohol-induced death rate: the sum of the 51 state counts over the sum of state populations; interval from the countInterval95% CI 14.8 to 15.0n49,061 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2020SourceCDC WONDER underlying cause of death in 2020 and 16.316.3 deaths per 100,000 residentsEstimandnational crude alcohol-induced death rate: the sum of the 51 state counts over the sum of state populations; interval from the countInterval95% CI 16.2 to 16.5n54,258 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2021SourceCDC WONDER underlying cause of death in 2021, and then fell to 13.713.7 deaths per 100,000 residentsEstimandnational crude alcohol-induced death rate: the sum of the 51 state counts over the sum of state populations; interval from the countInterval95% CI 13.6 to 13.9n46,714 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2024SourceCDC WONDER underlying cause of death in 2024. The number of alcohol-induced deaths rose 25.7% (95% CI 24.0% to 27.3%)25.7% percent rise in the number of deathsEstimandnational count of alcohol-induced deaths in 2020 over the 2019 count, minus 1; normal interval on the log ratioInterval95% CI 24.0% to 27.3%n49,061 deathsWeightsnone (full counts)Populationresidents of the United StatesPeriod2020 against 2019SourceCDC WONDER underlying cause of death between 2019 and 2020, from 39,04339,043 alcohol-induced deathsEstimandnational count of alcohol-induced deaths: the sum of the 51 state rowsWeightsnone (full count)Populationresidents of the United StatesPeriod2019SourceCDC WONDER underlying cause of death to 49,06149,061 alcohol-induced deathsEstimandnational count of alcohol-induced deaths: the sum of the 51 state rowsWeightsnone (full count)Populationresidents of the United StatesPeriod2020SourceCDC WONDER underlying cause of death. A study of alcohol-related deaths, a broader count that includes deaths where an alcohol-induced cause was a contributing cause and not the underlying one, reported a rise of 25.5%25.5% percent rise in the number of deathsEstimandrise in alcohol-related deaths (an alcohol-induced cause listed as the underlying or a contributing cause, ages 16 and over) reported by White, Castle, Powell, Hingson and Koob (2022) from NCHS mortality dataWeightsas reported in the studyPopulationresidents of the United States aged 16 and overPeriod2020 against 2019SourcePublished estimates from cited studies over the same year,[3] so the two measures rose by similar amounts. The suicide rate was 14.514.5 deaths per 100,000 residentsEstimandnational crude suicide death rate: the sum of the 51 state counts over the sum of state populations; interval from the countInterval95% CI 14.3 to 14.6n47,511 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2019SourceCDC WONDER underlying cause of death in 2019, fell 3.6%3.6% percent below the 2019 rateEstimand2019 national crude suicide rate minus the 2020 rate, over the 2019 rateInterval95% CI 2.3% to 4.8%n45,979 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2020 against 2019SourceCDC WONDER underlying cause of death in 2020 to 14.014.0 deaths per 100,000 residentsEstimandnational crude suicide death rate: the sum of the 51 state counts over the sum of state populations; interval from the countInterval95% CI 13.8 to 14.1n45,979 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2020SourceCDC WONDER underlying cause of death, and was 14.814.8 deaths per 100,000 residentsEstimandnational crude suicide death rate: the sum of the 51 state counts over the sum of state populations; interval from the countInterval95% CI 14.7 to 15.0n49,476 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2022SourceCDC WONDER underlying cause of death in 2022.
The 2024 values carry two cautions. WONDER's 2024 counts are final, but its 2024 population estimate comes from a new vintage: it grows 1.6%1.6% percent change in the national population estimateEstimandgrowth of WONDER's national population estimate from 2023 to 2024Weightsnone (population estimate)Populationresidents of the United StatesPeriod2023 to 2024SourceCDC WONDER underlying cause of death over 2023, against yearly growth of 0.3%0.3% percent change in the national population estimateEstimandsmallest yearly growth of WONDER's national population estimate in 2019 to 2023Weightsnone (population estimate)Populationresidents of the United StatesPeriodsmallest yearly change 2019 to 2023SourceCDC WONDER underlying cause of death to 0.7%0.7% percent change in the national population estimateEstimandlargest yearly growth of WONDER's national population estimate in 2019 to 2023Weightsnone (population estimate)Populationresidents of the United StatesPeriodlargest yearly change 2019 to 2023SourceCDC WONDER underlying cause of death in each year from 2019 to 2023. Had it grown at the mean yearly rate of 2019 to 2023, the 2024 rates would be 1.1%1.1% percent of the 2024 rateEstimandhow much higher the 2024 national rates would be had the population grown at the mean yearly rate of 2019 to 2023Weightsnone (population estimate)Populationresidents of the United StatesPeriod2024SourceCDC WONDER underlying cause of death higher, about 1.21.2 index points (2019 = 100)Estimandthe same difference for the overdose index of 2024, in index pointsWeightsnone (population estimate)Populationresidents of the United StatesPeriod2024SourceCDC WONDER underlying cause of death points of the overdose index. The fall in 2024 is therefore a little overstated by the denominator. The 2023 overdose count is low: North Carolina amended many 2023 overdose death certificates after WONDER's final 2023 file, so the national 2023 overdose point is lower than a count from current records would give.
Overdose and alcohol-induced deaths ran above the 2019 rate in every year from 2020 to 2024, and suicide did not
One way to put the three paths on a common scale counts the deaths above the number a flat 2019 rate would give in each year's population (Figure 2). From 2020 to 2024 that is 131,549 (95% CI 128,564 to 134,533)131,549 deaths above the 2019 rateEstimandobserved drug overdose deaths minus the 2019 crude rate times each year's population, summed over 2020 to 2024; Poisson intervalInterval95% CI 128,564 to 134,533n490,830 deathsWeightsnone (full counts)Populationresidents of the United StatesPeriod2020 to 2024SourceCDC WONDER underlying cause of death overdose deaths and 50,558 (95% CI 48,358 to 52,757)50,558 deaths above the 2019 rateEstimandobserved alcohol-induced deaths minus the 2019 crude rate times each year's population, summed over 2020 to 2024; Poisson intervalInterval95% CI 48,358 to 52,757n249,162 deathsWeightsnone (full counts)Populationresidents of the United StatesPeriod2020 to 2024SourceCDC WONDER underlying cause of death alcohol-induced deaths. For suicide it is 99 (95% CI −2279 to 2476)99 deaths above the 2019 rateEstimandobserved suicide deaths minus the 2019 crude rate times each year's population, summed over 2020 to 2024; Poisson intervalInterval95% CI −2279 to 2476n241,778 deathsWeightsnone (full counts)Populationresidents of the United StatesPeriod2020 to 2024SourceCDC WONDER underlying cause of death, an interval that includes zero. The overdose excess peaked at 36,22536,225 deaths above the 2019 rateEstimandlargest yearly difference between observed drug overdose deaths and the 2019 rate times the year's populationWeightsnone (full counts)Populationresidents of the United StatesPeriodthe year of the largest excess in 2020 to 2024SourceCDC WONDER underlying cause of death deaths in 2022 and was still 6,200 (95% CI 5,427 to 6,972)6,200 deaths above the 2019 rateEstimandobserved drug overdose deaths minus the 2019 crude rate times the 2024 population; Poisson intervalInterval95% CI 5,427 to 6,972n79,384 deathsWeightsnone (full counts)Populationresidents of the United StatesPeriod2024SourceCDC WONDER underlying cause of death in 2024. The alcohol-induced excess peaked at 14,78014,780 deaths above the 2019 rateEstimandlargest yearly difference between observed alcohol-induced deaths and the 2019 rate times the year's populationWeightsnone (full counts)Populationresidents of the United StatesPeriodthe year of the largest excess in 2020 to 2024SourceCDC WONDER underlying cause of death in 2021 and was 6,259 (95% CI 5,675 to 6,842)6,259 deaths above the 2019 rateEstimandobserved alcohol-induced deaths minus the 2019 crude rate times the 2024 population; Poisson intervalInterval95% CI 5,675 to 6,842n46,714 deathsWeightsnone (full counts)Populationresidents of the United StatesPeriod2024SourceCDC WONDER underlying cause of death in 2024.
Figure 2
From 2020 to 2024 the United States had 131,549 more overdose deaths than a flat 2019 rate gives
Observed national crude death rate per 100,000 residents and the 2019 rate held constant, United States, 2018 to 2024
Show data
| cause | rate | series | year |
|---|---|---|---|
| Overdose | 20.59 | Observed | 2018 |
| Overdose | 21.52 | At the 2019 rate | 2018 |
| Overdose | 21.52 | Observed | 2019 |
| Overdose | 21.52 | At the 2019 rate | 2019 |
| Overdose | 27.86 | Observed | 2020 |
| Overdose | 21.52 | At the 2019 rate | 2020 |
| Overdose | 32.15 | Observed | 2021 |
| Overdose | 21.52 | At the 2019 rate | 2021 |
| Overdose | 32.39 | Observed | 2022 |
| Overdose | 21.52 | At the 2019 rate | 2022 |
| Overdose | 31.35 | Observed | 2023 |
| Overdose | 21.52 | At the 2019 rate | 2023 |
| Overdose | 23.34 | Observed | 2024 |
| Overdose | 21.52 | At the 2019 rate | 2024 |
| Alcohol-induced deaths | 11.41 | Observed | 2018 |
| Alcohol-induced deaths | 11.89 | At the 2019 rate | 2018 |
| Alcohol-induced deaths | 11.89 | Observed | 2019 |
| Alcohol-induced deaths | 11.89 | At the 2019 rate | 2019 |
| Alcohol-induced deaths | 14.89 | Observed | 2020 |
| Alcohol-induced deaths | 11.89 | At the 2019 rate | 2020 |
| Alcohol-induced deaths | 16.35 | Observed | 2021 |
| Alcohol-induced deaths | 11.89 | At the 2019 rate | 2021 |
| Alcohol-induced deaths | 15.36 | Observed | 2022 |
| Alcohol-induced deaths | 11.89 | At the 2019 rate | 2022 |
| Alcohol-induced deaths | 14.31 | Observed | 2023 |
| Alcohol-induced deaths | 11.89 | At the 2019 rate | 2023 |
| Alcohol-induced deaths | 13.73 | Observed | 2024 |
| Alcohol-induced deaths | 11.89 | At the 2019 rate | 2024 |
| Suicide | 14.78 | Observed | 2018 |
| Suicide | 14.47 | At the 2019 rate | 2018 |
| Suicide | 14.47 | Observed | 2019 |
| Suicide | 14.47 | At the 2019 rate | 2019 |
| Suicide | 13.95 | Observed | 2020 |
| Suicide | 14.47 | At the 2019 rate | 2020 |
| Suicide | 14.52 | Observed | 2021 |
| Suicide | 14.47 | At the 2019 rate | 2021 |
| Suicide | 14.84 | Observed | 2022 |
| Suicide | 14.47 | At the 2019 rate | 2022 |
| Suicide | 14.72 | Observed | 2023 |
| Suicide | 14.47 | At the 2019 rate | 2023 |
| Suicide | 14.36 | Observed | 2024 |
| Suicide | 14.47 | At the 2019 rate | 2024 |
These totals are arithmetic. They do not estimate how many deaths any one event accounts for. The benchmark also ignores the rise that was already under way: the 2018 rates were 4.3%4.3% percent below the 2019 rateEstimand2019 national crude drug overdose death rate minus the 2018 rate, over the 2019 rateInterval95% CI 3.3% to 5.3%n67,367 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2018 against 2019SourceCDC WONDER underlying cause of death and 4.1%4.1% percent below the 2019 rateEstimand2019 national crude alcohol-induced death rate minus the 2018 rate, over the 2019 rateInterval95% CI 2.7% to 5.4%n37,329 deathsWeightsnone (crude rate from counts)Populationresidents of the United StatesPeriod2018 against 2019SourceCDC WONDER underlying cause of death below the 2019 rates for overdose and alcohol-induced deaths, so a benchmark that continued the earlier rise would give smaller totals. Because the rates are crude, a change in the age structure of the population would also move them.
The CDC panel shows the same overdose path, a homicide peak a year earlier and a flat suicide line
Homicide is not in the WONDER files used here, so Figure 3 turns to the county file of CDC's injury and violence dashboard, called the panel in this chapter. It carries 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. annual death rates for 3,1353,135 countiesEstimandcount of counties in the fileWeightsnone (full count)Populationcounties in CDC's county file (Connecticut's eight counties are absent)Period2019 to 2024SourceCDC injury and violence mapping counties; Connecticut's are absent. Where a county has few deaths CDC publishes a modeled rate, and where the model is unstable it publishes none. In 2019 the file has a stable rate for 2,9772,977 countiesEstimandcount of counties with a stable modeled drug overdose rate in 2019Weightsnone (full count)Populationcounties in CDC's county filePeriod2019SourceCDC injury and violence mapping counties for overdose, 3,0273,027 countiesEstimandcount of counties with a stable modeled homicide rate in 2019Weightsnone (full count)Populationcounties in CDC's county filePeriod2019SourceCDC injury and violence mapping for homicide and 2,8802,880 countiesEstimandcount of counties with a stable modeled suicide rate in 2019Weightsnone (full count)Populationcounties in CDC's county filePeriod2019SourceCDC injury and violence mapping for suicide. Overdose in the panel is unintentional or undetermined-intent drug poisoning, and suicide and homicide count every method. The national line is the mean of county rates weighted by county population, over the counties with a stable rate that year, with intervals from resampling counties.
Figure 3
In CDC's modeled county panel the overdose rate peaked in 2022 at 54.7% above its 2019 level and the homicide rate in 2021 at 35.2%, while the suicide rate stayed within 4.0% of its 2019 level
Mean of county death rates weighted by county population, relative to 2019 (2019 = 100), for overdose, homicide and suicide, counties with a stable modeled rate that year, United States, 2019 to 2024 (2024 provisional)
Show data
| cause | index | n_units | provisional | rate | rate_hi | rate_lo | year |
|---|---|---|---|---|---|---|---|
| Overdose | 100 | 2,977 | no | 19.97 | 21.18 | 18.77 | 2019 |
| Overdose | 131.9 | 3,012 | no | 26.35 | 27.77 | 25.02 | 2020 |
| Overdose | 154.2 | 3,045 | no | 30.80 | 32.31 | 29.36 | 2021 |
| Overdose | 154.7 | 3,040 | no | 30.90 | 32.41 | 29.51 | 2022 |
| Overdose | 150.1 | 3,035 | no | 29.97 | 31.39 | 28.62 | 2023 |
| Overdose | 112.0 | 3,006 | yes | 22.38 | 23.46 | 21.36 | 2024 |
| Homicide | 100 | 3,027 | no | 5.80 | 6.29 | 5.32 | 2019 |
| Homicide | 127.9 | 3,067 | no | 7.41 | 8.06 | 6.78 | 2020 |
| Homicide | 135.2 | 3,051 | no | 7.83 | 8.55 | 7.14 | 2021 |
| Homicide | 128.4 | 3,069 | no | 7.44 | 8.13 | 6.80 | 2022 |
| Homicide | 117.1 | 3,063 | no | 6.79 | 7.37 | 6.21 | 2023 |
| Homicide | 103.0 | 3,043 | yes | 5.97 | 6.46 | 5.51 | 2024 |
| Suicide | 100 | 2,880 | no | 14.42 | 14.99 | 13.84 | 2019 |
| Suicide | 95.97 | 2,903 | no | 13.84 | 14.38 | 13.29 | 2020 |
| Suicide | 100.3 | 2,888 | no | 14.47 | 15.04 | 13.87 | 2021 |
| Suicide | 102.7 | 2,891 | no | 14.81 | 15.36 | 14.23 | 2022 |
| Suicide | 101.8 | 2,870 | no | 14.69 | 15.24 | 14.12 | 2023 |
| Suicide | 100.7 | 2,870 | yes | 14.53 | 15.11 | 13.91 | 2024 |
On this measure the overdose rate peaked in 2022 at 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 above its 2019 level and was 12.0% (95% CI 7.4% to 17.2%)12.0% 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 7.4% to 17.2%n3,006 countiesWeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled drug overdose rate that yearPeriod2024 against 2019 (2024 provisional)SourceCDC injury and violence mapping above it in 2024. The homicide rate peaked a year earlier, in 2021, at 35.2% (95% CI 31.2% to 39.1%)35.2% percent above the 2019 rateEstimandweighted mean of county homicide rates in the year divided by the 2019 value, minus 1; bootstrap over counties with shared drawsInterval95% CI 31.2% to 39.1%n3,051 countiesWeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled homicide rate that yearPeriod2021 against 2019SourceCDC injury and violence mapping above 2019, and its 2024 value, 3.0% (95% CI −0.2% to 6.1%)3.0% percent above the 2019 rateEstimandweighted mean of county homicide rates in the year divided by the 2019 value, minus 1; bootstrap over counties with shared drawsInterval95% CI −0.2% to 6.1%n3,043 countiesWeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled homicide rate that yearPeriod2024 against 2019 (2024 provisional)SourceCDC injury and violence mapping above, has an interval that includes the 2019 level. The suicide rate stayed within 4.0%4.0% percent of the 2019 rateEstimandlargest absolute difference of the weighted mean county suicide rate from its 2019 valueWeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled suicide rate that yearPeriod2019 to 2024 against 2019 (2024 provisional)SourceCDC injury and violence mapping of 2019. In rates, the panel's overdose rate was 20.0 (95% CI 18.8 to 21.2)20.0 deaths per 100,000 residentsEstimandmean of county drug overdose rates weighted by county population; bootstrap over countiesInterval95% CI 18.8 to 21.2n2,977 countiesWeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled drug overdose rate that yearPeriod2019SourceCDC injury and violence mapping per hundred thousand residents in 2019 and 30.9 (95% CI 29.5 to 32.4)30.9 deaths per 100,000 residentsEstimandmean of county drug overdose rates weighted by county population; bootstrap over countiesInterval95% CI 29.5 to 32.4n3,040 countiesWeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled drug overdose rate that yearPeriod2022SourceCDC injury and violence mapping in 2022, the homicide rate 5.8 (95% CI 5.3 to 6.3)5.8 deaths per 100,000 residentsEstimandmean of county homicide rates weighted by county population; bootstrap over countiesInterval95% CI 5.3 to 6.3n3,027 countiesWeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled homicide rate that yearPeriod2019SourceCDC injury and violence mapping in 2019 and 7.8 (95% CI 7.1 to 8.6)7.8 deaths per 100,000 residentsEstimandmean of county homicide rates weighted by county population; bootstrap over countiesInterval95% CI 7.1 to 8.6n3,051 countiesWeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled homicide rate that yearPeriod2021SourceCDC injury and violence mapping in 2021, and the suicide rate 14.4 (95% CI 13.8 to 15.0)14.4 deaths per 100,000 residentsEstimandmean of county suicide rates weighted by county population; bootstrap over countiesInterval95% CI 13.8 to 15.0n2,880 countiesWeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled suicide rate that yearPeriod2019SourceCDC injury and violence mapping in 2019 and 14.5 (95% CI 13.9 to 15.1)14.5 deaths per 100,000 residentsEstimandmean of county suicide rates weighted by county population; bootstrap over countiesInterval95% CI 13.9 to 15.1n2,870 countiesWeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled suicide rate that yearPeriod2024 (provisional)SourceCDC injury and violence mapping in 2024. Restricting overdose to the counties with a stable rate in every year gives a 2022 rise of 54.5% (95% CI 49.7% to 59.1%)54.5% percent above the 2019 rateEstimandweighted mean of county overdose rates in 2022 divided by the 2019 value, minus 1, over counties with a stable rate in all six years; bootstrap over countiesInterval95% CI 49.7% to 59.1%n2,648 countiesWeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled overdose rate in every yearPeriod2022 against 2019SourceCDC injury and violence mapping, close to the full-county figure. A CDC report on firearm homicide, the subject of Chapter 6.2, Gun homicide and the causes of early death, found that the age-adjusted rate rose 34.6%34.6% percent rise in the firearm homicide rateEstimandrise in the age-adjusted firearm homicide rate reported by Kegler and colleagues (2022) from NCHS mortality dataWeightsas reported in the studyPopulationresidents of the United StatesPeriod2020 against 2019SourcePublished estimates from cited studies from 2019 to 2020.[4] The panel's all-method homicide rate rose 27.9% (95% CI 24.9% to 30.8%)27.9% percent above the 2019 rateEstimandweighted mean of county homicide rates in the year divided by the 2019 value, minus 1; bootstrap over counties with shared drawsInterval95% CI 24.9% to 30.8%n3,067 countiesWeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled homicide rate that yearPeriod2020 against 2019SourceCDC injury and violence mapping over the same year, a smaller rise in a different measure.
The two sources give different rises for overdose, and the difference tracks deaths that only WONDER counts
WONDER's overdose rate rose 50.5% (95% CI 49.1% to 51.9%)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 between 2019 and 2022 and the panel's 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. The panel's interval, which resamples counties, includes WONDER's rise, and WONDER's interval, which reflects only the randomness of the counts, does not include the panel's. The two intervals answer different questions. The difference of 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 has an accounting explanation more than a statistical one.
The series differ in three ways. First, WONDER counts drug poisonings of every intent, and the panel counts unintentional and undetermined-intent poisonings, so poisonings recorded as suicide or homicide are in WONDER and not in the panel. NCHS reports that in 2023 4.4%4.4% percent of drug overdose deathsEstimandshare of drug overdose deaths that were suicides, reported in NCHS Data Brief 522 (Garnett and Minino 2024) from final 2023 death certificatesWeightsas reported in the studyPopulationresidents of the United StatesPeriod2023SourcePublished estimates from cited studies of drug overdose deaths were suicides and under 1.0%1.0% percent of drug overdose deathsEstimandupper bound on the share of drug overdose deaths that were homicides (reported as less than 1.0 percent), NCHS Data Brief 522 (Garnett and Minino 2024)Weightsas reported in the studyPopulationresidents of the United StatesPeriod2023SourcePublished estimates from cited studies were homicides.[2] Second, the panel leaves out Connecticut, which accounts for 1,2141,214 drug overdose deathsEstimandWONDER drug poisoning deaths of any intent in ConnecticutWeightsnone (full count)PopulationConnecticut residentsPeriod2019SourceCDC WONDER underlying cause of death of WONDER's deaths in 2019, and leaving Connecticut out of WONDER moves its rise from 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 to 51.0% (95% CI 49.6% to 52.5%)51.0% percent above the 2019 rateEstimandcrude drug overdose death rate outside Connecticut in 2022 divided by the 2019 rate, minus 1; normal interval on the log ratio of the two death countsInterval95% CI 49.6% to 52.5%n106,459 deathsWeightsnone (crude rate from counts)Populationresidents of the 50 states and DC outside ConnecticutPeriod2022 against 2019SourceCDC WONDER underlying cause of death. Third, the panel has no rate for the county-years CDC marks unstable and models the rest. Counties with a stable rate in 2019 hold 99.5%99.5% percent of residentsEstimandshare of residents living in counties with a stable modeled overdose rate in 2019WeightsWONDER county populationPopulationresidents of the 50 states and DC outside ConnecticutPeriod2019SourceCDC injury and violence mapping of residents outside Connecticut, so the omitted counties are few.
The files used here do not record intent, so the chapter cannot split the difference by these three. It can show how the difference behaves (Figure 4). The panel's deaths, implied by multiplying each county's rate by WONDER's county population, are 64,51164,511 drug overdose deaths impliedEstimandsum over counties of the modeled overdose rate times WONDER's county population, over 100,000WeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled overdose rate that yearPeriod2019SourceCDC injury and violence mapping in 2019 and 101,642101,642 drug overdose deaths impliedEstimandsum over counties of the modeled overdose rate times WONDER's county population, over 100,000WeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled overdose rate that yearPeriod2022SourceCDC injury and violence mapping in 2022. WONDER's count outside Connecticut is 69,41669,416 drug overdose deathsEstimandWONDER drug poisoning deaths of any intent, the 50 state rows other than Connecticut summedWeightsnone (full count)Populationresidents of the 50 states and DC outside ConnecticutPeriod2019SourceCDC WONDER underlying cause of death and 106,459106,459 drug overdose deathsEstimandWONDER drug poisoning deaths of any intent, the 50 state rows other than Connecticut summedWeightsnone (full count)Populationresidents of the 50 states and DC outside ConnecticutPeriod2022SourceCDC WONDER underlying cause of death. The gap is 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, and it stays within a narrow band in the years between. Both series add about the same number of deaths between 2019 and 2022, 37,04337,043 drug overdose deaths addedEstimandWONDER count outside Connecticut in 2022 minus the count in 2019Weightsnone (full counts)Populationresidents of the 50 states and DC outside ConnecticutPeriod2022 against 2019SourceCDC WONDER underlying cause of death in WONDER and 37,13237,132 drug overdose deaths addedEstimandthe panel's implied deaths in 2022 minus those in 2019WeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled overdose rate that yearPeriod2022 against 2019SourceCDC injury and violence mapping in the panel, so the panel's smaller base turns the same increase into a larger percentage. Adding the 2019 gap to the panel's deaths in every year lowers its rise from 54.7%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 to 51.2%51.2% percent above the 2019 rateEstimandthe panel's implied deaths plus the 2019 gap in both years, over WONDER's population outside Connecticut: 2022 rate over the 2019 rate, minus 1Weightssee the two seriesPopulationresidents of the 50 states and DC outside ConnecticutPeriod2022 against 2019SourceCDC injury and violence mapping, close to WONDER's 51.0%51.0% percent above the 2019 rateEstimandcrude drug overdose death rate outside Connecticut in 2022 divided by the 2019 rate, minus 1; normal interval on the log ratio of the two death countsInterval95% CI 49.6% to 52.5%n106,459 deathsWeightsnone (crude rate from counts)Populationresidents of the 50 states and DC outside ConnecticutPeriod2022 against 2019SourceCDC WONDER underlying cause of death outside Connecticut. By 2023 the gap is 4.4%4.4% percent of WONDER's countEstimandWONDER count outside Connecticut minus the panel's implied deaths, over WONDER's countWeightssee the two seriesPopulationresidents of the 50 states and DC outside ConnecticutPeriod2023SourceCDC WONDER underlying cause of death of WONDER's count outside Connecticut, which is within what the NCHS split for that year implies: 4.4%4.4% percent of drug overdose deathsEstimandshare of drug overdose deaths that were suicides, reported in NCHS Data Brief 522 (Garnett and Minino 2024) from final 2023 death certificatesWeightsas reported in the studyPopulationresidents of the United StatesPeriod2023SourcePublished estimates from cited studies for suicides plus under 1.0%1.0% percent of drug overdose deathsEstimandupper bound on the share of drug overdose deaths that were homicides (reported as less than 1.0 percent), NCHS Data Brief 522 (Garnett and Minino 2024)Weightsas reported in the studyPopulationresidents of the United StatesPeriod2023SourcePublished estimates from cited studies for homicides. That is one year. The gap was 7.1%7.1% percent of WONDER's countEstimandWONDER count outside Connecticut minus the panel's implied deaths, over WONDER's countWeightssee the two seriesPopulationresidents of the 50 states and DC outside ConnecticutPeriod2019SourceCDC WONDER underlying cause of death of WONDER's count in 2019 and 4.5%4.5% percent of WONDER's countEstimandWONDER count outside Connecticut minus the panel's implied deaths, over WONDER's countWeightssee the two seriesPopulationresidents of the 50 states and DC outside ConnecticutPeriod2022SourceCDC WONDER underlying cause of death in 2022, and the intent split for 2019 is not in the files used here, so the match in 2023 is consistent with the intent explanation and does not prove it.
Figure 4
WONDER's overdose rate rose 51.0% from 2019 to 2022 outside Connecticut and the panel's rose 54.7%, a difference that matches a roughly constant number of deaths the panel does not count
Drug overdose deaths and crude rates, CDC WONDER (poisoning of any intent) and the CDC county panel (unintentional or undetermined intent), 2019 to 2024
Both series add about the same number of overdose deaths from 2019 to 2022, 37,043 in WONDER outside Connecticut and 37,132 in the panel
Overdose deaths per year, CDC WONDER drug poisoning of any intent outside Connecticut and the deaths implied by the CDC panel's modeled county rates, 2019 to 2024 (the panel's 2024 values are provisional)
The gap between the lines is 4,905 deaths in 2019 and 4,817 in 2022: deaths that WONDER counts and the panel's implied count does not. Both lines rise by about the same number of deaths from different bases, so the panel's rise is the larger percentage. The panel's deaths are the sum over counties of the modeled rate times WONDER's county population over one hundred thousand.
Show data
| deaths | provisional | series | year |
|---|---|---|---|
| 69416 | no | CDC WONDER, any intent, outside Connecticut | 2019 |
| 64510.6 | no | CDC panel, unintentional or undetermined intent | 2019 |
| 90428 | no | CDC WONDER, any intent, outside Connecticut | 2020 |
| 85588.1 | no | CDC panel, unintentional or undetermined intent | 2020 |
| 105147 | no | CDC WONDER, any intent, outside Connecticut | 2021 |
| 100904 | no | CDC panel, unintentional or undetermined intent | 2021 |
| 106459 | no | CDC WONDER, any intent, outside Connecticut | 2022 |
| 101642 | no | CDC panel, unintentional or undetermined intent | 2022 |
| 103689 | no | CDC WONDER, any intent, outside Connecticut | 2023 |
| 99080.1 | no | CDC panel, unintentional or undetermined intent | 2023 |
| 78389 | no | CDC WONDER, any intent, outside Connecticut | 2024 |
| 75033.4 | yes | CDC panel, unintentional or undetermined intent | 2024 |
The chapter uses WONDER for national counts and rates and the panel for homicide and for the rates of small counties, and the text names the source each time.
Rates are higher in more deprived counties, and the larger overdose rise in them appears only in the counties WONDER withholds
Figure 5 splits the series by county deprivation. Counties are ranked 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 cut into thirds with equal numbers of counties. Counties with no index value are left out of the thirds: 99 countiesEstimandcount of those counties with no Area Deprivation Index value, left out of the thirdsn889 countiesWeightsnone (full count)Populationcounties whose drug overdose count is published in every year 2018 to 2024Period2018 to 2024SourceCDC WONDER underlying cause of death of the 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 complete overdose counties below and 1313 countiesEstimandcount of those counties with no Area Deprivation Index value, left out of the thirdsn2,648 countiesWeightsnone (full count)Populationcounties with a stable modeled overdose rate in every year 2019 to 2024Period2019 to 2024SourceCDC injury and violence mapping of the 2,6482,648 countiesEstimandcount of counties with a stable modeled drug overdose rate and a population in every yearWeightsnone (full count)Populationcounties in CDC's county filePeriod2019 to 2024SourceCDC injury and violence mapping panel counties for overdose. WONDER publishes a county's count only when it is zero or at least 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, and the chapter does not impute withheld counts. It uses 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 whose count is published in every year from 2018 to 2024, where a count of zero counts as published: 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 for overdose, 629629 countiesEstimandcount of counties whose alcohol-induced 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 for alcohol-induced deaths and 718718 countiesEstimandcount of counties whose suicide 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 for suicide.
Complete counties are selected on the outcome as well as on size. Chapter 10.5, Suppressed counties in death data covers how WONDER's rule removes counties and why pooling a county's published years is biased, and it shows that among counties of similar size, complete counties have much higher modeled rates than the rest, except among the smallest. The set includes counties with no deaths: 9999 countiesEstimandcount of those counties with zero deaths in all seven yearsn889 countiesWeightsnone (full count)Populationcounties whose drug overdose count is published in every year 2018 to 2024Period2018 to 2024SourceCDC WONDER underlying cause of death of the complete overdose counties, 3939 countiesEstimandcount of those counties with zero deaths in all seven yearsn629 countiesWeightsnone (full count)Populationcounties whose alcohol-induced count is published in every year 2018 to 2024Period2018 to 2024SourceCDC WONDER underlying cause of death of the alcohol-induced and 2424 countiesEstimandcount of those counties with zero deaths in all seven yearsn718 countiesWeightsnone (full count)Populationcounties whose suicide count is published in every year 2018 to 2024Period2018 to 2024SourceCDC WONDER underlying cause of death of the suicide counties have zero deaths in every year from 2018 to 2024, and 7676 countiesEstimandcount of those counties in the most deprived third of the complete overdose countiesWeightsnone (full count)Populationcomplete overdose counties with zero deaths in all seven yearsPeriod2018 to 2024SourceCDC WONDER underlying cause of death of the overdose ones are in the most deprived third. For national totals the selection matters little: the overdose rate pooled over complete counties was 48.9% (95% CI 44.0% to 53.9%)48.9% percent above the 2019 rateEstimandpooled crude drug overdose rate of the complete counties in the year divided by the 2019 rate, minus 1; bootstrap over countiesInterval95% CI 44.0% to 53.9%n889 countiesWeightsnone (crude rates from counts)Populationresidents of counties whose drug overdose count is published in every yearPeriod2022 against 2019SourceCDC WONDER underlying cause of death above 2019 in 2022, against 50.5% (95% CI 49.1% to 51.9%)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 for the nation. For comparisons between counties it matters more, so the figure also shows the panel, whose modeled rates cover nearly every county. The thirds are thirds of the counties in each version, so the WONDER thirds and the panel thirds are different sets of counties.
Figure 5
Among counties with published counts in every year, death rates in 2022 were higher in the most deprived third of counties than in the least deprived third, by 1.49 times for overdose, 1.22 for alcohol-induced deaths and 1.37 for suicide
Pooled crude death rates per 100,000 residents by third of counties ranked by Area Deprivation Index, counties whose count CDC WONDER publishes in every year 2018 to 2024, United States
Deaths per 100,000 residents
- Least deprived third
- Middle third
- Most deprived third
Show data
| cause | conf_high | conf_low | index | index_hi | index_lo | n_units | provisional | rate | source | third | year |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Overdose | 20.41 | 17.14 | 95.64 | 98.36 | 93.06 | 294 | no | 18.76 | CDC WONDER, counties with published counts in every year | Least deprived third | 2018 |
| Overdose | 21.25 | 18.06 | 100 | n/a | n/a | 294 | no | 19.61 | CDC WONDER, counties with published counts in every year | Least deprived third | 2019 |
| Overdose | 27.08 | 23.60 | 128.7 | 133.0 | 124.4 | 294 | no | 25.25 | CDC WONDER, counties with published counts in every year | Least deprived third | 2020 |
| Overdose | 30.62 | 26.97 | 146.6 | 152.9 | 140.4 | 294 | no | 28.74 | CDC WONDER, counties with published counts in every year | Least deprived third | 2021 |
| Overdose | 31.02 | 27.35 | 148.4 | 156.0 | 140.7 | 294 | no | 29.11 | CDC WONDER, counties with published counts in every year | Least deprived third | 2022 |
| Overdose | 31.14 | 27.22 | 148.4 | 157.7 | 139.2 | 294 | no | 29.10 | CDC WONDER, counties with published counts in every year | Least deprived third | 2023 |
| Overdose | 23.98 | 20.63 | 113.4 | 121.5 | 105.1 | 294 | no | 22.23 | CDC WONDER, counties with published counts in every year | Least deprived third | 2024 |
| Overdose | 28.90 | 22.89 | 94.74 | 97.22 | 92.23 | 293 | no | 25.68 | CDC WONDER, counties with published counts in every year | Middle third | 2018 |
| Overdose | 30.46 | 24.10 | 100 | n/a | n/a | 293 | no | 27.11 | CDC WONDER, counties with published counts in every year | Middle third | 2019 |
| Overdose | 39.24 | 31.57 | 130.2 | 134.5 | 125.8 | 293 | no | 35.29 | CDC WONDER, counties with published counts in every year | Middle third | 2020 |
| Overdose | 44.63 | 36.57 | 149.1 | 156.0 | 142.0 | 293 | no | 40.40 | CDC WONDER, counties with published counts in every year | Middle third | 2021 |
| Overdose | 44.57 | 36.69 | 149.2 | 156.2 | 142.4 | 293 | no | 40.45 | CDC WONDER, counties with published counts in every year | Middle third | 2022 |
| Overdose | 41.87 | 34.36 | 139.8 | 147.2 | 132.6 | 293 | no | 37.90 | CDC WONDER, counties with published counts in every year | Middle third | 2023 |
| Overdose | 30.13 | 25.11 | 101.3 | 107.7 | 95.31 | 293 | no | 27.47 | CDC WONDER, counties with published counts in every year | Middle third | 2024 |
| Overdose | 31.44 | 24.16 | 96.83 | 100.5 | 92.89 | 293 | no | 28.02 | CDC WONDER, counties with published counts in every year | Most deprived third | 2018 |
| Overdose | 32.29 | 24.93 | 100 | n/a | n/a | 293 | no | 28.94 | CDC WONDER, counties with published counts in every year | Most deprived third | 2019 |
| Overdose | 40.80 | 33.10 | 128.4 | 135.5 | 122.8 | 293 | no | 37.15 | CDC WONDER, counties with published counts in every year | Most deprived third | 2020 |
| Overdose | 47.40 | 38.89 | 149.8 | 160.9 | 141.9 | 293 | no | 43.36 | CDC WONDER, counties with published counts in every year | Most deprived third | 2021 |
| Overdose | 47.35 | 39.19 | 150.3 | 162.1 | 141.8 | 293 | no | 43.50 | CDC WONDER, counties with published counts in every year | Most deprived third | 2022 |
| Overdose | 45.63 | 37.48 | 144.4 | 154.2 | 137.2 | 293 | no | 41.80 | CDC WONDER, counties with published counts in every year | Most deprived third | 2023 |
| Overdose | 31.22 | 26.33 | 99.94 | 109.6 | 93.10 | 293 | no | 28.92 | CDC WONDER, counties with published counts in every year | Most deprived third | 2024 |
| Alcohol-induced deaths | 11.95 | 10.41 | 96.41 | 98.63 | 94.15 | 208 | no | 11.17 | CDC WONDER, counties with published counts in every year | Least deprived third | 2018 |
| Alcohol-induced deaths | 12.41 | 10.77 | 100 | n/a | n/a | 208 | no | 11.59 | CDC WONDER, counties with published counts in every year | Least deprived third | 2019 |
| Alcohol-induced deaths | 15.14 | 13.21 | 122.1 | 125.1 | 119.2 | 208 | no | 14.15 | CDC WONDER, counties with published counts in every year | Least deprived third | 2020 |
| Alcohol-induced deaths | 16.75 | 14.28 | 133.9 | 137.7 | 130.0 | 208 | no | 15.52 | CDC WONDER, counties with published counts in every year | Least deprived third | 2021 |
| Alcohol-induced deaths | 15.71 | 13.51 | 125.9 | 129.2 | 122.6 | 208 | no | 14.60 | CDC WONDER, counties with published counts in every year | Least deprived third | 2022 |
| Alcohol-induced deaths | 14.83 | 12.70 | 118.7 | 121.8 | 115.3 | 208 | no | 13.76 | CDC WONDER, counties with published counts in every year | Least deprived third | 2023 |
| Alcohol-induced deaths | 14.08 | 11.98 | 112.4 | 115.3 | 109.0 | 208 | no | 13.03 | CDC WONDER, counties with published counts in every year | Least deprived third | 2024 |
| Alcohol-induced deaths | 12.68 | 10.44 | 97.27 | 100.9 | 93.91 | 207 | no | 11.45 | CDC WONDER, counties with published counts in every year | Middle third | 2018 |
| Alcohol-induced deaths | 12.95 | 10.80 | 100 | n/a | n/a | 207 | no | 11.77 | CDC WONDER, counties with published counts in every year | Middle third | 2019 |
| Alcohol-induced deaths | 16.37 | 13.78 | 127.1 | 130.6 | 123.7 | 207 | no | 14.96 | CDC WONDER, counties with published counts in every year | Middle third | 2020 |
| Alcohol-induced deaths | 17.40 | 14.84 | 135.8 | 140.3 | 131.0 | 207 | no | 15.98 | CDC WONDER, counties with published counts in every year | Middle third | 2021 |
| Alcohol-induced deaths | 16.33 | 14.00 | 127.9 | 132.7 | 123.0 | 207 | no | 15.05 | CDC WONDER, counties with published counts in every year | Middle third | 2022 |
| Alcohol-induced deaths | 15.18 | 13.01 | 119.2 | 123.5 | 114.8 | 207 | no | 14.03 | CDC WONDER, counties with published counts in every year | Middle third | 2023 |
| Alcohol-induced deaths | 14.48 | 12.43 | 113.5 | 118.7 | 108.5 | 207 | no | 13.36 | CDC WONDER, counties with published counts in every year | Middle third | 2024 |
| Alcohol-induced deaths | 13.99 | 12.03 | 95.42 | 99.55 | 91.73 | 207 | no | 12.95 | CDC WONDER, counties with published counts in every year | Most deprived third | 2018 |
| Alcohol-induced deaths | 14.55 | 12.62 | 100 | n/a | n/a | 207 | no | 13.57 | CDC WONDER, counties with published counts in every year | Most deprived third | 2019 |
| Alcohol-induced deaths | 18.68 | 15.89 | 126.7 | 131.5 | 121.9 | 207 | no | 17.20 | CDC WONDER, counties with published counts in every year | Most deprived third | 2020 |
| Alcohol-induced deaths | 20.41 | 17.37 | 138.5 | 144.1 | 133.4 | 207 | no | 18.79 | CDC WONDER, counties with published counts in every year | Most deprived third | 2021 |
| Alcohol-induced deaths | 19.44 | 16.44 | 131.7 | 137.2 | 126.3 | 207 | no | 17.87 | CDC WONDER, counties with published counts in every year | Most deprived third | 2022 |
| Alcohol-induced deaths | 17.45 | 15.13 | 119.8 | 124.6 | 114.9 | 207 | no | 16.26 | CDC WONDER, counties with published counts in every year | Most deprived third | 2023 |
| Alcohol-induced deaths | 16.85 | 14.79 | 116.3 | 121.3 | 111.5 | 207 | no | 15.78 | CDC WONDER, counties with published counts in every year | Most deprived third | 2024 |
| Suicide | 13.58 | 11.82 | 101.3 | 103.4 | 99.14 | 239 | no | 12.66 | CDC WONDER, counties with published counts in every year | Least deprived third | 2018 |
| Suicide | 13.43 | 11.66 | 100 | n/a | n/a | 239 | no | 12.50 | CDC WONDER, counties with published counts in every year | Least deprived third | 2019 |
| Suicide | 12.70 | 11.07 | 94.53 | 96.58 | 92.48 | 239 | no | 11.82 | CDC WONDER, counties with published counts in every year | Least deprived third | 2020 |
| Suicide | 13.07 | 11.30 | 97.12 | 99.14 | 94.95 | 239 | no | 12.14 | CDC WONDER, counties with published counts in every year | Least deprived third | 2021 |
| Suicide | 13.48 | 11.76 | 100.5 | 102.5 | 98.25 | 239 | no | 12.56 | CDC WONDER, counties with published counts in every year | Least deprived third | 2022 |
| Suicide | 13.25 | 11.54 | 98.56 | 100.8 | 96.21 | 239 | no | 12.32 | CDC WONDER, counties with published counts in every year | Least deprived third | 2023 |
| Suicide | 12.92 | 11.09 | 95.73 | 98.00 | 93.52 | 239 | no | 11.96 | CDC WONDER, counties with published counts in every year | Least deprived third | 2024 |
| Suicide | 16.26 | 13.89 | 100.9 | 103.6 | 98.43 | 238 | no | 15.01 | CDC WONDER, counties with published counts in every year | Middle third | 2018 |
| Suicide | 16.08 | 13.85 | 100 | n/a | n/a | 238 | no | 14.87 | CDC WONDER, counties with published counts in every year | Middle third | 2019 |
| Suicide | 15.01 | 13.10 | 94.06 | 96.40 | 91.55 | 238 | no | 13.99 | CDC WONDER, counties with published counts in every year | Middle third | 2020 |
| Suicide | 15.86 | 13.87 | 99.47 | 102.4 | 96.58 | 238 | no | 14.79 | CDC WONDER, counties with published counts in every year | Middle third | 2021 |
| Suicide | 15.97 | 14.10 | 100.9 | 104.2 | 97.32 | 238 | no | 15.01 | CDC WONDER, counties with published counts in every year | Middle third | 2022 |
| Suicide | 15.94 | 14.07 | 100.6 | 103.6 | 97.43 | 238 | no | 14.96 | CDC WONDER, counties with published counts in every year | Middle third | 2023 |
| Suicide | 15.66 | 13.65 | 98.27 | 101.0 | 95.41 | 238 | no | 14.62 | CDC WONDER, counties with published counts in every year | Middle third | 2024 |
| Suicide | 17.74 | 15.83 | 106.2 | 109.6 | 103.0 | 238 | no | 16.74 | CDC WONDER, counties with published counts in every year | Most deprived third | 2018 |
| Suicide | 16.60 | 14.99 | 100 | n/a | n/a | 238 | no | 15.77 | CDC WONDER, counties with published counts in every year | Most deprived third | 2019 |
| Suicide | 16.95 | 15.11 | 101.6 | 105.0 | 98.31 | 238 | no | 16.02 | CDC WONDER, counties with published counts in every year | Most deprived third | 2020 |
| Suicide | 17.43 | 15.59 | 104.5 | 108.6 | 100.9 | 238 | no | 16.48 | CDC WONDER, counties with published counts in every year | Most deprived third | 2021 |
| Suicide | 18.16 | 16.29 | 109.1 | 113.1 | 105.4 | 238 | no | 17.20 | CDC WONDER, counties with published counts in every year | Most deprived third | 2022 |
| Suicide | 18.25 | 16.46 | 109.7 | 113.8 | 106.3 | 238 | no | 17.30 | CDC WONDER, counties with published counts in every year | Most deprived third | 2023 |
| Suicide | 17.58 | 15.87 | 105.8 | 109.8 | 102.2 | 238 | no | 16.69 | CDC WONDER, counties with published counts in every year | Most deprived third | 2024 |
| Overdose | 20.26 | 17.68 | 100 | n/a | n/a | 879 | no | 18.99 | CDC panel, counties with a stable rate in every year | Least deprived third | 2019 |
| Overdose | 26.50 | 23.46 | 131.4 | 134.8 | 127.7 | 879 | no | 24.95 | CDC panel, counties with a stable rate in every year | Least deprived third | 2020 |
| Overdose | 30.43 | 27.21 | 151.7 | 157.0 | 146.7 | 879 | no | 28.79 | CDC panel, counties with a stable rate in every year | Least deprived third | 2021 |
| Overdose | 30.30 | 27.19 | 151.4 | 157.6 | 145.2 | 879 | no | 28.75 | CDC panel, counties with a stable rate in every year | Least deprived third | 2022 |
| Overdose | 29.83 | 26.69 | 148.8 | 156.1 | 141.5 | 879 | no | 28.26 | CDC panel, counties with a stable rate in every year | Least deprived third | 2023 |
| Overdose | 22.77 | 20.26 | 113.2 | 120.0 | 106.6 | 879 | yes | 21.49 | CDC panel, counties with a stable rate in every year | Least deprived third | 2024 |
| Overdose | 26.97 | 21.01 | 100 | n/a | n/a | 878 | no | 23.86 | CDC panel, counties with a stable rate in every year | Middle third | 2019 |
| Overdose | 34.45 | 28.17 | 130.8 | 136.4 | 125.9 | 878 | no | 31.19 | CDC panel, counties with a stable rate in every year | Middle third | 2020 |
| Overdose | 40.28 | 33.69 | 154.9 | 163.8 | 147.2 | 878 | no | 36.95 | CDC panel, counties with a stable rate in every year | Middle third | 2021 |
| Overdose | 41.21 | 34.54 | 158.5 | 168.2 | 150.0 | 878 | no | 37.81 | CDC panel, counties with a stable rate in every year | Middle third | 2022 |
| Overdose | 38.62 | 32.05 | 147.9 | 156.3 | 140.7 | 878 | no | 35.29 | CDC panel, counties with a stable rate in every year | Middle third | 2023 |
| Overdose | 28.12 | 23.28 | 107.2 | 114.1 | 101.3 | 878 | yes | 25.57 | CDC panel, counties with a stable rate in every year | Middle third | 2024 |
| Overdose | 21.32 | 17.12 | 100 | n/a | n/a | 878 | no | 19.19 | CDC panel, counties with a stable rate in every year | Most deprived third | 2019 |
| Overdose | 29.54 | 23.91 | 139.4 | 145.0 | 134.3 | 878 | no | 26.75 | CDC panel, counties with a stable rate in every year | Most deprived third | 2020 |
| Overdose | 37.00 | 29.90 | 175.0 | 184.8 | 166.0 | 878 | no | 33.59 | CDC panel, counties with a stable rate in every year | Most deprived third | 2021 |
| Overdose | 35.94 | 29.39 | 171.0 | 180.7 | 162.3 | 878 | no | 32.81 | CDC panel, counties with a stable rate in every year | Most deprived third | 2022 |
| Overdose | 35.48 | 29.10 | 168.9 | 178.1 | 160.6 | 878 | no | 32.41 | CDC panel, counties with a stable rate in every year | Most deprived third | 2023 |
| Overdose | 24.81 | 20.66 | 118.7 | 126.3 | 111.8 | 878 | yes | 22.77 | CDC panel, counties with a stable rate in every year | Most deprived third | 2024 |
| Homicide | 5.74 | 4.64 | 100 | n/a | n/a | 914 | no | 5.15 | CDC panel, counties with a stable rate in every year | Least deprived third | 2019 |
| Homicide | 7.40 | 5.83 | 127.1 | 130.6 | 123.2 | 914 | no | 6.55 | CDC panel, counties with a stable rate in every year | Least deprived third | 2020 |
| Homicide | 7.97 | 6.20 | 136.2 | 141.3 | 130.9 | 914 | no | 7.02 | CDC panel, counties with a stable rate in every year | Least deprived third | 2021 |
| Homicide | 7.50 | 5.91 | 128.8 | 133.1 | 124.3 | 914 | no | 6.64 | CDC panel, counties with a stable rate in every year | Least deprived third | 2022 |
| Homicide | 6.74 | 5.36 | 116.5 | 120.5 | 112.3 | 914 | no | 6.00 | CDC panel, counties with a stable rate in every year | Least deprived third | 2023 |
| Homicide | 5.92 | 4.75 | 102.7 | 106.6 | 98.82 | 914 | yes | 5.29 | CDC panel, counties with a stable rate in every year | Least deprived third | 2024 |
| Homicide | 9.24 | 6.80 | 100 | n/a | n/a | 914 | no | 7.95 | CDC panel, counties with a stable rate in every year | Middle third | 2019 |
| Homicide | 11.90 | 8.72 | 128.9 | 135.7 | 122.2 | 914 | no | 10.25 | CDC panel, counties with a stable rate in every year | Middle third | 2020 |
| Homicide | 12.05 | 8.94 | 131.4 | 138.6 | 124.7 | 914 | no | 10.45 | CDC panel, counties with a stable rate in every year | Middle third | 2021 |
| Homicide | 11.59 | 8.56 | 125.9 | 133.1 | 118.7 | 914 | no | 10.01 | CDC panel, counties with a stable rate in every year | Middle third | 2022 |
| Homicide | 10.73 | 7.86 | 116.0 | 124.9 | 107.8 | 914 | no | 9.23 | CDC panel, counties with a stable rate in every year | Middle third | 2023 |
| Homicide | 9.29 | 6.94 | 101.5 | 108.6 | 94.92 | 914 | yes | 8.07 | CDC panel, counties with a stable rate in every year | Middle third | 2024 |
| Homicide | 7.81 | 6.05 | 100 | n/a | n/a | 914 | no | 6.90 | CDC panel, counties with a stable rate in every year | Most deprived third | 2019 |
| Homicide | 10.38 | 7.87 | 130.7 | 138.5 | 122.6 | 914 | no | 9.02 | CDC panel, counties with a stable rate in every year | Most deprived third | 2020 |
| Homicide | 11.28 | 8.43 | 140.8 | 149.8 | 132.3 | 914 | no | 9.72 | CDC panel, counties with a stable rate in every year | Most deprived third | 2021 |
| Homicide | 10.80 | 8.23 | 135.8 | 144.8 | 127.5 | 914 | no | 9.37 | CDC panel, counties with a stable rate in every year | Most deprived third | 2022 |
| Homicide | 10.11 | 7.69 | 127.7 | 136.2 | 119.3 | 914 | no | 8.81 | CDC panel, counties with a stable rate in every year | Most deprived third | 2023 |
| Homicide | 9.08 | 6.79 | 113.2 | 120.8 | 105.9 | 914 | yes | 7.81 | CDC panel, counties with a stable rate in every year | Most deprived third | 2024 |
| Suicide | 14.20 | 12.80 | 100 | n/a | n/a | 725 | no | 13.47 | CDC panel, counties with a stable rate in every year | Least deprived third | 2019 |
| Suicide | 13.35 | 12.04 | 94.06 | 95.56 | 92.45 | 725 | no | 12.67 | CDC panel, counties with a stable rate in every year | Least deprived third | 2020 |
| Suicide | 13.95 | 12.59 | 98.19 | 99.84 | 96.56 | 725 | no | 13.22 | CDC panel, counties with a stable rate in every year | Least deprived third | 2021 |
| Suicide | 14.26 | 12.90 | 100.5 | 102.3 | 98.63 | 725 | no | 13.54 | CDC panel, counties with a stable rate in every year | Least deprived third | 2022 |
| Suicide | 14.09 | 12.77 | 99.46 | 101.1 | 97.62 | 725 | no | 13.39 | CDC panel, counties with a stable rate in every year | Least deprived third | 2023 |
| Suicide | 14.05 | 12.64 | 98.85 | 100.6 | 97.08 | 725 | yes | 13.31 | CDC panel, counties with a stable rate in every year | Least deprived third | 2024 |
| Suicide | 16.86 | 15.64 | 100 | n/a | n/a | 724 | no | 16.20 | CDC panel, counties with a stable rate in every year | Middle third | 2019 |
| Suicide | 16.81 | 15.45 | 99.39 | 102.1 | 96.62 | 724 | no | 16.11 | CDC panel, counties with a stable rate in every year | Middle third | 2020 |
| Suicide | 17.55 | 16.12 | 103.6 | 106.6 | 100.7 | 724 | no | 16.79 | CDC panel, counties with a stable rate in every year | Middle third | 2021 |
| Suicide | 18.05 | 16.65 | 106.9 | 109.7 | 104.1 | 724 | no | 17.32 | CDC panel, counties with a stable rate in every year | Middle third | 2022 |
| Suicide | 18.01 | 16.58 | 106.6 | 109.7 | 103.6 | 724 | no | 17.27 | CDC panel, counties with a stable rate in every year | Middle third | 2023 |
| Suicide | 17.59 | 16.28 | 104.3 | 107.2 | 101.5 | 724 | yes | 16.90 | CDC panel, counties with a stable rate in every year | Middle third | 2024 |
| Suicide | 17.95 | 16.00 | 100 | n/a | n/a | 725 | no | 17.03 | CDC panel, counties with a stable rate in every year | Most deprived third | 2019 |
| Suicide | 18.00 | 15.84 | 99.81 | 103.4 | 96.23 | 725 | no | 17.00 | CDC panel, counties with a stable rate in every year | Most deprived third | 2020 |
| Suicide | 19.03 | 16.74 | 105.5 | 109.5 | 101.6 | 725 | no | 17.96 | CDC panel, counties with a stable rate in every year | Most deprived third | 2021 |
| Suicide | 18.98 | 16.79 | 105.5 | 109.3 | 101.6 | 725 | no | 17.96 | CDC panel, counties with a stable rate in every year | Most deprived third | 2022 |
| Suicide | 19.07 | 17.05 | 106.4 | 109.8 | 103.0 | 725 | no | 18.12 | CDC panel, counties with a stable rate in every year | Most deprived third | 2023 |
| Suicide | 18.88 | 16.76 | 104.9 | 108.6 | 101.4 | 725 | yes | 17.88 | CDC panel, counties with a stable rate in every year | Most deprived third | 2024 |
| Overdose, counties complete in WONDER | 19.68 | 16.61 | 100 | n/a | n/a | 294 | no | 18.11 | CDC panel, overdose, counties complete in WONDER and other counties | Least deprived third | 2019 |
| Overdose, counties complete in WONDER | 25.48 | 22.06 | 130.9 | 135.6 | 126.3 | 294 | no | 23.70 | CDC panel, overdose, counties complete in WONDER and other counties | Least deprived third | 2020 |
| Overdose, counties complete in WONDER | 29.21 | 25.65 | 151.1 | 158.0 | 144.5 | 294 | no | 27.36 | CDC panel, overdose, counties complete in WONDER and other counties | Least deprived third | 2021 |
| Overdose, counties complete in WONDER | 29.45 | 25.77 | 152.3 | 160.5 | 143.9 | 294 | no | 27.57 | CDC panel, overdose, counties complete in WONDER and other counties | Least deprived third | 2022 |
| Overdose, counties complete in WONDER | 29.68 | 25.82 | 152.8 | 163.1 | 143.0 | 294 | no | 27.67 | CDC panel, overdose, counties complete in WONDER and other counties | Least deprived third | 2023 |
| Overdose, counties complete in WONDER | 22.97 | 19.68 | 117.4 | 126.2 | 108.6 | 294 | yes | 21.25 | CDC panel, overdose, counties complete in WONDER and other counties | Least deprived third | 2024 |
| Overdose, counties complete in WONDER | 28.83 | 22.63 | 100 | n/a | n/a | 293 | no | 25.57 | CDC panel, overdose, counties complete in WONDER and other counties | Middle third | 2019 |
| Overdose, counties complete in WONDER | 37.56 | 30.06 | 131.9 | 136.7 | 127.0 | 293 | no | 33.72 | CDC panel, overdose, counties complete in WONDER and other counties | Middle third | 2020 |
| Overdose, counties complete in WONDER | 43.15 | 35.17 | 152.4 | 160.1 | 144.8 | 293 | no | 38.96 | CDC panel, overdose, counties complete in WONDER and other counties | Middle third | 2021 |
| Overdose, counties complete in WONDER | 43.07 | 35.24 | 152.4 | 160.0 | 144.9 | 293 | no | 38.97 | CDC panel, overdose, counties complete in WONDER and other counties | Middle third | 2022 |
| Overdose, counties complete in WONDER | 40.38 | 32.97 | 142.5 | 150.6 | 134.7 | 293 | no | 36.45 | CDC panel, overdose, counties complete in WONDER and other counties | Middle third | 2023 |
| Overdose, counties complete in WONDER | 29.32 | 24.27 | 104.0 | 110.9 | 97.49 | 293 | yes | 26.59 | CDC panel, overdose, counties complete in WONDER and other counties | Middle third | 2024 |
| Overdose, counties complete in WONDER | 30.78 | 23.47 | 100 | n/a | n/a | 293 | no | 27.41 | CDC panel, overdose, counties complete in WONDER and other counties | Most deprived third | 2019 |
| Overdose, counties complete in WONDER | 39.04 | 31.47 | 129.3 | 137.6 | 122.8 | 293 | no | 35.44 | CDC panel, overdose, counties complete in WONDER and other counties | Most deprived third | 2020 |
| Overdose, counties complete in WONDER | 45.82 | 37.56 | 152.6 | 164.5 | 143.8 | 293 | no | 41.84 | CDC panel, overdose, counties complete in WONDER and other counties | Most deprived third | 2021 |
| Overdose, counties complete in WONDER | 45.52 | 37.53 | 152.3 | 164.8 | 143.0 | 293 | no | 41.75 | CDC panel, overdose, counties complete in WONDER and other counties | Most deprived third | 2022 |
| Overdose, counties complete in WONDER | 43.99 | 35.96 | 146.5 | 157.0 | 138.6 | 293 | no | 40.14 | CDC panel, overdose, counties complete in WONDER and other counties | Most deprived third | 2023 |
| Overdose, counties complete in WONDER | 29.98 | 25.27 | 101.2 | 111.5 | 93.85 | 293 | yes | 27.73 | CDC panel, overdose, counties complete in WONDER and other counties | Most deprived third | 2024 |
| Overdose, other counties | 13.94 | 12.55 | 100 | n/a | n/a | 585 | no | 13.22 | CDC panel, overdose, counties complete in WONDER and other counties | Least deprived third | 2019 |
| Overdose, other counties | 18.12 | 16.29 | 130.0 | 135.4 | 124.7 | 585 | no | 17.18 | CDC panel, overdose, counties complete in WONDER and other counties | Least deprived third | 2020 |
| Overdose, other counties | 22.24 | 20.05 | 159.8 | 167.2 | 152.4 | 585 | no | 21.13 | CDC panel, overdose, counties complete in WONDER and other counties | Least deprived third | 2021 |
| Overdose, other counties | 22.40 | 20.11 | 160.2 | 168.3 | 152.4 | 585 | no | 21.19 | CDC panel, overdose, counties complete in WONDER and other counties | Least deprived third | 2022 |
| Overdose, other counties | 20.77 | 18.71 | 148.7 | 156.8 | 141.3 | 585 | no | 19.66 | CDC panel, overdose, counties complete in WONDER and other counties | Least deprived third | 2023 |
| Overdose, other counties | 16.17 | 14.50 | 115.7 | 123.0 | 108.9 | 585 | yes | 15.30 | CDC panel, overdose, counties complete in WONDER and other counties | Least deprived third | 2024 |
| Overdose, other counties | 14.61 | 13.28 | 100 | n/a | n/a | 585 | no | 13.93 | CDC panel, overdose, counties complete in WONDER and other counties | Middle third | 2019 |
| Overdose, other counties | 20.58 | 18.35 | 139.8 | 145.8 | 133.7 | 585 | no | 19.47 | CDC panel, overdose, counties complete in WONDER and other counties | Middle third | 2020 |
| Overdose, other counties | 25.35 | 22.62 | 172.5 | 180.4 | 164.2 | 585 | no | 24.02 | CDC panel, overdose, counties complete in WONDER and other counties | Middle third | 2021 |
| Overdose, other counties | 25.49 | 22.64 | 173.0 | 181.0 | 164.5 | 585 | no | 24.09 | CDC panel, overdose, counties complete in WONDER and other counties | Middle third | 2022 |
| Overdose, other counties | 23.65 | 21.27 | 161.2 | 168.6 | 153.9 | 585 | no | 22.45 | CDC panel, overdose, counties complete in WONDER and other counties | Middle third | 2023 |
| Overdose, other counties | 17.95 | 16.27 | 122.7 | 128.9 | 117.0 | 585 | yes | 17.09 | CDC panel, overdose, counties complete in WONDER and other counties | Middle third | 2024 |
| Overdose, other counties | 15.05 | 13.43 | 100 | n/a | n/a | 585 | no | 14.26 | CDC panel, overdose, counties complete in WONDER and other counties | Most deprived third | 2019 |
| Overdose, other counties | 22.72 | 19.91 | 149.9 | 157.6 | 142.7 | 585 | no | 21.38 | CDC panel, overdose, counties complete in WONDER and other counties | Most deprived third | 2020 |
| Overdose, other counties | 30.08 | 26.02 | 197.6 | 209.0 | 187.2 | 585 | no | 28.18 | CDC panel, overdose, counties complete in WONDER and other counties | Most deprived third | 2021 |
| Overdose, other counties | 29.50 | 26.06 | 194.9 | 205.0 | 185.1 | 585 | no | 27.80 | CDC panel, overdose, counties complete in WONDER and other counties | Most deprived third | 2022 |
| Overdose, other counties | 29 | 24.98 | 189.5 | 200.6 | 178.0 | 585 | no | 27.03 | CDC panel, overdose, counties complete in WONDER and other counties | Most deprived third | 2023 |
| Overdose, other counties | 21.34 | 18.84 | 140.9 | 149.4 | 132.7 | 585 | yes | 20.09 | CDC panel, overdose, counties complete in WONDER and other counties | Most deprived third | 2024 |
In complete counties the most deprived third, which holds 293293 countiesEstimandcount of counties in the thirdWeightsnone (full count)Populationcounties in the most deprived third (drug overdose)Period2018 to 2024SourceCDC WONDER underlying cause of death counties for overdose, 207207 countiesEstimandcount of counties in the thirdWeightsnone (full count)Populationcounties in the most deprived third (alcohol-induced)Period2018 to 2024SourceCDC WONDER underlying cause of death for alcohol-induced deaths and 238238 countiesEstimandcount of counties in the thirdWeightsnone (full count)Populationcounties in the most deprived third (suicide)Period2018 to 2024SourceCDC WONDER underlying cause of death for suicide, had higher rates than the least deprived third in every year for all three kinds of death. In 2022 the ratio was 1.49 (95% CI 1.33 to 1.66)1.49 ratio of ratesEstimandratio of the pooled drug overdose rates of the two thirds; bootstrap over countiesInterval95% CI 1.33 to 1.66n587 countiesWeightsnone (crude rates from counts)Populationthe most deprived third of counties whose count is published in every year relative to the least deprived third (drug overdose)Period2022SourceCDC WONDER underlying cause of death for overdose, 1.22 (95% CI 1.10 to 1.37)1.22 ratio of ratesEstimandratio of the pooled alcohol-induced rates of the two thirds; bootstrap over countiesInterval95% CI 1.10 to 1.37n415 countiesWeightsnone (crude rates from counts)Populationthe most deprived third of counties whose count is published in every year relative to the least deprived third (alcohol-induced)Period2022SourceCDC WONDER underlying cause of death for alcohol-induced deaths and 1.37 (95% CI 1.25 to 1.49)1.37 ratio of ratesEstimandratio of the pooled suicide rates of the two thirds; bootstrap over countiesInterval95% CI 1.25 to 1.49n477 countiesWeightsnone (crude rates from counts)Populationthe most deprived third of counties whose count is published in every year relative to the least deprived third (suicide)Period2022SourceCDC WONDER underlying cause of death for suicide. The overdose rate rose by about the same proportion in the least and most deprived 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 above 2019 in the least deprived third 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, a difference of +1.9 (95% CI −9.4 to 16.4)+1.9 index points (2019 = 100)Estimandindex of the most deprived third's pooled overdose rate (2019 = 100) minus the same index of the least deprived third; bootstrap over counties with shared drawsInterval95% CI −9.4 to 16.4n587 countiesWeightsnone (crude rates from counts)Populationcounties whose overdose count is published in every year, outer thirdsPeriod2022 against 2019SourceCDC WONDER underlying cause of death index points, which includes zero. The same holds for alcohol-induced deaths in 2021, at 33.9% (95% CI 30.0% to 37.7%)33.9% percent above the 2019 rateEstimandpooled alcohol-induced rate of the least deprived third of counties in the year over its 2019 rate, minus 1; bootstrap over counties with shared drawsInterval95% CI 30.0% to 37.7%n208 countiesWeightsnone (crude rates from counts)Populationresidents of the least deprived third of counties whose count is published in every year (alcohol-induced)Period2021 against 2019SourceCDC WONDER underlying cause of death and 38.5% (95% CI 33.4% to 44.1%)38.5% percent above the 2019 rateEstimandpooled alcohol-induced rate of the most deprived third of counties in the year over its 2019 rate, minus 1; bootstrap over counties with shared drawsInterval95% CI 33.4% to 44.1%n207 countiesWeightsnone (crude rates from counts)Populationresidents of the most deprived third of counties whose count is published in every year (alcohol-induced)Period2021 against 2019SourceCDC WONDER underlying cause of death. By 2024 the overdose rate in the most deprived third was 28.928.9 deaths per 100,000 residentsEstimandpooled drug overdose rate of the most deprived third of counties; bootstrap over countiesInterval95% CI 26.3 to 31.2n293 countiesWeightsnone (crude rates from counts)Populationresidents of the most deprived third of counties whose count is published in every year (drug overdose)Period2024SourceCDC WONDER underlying cause of death per hundred thousand residents, level with its 2019 value of 28.928.9 deaths per 100,000 residentsEstimandpooled drug overdose rate of the most deprived third of counties; bootstrap over countiesInterval95% CI 24.9 to 32.3n293 countiesWeightsnone (crude rates from counts)Populationresidents of the most deprived third of counties whose count is published in every year (drug overdose)Period2019SourceCDC WONDER underlying cause of death, while the least deprived third was 13.4% (95% CI 5.1% to 21.5%)13.4% 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 5.1% to 21.5%n294 countiesWeightsnone (crude rates from counts)Populationresidents of the least deprived third of counties whose count is published in every year (drug overdose)Period2024 against 2019SourceCDC WONDER underlying cause of death above its 2019 level. The most deprived third's index minus the least deprived third's was then −13.4 (95% CI −23.4 to −1.0)−13.4 index points (2019 = 100)Estimandindex of the most deprived third's pooled overdose rate (2019 = 100) minus the same index of the least deprived third; bootstrap over counties with shared drawsInterval95% CI −23.4 to −1.0n587 countiesWeightsnone (crude rates from counts)Populationcounties whose overdose count is published in every year, outer thirdsPeriod2024 against 2019SourceCDC WONDER underlying cause of death index points, an interval that excludes zero. Dropping the complete counties with no deaths and cutting the thirds again leaves the 2022 result in place: the index is 49.0% (95% CI 41.1% to 56.7%)49.0% percent above the 2019 rateEstimandpooled crude overdose rate of the third in 2022 over its 2019 rate, minus 1; bootstrap over counties with shared drawsInterval95% CI 41.1% to 56.7%n264 countiesWeightsnone (crude rates from counts)Populationresidents of the least deprived third of complete overdose counties with at least one death, thirds cut again among themPeriod2022 against 2019SourceCDC WONDER underlying cause of death above 2019 in the least deprived third and 54.1% (95% CI 45.8% to 63.9%)54.1% percent above the 2019 rateEstimandpooled crude overdose rate of the third in 2022 over its 2019 rate, minus 1; bootstrap over counties with shared drawsInterval95% CI 45.8% to 63.9%n263 countiesWeightsnone (crude rates from counts)Populationresidents of the most deprived third of complete overdose counties with at least one death, thirds cut again among themPeriod2022 against 2019SourceCDC WONDER underlying cause of death in the most deprived, and the intervals overlap.
The panel's overdose rates for all of its counties tell a different story. Its least and most deprived thirds had the same overdose rate in 2019, 19.0 (95% CI 17.7 to 20.3)19.0 deaths per 100,000 residentsEstimandpooled drug overdose rate of the least deprived third of counties; bootstrap over countiesInterval95% CI 17.7 to 20.3n879 countiesWeightsWONDER county population of the yearPopulationresidents of the least deprived third of counties with a stable modeled rate in every year (drug overdose)Period2019SourceCDC injury and violence mapping and 19.2 (95% CI 17.1 to 21.3)19.2 deaths per 100,000 residentsEstimandpooled drug overdose rate of the most deprived third of counties; bootstrap over countiesInterval95% CI 17.1 to 21.3n878 countiesWeightsWONDER county population of the yearPopulationresidents of the most deprived third of counties with a stable modeled rate in every year (drug overdose)Period2019SourceCDC injury and violence mapping, a ratio of 1.01 (95% CI 0.88 to 1.15)1.01 ratio of ratesEstimandratio of the pooled drug overdose rates of the two thirds; bootstrap over countiesInterval95% CI 0.88 to 1.15n1,757 countiesWeightsWONDER county population of the yearPopulationthe most deprived third of counties with a stable modeled rate in every year relative to the least deprived third (drug overdose)Period2019SourceCDC injury and violence mapping. The most deprived third then rose further: in 2022 its rate was 71.0% (95% CI 62.3% to 80.7%)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 above its 2019 level, against 51.4% (95% CI 45.2% to 57.6%)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, a difference of +19.6 (95% CI 8.6 to 31.3)+19.6 index points (2019 = 100)Estimandindex of the most deprived third's pooled overdose rate (2019 = 100) minus the same index of the least deprived third; bootstrap over counties with shared drawsInterval95% CI 8.6 to 31.3n1,757 countiesWeightsWONDER county population of the yearPopulationcounties with a stable modeled overdose rate in every year, outer thirdsPeriod2022 against 2019SourceCDC injury and violence mapping index points that excludes zero, and the ratio was 1.14 (95% CI 1.01 to 1.27)1.14 ratio of ratesEstimandratio of the pooled drug overdose rates of the two thirds; bootstrap over countiesInterval95% CI 1.01 to 1.27n1,757 countiesWeightsWONDER county population of the yearPopulationthe most deprived third of counties with a stable modeled rate in every year relative to the least deprived third (drug overdose)Period2022SourceCDC injury and violence mapping. In 2024 the most and least deprived thirds were 18.7% (95% CI 11.8% to 26.3%)18.7% 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 11.8% to 26.3%n878 countiesWeightsWONDER county population of the yearPopulationresidents of the most deprived third of counties with a stable modeled rate in every year (drug overdose)Period2024 against 2019 (2024 provisional)SourceCDC injury and violence mapping and 13.2% (95% CI 6.6% to 20.0%)13.2% 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 6.6% to 20.0%n879 countiesWeightsWONDER county population of the yearPopulationresidents of the least deprived third of counties with a stable modeled rate in every year (drug overdose)Period2024 against 2019 (2024 provisional)SourceCDC injury and violence mapping above 2019, and the difference was +5.5 (95% CI −3.9 to 15.5)+5.5 index points (2019 = 100)Estimandindex of the most deprived third's pooled overdose rate (2019 = 100) minus the same index of the least deprived third; bootstrap over counties with shared drawsInterval95% CI −3.9 to 15.5n1,757 countiesWeightsWONDER county population of the yearPopulationcounties with a stable modeled overdose rate in every year, outer thirdsPeriod2024 against 2019SourceCDC injury and violence mapping index points, an interval that includes zero.
That difference between the two sources is a difference between sets of counties. Restricted to the 880880 countiesEstimandcount of countiesWeightsnone (full count)Populationbalanced panel counties that are complete in WONDER's overdose cut, with WONDER's thirdsPeriod2019 to 2024SourceCDC injury and violence mapping counties that are complete in WONDER and cut into WONDER's thirds, the panel's overdose rate in 2022 is 52.3% (95% CI 43.9% to 60.5%)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 above 2019 in the least deprived third and 52.3% (95% CI 43.0% to 64.8%)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, a difference of +0.1 (95% CI −12.1 to 16.1)+0.1 index points (2019 = 100)Estimandindex of the most deprived third's pooled overdose rate (2019 = 100) minus the same index of the least deprived third; bootstrap over counties with shared drawsInterval95% CI −12.1 to 16.1n587 countiesWeightsWONDER county population of the yearPopulationbalanced panel counties that are complete in WONDER's overdose cut, with WONDER's thirdsPeriod2022 against 2019SourceCDC injury and violence mapping index points, and the 2019 ratio is 1.51 (95% CI 1.28 to 1.75)1.51 ratio of ratesEstimandratio of the pooled modeled overdose rates of the two thirds; bootstrap over countiesInterval95% CI 1.28 to 1.75n587 countiesWeightsWONDER county population of the yearPopulationthe most deprived third relative to the least deprived third of the balanced panel counties that are complete in WONDER's overdose cut, with WONDER's thirdsPeriod2019SourceCDC injury and violence mapping, against 1.48 (95% CI 1.26 to 1.69)1.48 ratio of ratesEstimandratio of the pooled drug overdose rates of the two thirds; bootstrap over countiesInterval95% CI 1.26 to 1.69n587 countiesWeightsnone (crude rates from counts)Populationthe most deprived third of counties whose count is published in every year relative to the least deprived third (drug overdose)Period2019SourceCDC WONDER underlying cause of death in WONDER itself. Where WONDER publishes every year, the two sources give the same answer; Chapter 6.3, Overdose, alcohol and suicide shows the same for county rates. In 2024 the panel inside those counties has a difference of −16.2 (95% CI −27.2 to −2.6)−16.2 index points (2019 = 100)Estimandindex of the most deprived third's pooled overdose rate (2019 = 100) minus the same index of the least deprived third; bootstrap over counties with shared drawsInterval95% CI −27.2 to −2.6n587 countiesWeightsWONDER county population of the yearPopulationbalanced panel counties that are complete in WONDER's overdose cut, with WONDER's thirdsPeriod2024 against 2019SourceCDC injury and violence mapping index points, which also excludes zero and has the sign of WONDER's. In the other 1,7591,759 countiesEstimandcount of countiesWeightsnone (full count)Populationbalanced panel counties that are not complete in WONDER's overdose cut, with thirds cut among themPeriod2019 to 2024SourceCDC injury and violence mapping balanced panel counties, those WONDER withholds in at least one year, the most deprived third rose 94.9% (95% CI 85.1% to 105.0%)94.9% 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 85.1% to 105.0%n585 countiesWeightsWONDER county population of the yearPopulationresidents of the most deprived third of the balanced panel counties that are not complete in WONDER's overdose cut, with thirds cut among themPeriod2022 against 2019SourceCDC injury and violence mapping above 2019 in 2022 against 60.2% (95% CI 52.4% to 68.3%)60.2% 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 52.4% to 68.3%n585 countiesWeightsWONDER county population of the yearPopulationresidents of the least deprived third of the balanced panel counties that are not complete in WONDER's overdose cut, with thirds cut among themPeriod2022 against 2019SourceCDC injury and violence mapping in the least deprived third, a difference of +34.7 (95% CI 21.1 to 47.3)+34.7 index points (2019 = 100)Estimandindex of the most deprived third's pooled overdose rate (2019 = 100) minus the same index of the least deprived third; bootstrap over counties with shared drawsInterval95% CI 21.1 to 47.3n1,170 countiesWeightsWONDER county population of the yearPopulationbalanced panel counties that are not complete in WONDER's overdose cut, with thirds cut among themPeriod2022 against 2019SourceCDC injury and violence mapping index points, and the difference was still +25.2 (95% CI 14.3 to 36.0)+25.2 index points (2019 = 100)Estimandindex of the most deprived third's pooled overdose rate (2019 = 100) minus the same index of the least deprived third; bootstrap over counties with shared drawsInterval95% CI 14.3 to 36.0n1,170 countiesWeightsWONDER county population of the yearPopulationbalanced panel counties that are not complete in WONDER's overdose cut, with thirds cut among themPeriod2024 against 2019SourceCDC injury and violence mapping in 2024. Only the modeled panel covers those counties, and each has a county-year with between one death and 99 deaths in a county-yearEstimanddefinition: the largest county-year count that WONDER withholdsWeightsnone (definition)Populationcounty-years in CDC WONDERPerioddeaths in 2018 to 2024SourceCDC WONDER underlying cause of death deaths. Whether the larger rise in their most deprived third is real or the model smoothing small deprived counties toward their neighbors cannot be tested with these files.
Homicide, which only the panel measures, was higher in the most deprived third throughout, with a ratio of 1.34 (95% CI 1.13 to 1.60)1.34 ratio of ratesEstimandratio of the pooled homicide rates of the two thirds; bootstrap over countiesInterval95% CI 1.13 to 1.60n1,828 countiesWeightsWONDER county population of the yearPopulationthe most deprived third of counties with a stable modeled rate in every year relative to the least deprived third (homicide)Period2019SourceCDC injury and violence mapping in 2019 and 1.48 (95% CI 1.23 to 1.80)1.48 ratio of ratesEstimandratio of the pooled homicide rates of the two thirds; bootstrap over countiesInterval95% CI 1.23 to 1.80n1,828 countiesWeightsWONDER county population of the yearPopulationthe most deprived third of counties with a stable modeled rate in every year relative to the least deprived third (homicide)Period2024 (provisional)SourceCDC injury and violence mapping in 2024. Both thirds rose by similar proportions to 2021, 36.2% (95% CI 30.9% to 41.3%)36.2% percent above the 2019 rateEstimandpooled homicide rate of the least deprived third of counties in the year over its 2019 rate, minus 1; bootstrap over counties with shared drawsInterval95% CI 30.9% to 41.3%n914 countiesWeightsWONDER county population of the yearPopulationresidents of the least deprived third of counties with a stable modeled rate in every year (homicide)Period2021 against 2019SourceCDC injury and violence mapping and 40.8% (95% CI 32.3% to 49.8%)40.8% percent above the 2019 rateEstimandpooled homicide rate of the most deprived third of counties in the year over its 2019 rate, minus 1; bootstrap over counties with shared drawsInterval95% CI 32.3% to 49.8%n914 countiesWeightsWONDER county population of the yearPopulationresidents of the most deprived third of counties with a stable modeled rate in every year (homicide)Period2021 against 2019SourceCDC injury and violence mapping above 2019. By 2024 the least deprived third was 2.7% (95% CI −1.2% to 6.6%)2.7% percent above the 2019 rateEstimandpooled homicide rate of the least deprived third of counties in the year over its 2019 rate, minus 1; bootstrap over counties with shared drawsInterval95% CI −1.2% to 6.6%n914 countiesWeightsWONDER county population of the yearPopulationresidents of the least deprived third of counties with a stable modeled rate in every year (homicide)Period2024 against 2019 (2024 provisional)SourceCDC injury and violence mapping above its 2019 level, an interval that includes the 2019 level, and the most deprived third was still 13.2% (95% CI 5.9% to 20.8%)13.2% percent above the 2019 rateEstimandpooled homicide rate of the most deprived third of counties in the year over its 2019 rate, minus 1; bootstrap over counties with shared drawsInterval95% CI 5.9% to 20.8%n914 countiesWeightsWONDER county population of the yearPopulationresidents of the most deprived third of counties with a stable modeled rate in every year (homicide)Period2024 against 2019 (2024 provisional)SourceCDC injury and violence mapping above. Suicide rates are higher in the most deprived third, with a ratio of 1.26 (95% CI 1.15 to 1.38)1.26 ratio of ratesEstimandratio of the pooled suicide rates of the two thirds; bootstrap over countiesInterval95% CI 1.15 to 1.38n477 countiesWeightsnone (crude rates from counts)Populationthe most deprived third of counties whose count is published in every year relative to the least deprived third (suicide)Period2019SourceCDC WONDER underlying cause of death in 2019 and 1.37 (95% CI 1.25 to 1.49)1.37 ratio of ratesEstimandratio of the pooled suicide rates of the two thirds; bootstrap over countiesInterval95% CI 1.25 to 1.49n477 countiesWeightsnone (crude rates from counts)Populationthe most deprived third of counties whose count is published in every year relative to the least deprived third (suicide)Period2022SourceCDC WONDER underlying cause of death in 2022 in WONDER. The next section shows that the difference between the thirds in suicide rates was as large in 2018 as in 2020.
Within the same counties, the overdose rise starts in 2020 and the fall comes in 2024
An event study asks how an outcome moved around a date, relative to a reference year. Here the date is the arrival of the pandemic in 2020 and the reference year is 2019, the last year before it. Every county met the date together, so no county is unexposed, and the design is descriptive. It shows how death rates moved within the same counties, with each county's own level removed by a fixed effectFixed effectsA regression adjustment that gives each group, such as each county, its own baseline. The estimate then rests on differences within groups., and it does not isolate what the pandemic did. Each coefficient is the population-weighted average change in a county's death rate since 2019, in deaths per hundred thousand residents. The model has a fixed effect for every county and every year, weights each county-year by its population and clusters errors by state (DC counts as one), so that counties in one state may share shocks. It is fitted with pyfixest. Clustering by county gives intervals about 2.02.0 ratio of standard errorsEstimandstandard error of the 2022 coefficient clustered by state over the standard error clustered by countyWeightssee the modelPopulationthe WONDER overdose event studyPeriod2022 against 2019SourceCDC WONDER underlying cause of death times narrower for the 2022 overdose coefficient, and the chapter reports the wider ones.
Figure 6
Within the same counties, the overdose rate in 2022 was 11.2 deaths per hundred thousand residents above its 2019 level and the alcohol-induced rate in 2021 4.3 above, while suicide rates never moved by more than about 0.6 deaths per hundred thousand residents
Two-way fixed-effects event study: population-weighted average change in a county's crude death rate since 2019, deaths per 100,000 residents, counties whose count CDC WONDER publishes in every year, 2018 to 2024, errors clustered by state
Change in deaths per 100,000 residents since 2019
- Overdose
- Alcohol-induced deaths
- Suicide
Show data
| cause | conf_high | conf_low | estimate | n_units | provisional | source | year |
|---|---|---|---|---|---|---|---|
| Overdose | −0.456 | −1.63 | −1.04 | 889 | no | CDC WONDER, counties with published counts in every year | 2018 |
| Overdose | n/a | n/a | 0 | 889 | no | CDC WONDER, counties with published counts in every year | 2019 |
| Overdose | 7.68 | 5.65 | 6.66 | 889 | no | CDC WONDER, counties with published counts in every year | 2020 |
| Overdose | 12.52 | 9.35 | 10.94 | 889 | no | CDC WONDER, counties with published counts in every year | 2021 |
| Overdose | 12.95 | 9.50 | 11.23 | 889 | no | CDC WONDER, counties with published counts in every year | 2022 |
| Overdose | 12.64 | 8.02 | 10.33 | 889 | no | CDC WONDER, counties with published counts in every year | 2023 |
| Overdose | 4.82 | −1.14 | 1.84 | 889 | no | CDC WONDER, counties with published counts in every year | 2024 |
| Alcohol-induced deaths | −0.126 | −0.707 | −0.416 | 629 | no | CDC WONDER, counties with published counts in every year | 2018 |
| Alcohol-induced deaths | n/a | n/a | 0 | 629 | no | CDC WONDER, counties with published counts in every year | 2019 |
| Alcohol-induced deaths | 3.35 | 2.51 | 2.93 | 629 | no | CDC WONDER, counties with published counts in every year | 2020 |
| Alcohol-induced deaths | 5.00 | 3.51 | 4.26 | 629 | no | CDC WONDER, counties with published counts in every year | 2021 |
| Alcohol-induced deaths | 3.91 | 2.76 | 3.34 | 629 | no | CDC WONDER, counties with published counts in every year | 2022 |
| Alcohol-induced deaths | 2.79 | 1.84 | 2.31 | 629 | no | CDC WONDER, counties with published counts in every year | 2023 |
| Alcohol-induced deaths | 2.13 | 1.21 | 1.67 | 629 | no | CDC WONDER, counties with published counts in every year | 2024 |
| Suicide | 0.498 | 0.114 | 0.306 | 718 | no | CDC WONDER, counties with published counts in every year | 2018 |
| Suicide | n/a | n/a | 0 | 718 | no | CDC WONDER, counties with published counts in every year | 2019 |
| Suicide | −0.310 | −0.902 | −0.606 | 718 | no | CDC WONDER, counties with published counts in every year | 2020 |
| Suicide | 0.234 | −0.461 | −0.114 | 718 | no | CDC WONDER, counties with published counts in every year | 2021 |
| Suicide | 0.628 | −0.074 | 0.277 | 718 | no | CDC WONDER, counties with published counts in every year | 2022 |
| Suicide | 0.479 | −0.206 | 0.136 | 718 | no | CDC WONDER, counties with published counts in every year | 2023 |
| Suicide | 0.156 | −0.662 | −0.253 | 718 | no | CDC WONDER, counties with published counts in every year | 2024 |
| Overdose | n/a | n/a | 0 | 2,648 | no | CDC panel, counties with a stable rate in every year | 2019 |
| Overdose | 7.45 | 5.32 | 6.39 | 2,648 | no | CDC panel, counties with a stable rate in every year | 2020 |
| Overdose | 12.50 | 9.28 | 10.89 | 2,648 | no | CDC panel, counties with a stable rate in every year | 2021 |
| Overdose | 12.69 | 9.35 | 11.02 | 2,648 | no | CDC panel, counties with a stable rate in every year | 2022 |
| Overdose | 12.23 | 8.02 | 10.12 | 2,648 | no | CDC panel, counties with a stable rate in every year | 2023 |
| Overdose | 5.18 | −0.078 | 2.55 | 2,648 | yes | CDC panel, counties with a stable rate in every year | 2024 |
| Homicide | n/a | n/a | 0 | 2,755 | no | CDC panel, counties with a stable rate in every year | 2019 |
| Homicide | 1.88 | 1.38 | 1.63 | 2,755 | no | CDC panel, counties with a stable rate in every year | 2020 |
| Homicide | 2.47 | 1.71 | 2.09 | 2,755 | no | CDC panel, counties with a stable rate in every year | 2021 |
| Homicide | 2.04 | 1.38 | 1.71 | 2,755 | no | CDC panel, counties with a stable rate in every year | 2022 |
| Homicide | 1.37 | 0.751 | 1.06 | 2,755 | no | CDC panel, counties with a stable rate in every year | 2023 |
| Homicide | 0.508 | −0.012 | 0.248 | 2,755 | yes | CDC panel, counties with a stable rate in every year | 2024 |
| Suicide | n/a | n/a | 0 | 2,184 | no | CDC panel, counties with a stable rate in every year | 2019 |
| Suicide | −0.322 | −0.911 | −0.617 | 2,184 | no | CDC panel, counties with a stable rate in every year | 2020 |
| Suicide | 0.330 | −0.331 | −0.001 | 2,184 | no | CDC panel, counties with a stable rate in every year | 2021 |
| Suicide | 0.652 | −0.028 | 0.312 | 2,184 | no | CDC panel, counties with a stable rate in every year | 2022 |
| Suicide | 0.523 | −0.129 | 0.197 | 2,184 | no | CDC panel, counties with a stable rate in every year | 2023 |
| Suicide | 0.474 | −0.374 | 0.050 | 2,184 | yes | CDC panel, counties with a stable rate in every year | 2024 |
In complete counties the overdose rate in 2022 was 11.2 (95% CI 9.5 to 13.0)11.2 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, drug overdose, change in the county death rate since 2019; county-population weights, errors clustered by stateInterval95% CI 9.5 to 13.0n889 countiesWeightscounty population of the yearPopulationcomplete counties with drug overdose countsPeriod2022 against 2019SourceCDC WONDER underlying cause of death deaths per hundred thousand residents above its 2019 level, with 10.910.9 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, drug overdose, change in the county death rate since 2019; county-population weights, errors clustered by stateInterval95% CI 9.3 to 12.5n889 countiesWeightscounty population of the yearPopulationcomplete counties with drug overdose countsPeriod2021 against 2019SourceCDC WONDER underlying cause of death in 2021 and 10.310.3 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, drug overdose, change in the county death rate since 2019; county-population weights, errors clustered by stateInterval95% CI 8.0 to 12.6n889 countiesWeightscounty population of the yearPopulationcomplete counties with drug overdose countsPeriod2023 against 2019SourceCDC WONDER underlying cause of death in 2023. In 2024 the coefficient was 1.8 (95% CI −1.1 to 4.8)1.8 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, drug overdose, change in the county death rate since 2019; county-population weights, errors clustered by stateInterval95% CI −1.1 to 4.8n889 countiesWeightscounty population of the yearPopulationcomplete counties with drug overdose countsPeriod2024 against 2019SourceCDC WONDER underlying cause of death, an interval that includes zero. The alcohol-induced rate was 4.3 (95% CI 3.5 to 5.0)4.3 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, alcohol-induced, change in the county death rate since 2019; county-population weights, errors clustered by stateInterval95% CI 3.5 to 5.0n629 countiesWeightscounty population of the yearPopulationcomplete counties with alcohol-induced countsPeriod2021 against 2019SourceCDC WONDER underlying cause of death above in 2021 and still 1.7 (95% CI 1.2 to 2.1)1.7 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, alcohol-induced, change in the county death rate since 2019; county-population weights, errors clustered by stateInterval95% CI 1.2 to 2.1n629 countiesWeightscounty population of the yearPopulationcomplete counties with alcohol-induced countsPeriod2024 against 2019SourceCDC WONDER underlying cause of death above in 2024. Suicide never moved by more than about 0.60.6 deaths per 100,000 residentsEstimandlargest absolute event-study coefficient for suicide, change in the county death rate since 2019Weightscounty population of the yearPopulationcounties with suicide counts in the event studyPeriod2018 to 2024SourceCDC WONDER underlying cause of death deaths per hundred thousand residents. The panel version uses the counties with a stable rate in every year, 2,6482,648 countiesEstimandcount of counties with a stable modeled drug overdose rate and a population in every yearWeightsnone (full count)Populationcounties in CDC's county filePeriod2019 to 2024SourceCDC injury and violence mapping for overdose, 2,7552,755 countiesEstimandcount of counties with a stable modeled homicide rate and a population in every yearWeightsnone (full count)Populationcounties in CDC's county filePeriod2019 to 2024SourceCDC injury and violence mapping for homicide and 2,1842,184 countiesEstimandcount of counties with a stable modeled suicide rate and a population in every yearWeightsnone (full count)Populationcounties in CDC's county filePeriod2019 to 2024SourceCDC injury and violence mapping for suicide, and gives the same overdose path, with 11.0 (95% CI 9.3 to 12.7)11.0 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, drug overdose, change in the county death rate since 2019; county-population weights, errors clustered by stateInterval95% CI 9.3 to 12.7n2,648 countiesWeightscounty population of the yearPopulationbalanced counties with drug overdose countsPeriod2022 against 2019SourceCDC injury and violence mapping in 2022 and 2.5 (95% CI −0.1 to 5.2)2.5 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, drug overdose, change in the county death rate since 2019; county-population weights, errors clustered by stateInterval95% CI −0.1 to 5.2n2,648 countiesWeightscounty population of the yearPopulationbalanced counties with drug overdose countsPeriod2024 against 2019 (2024 provisional)SourceCDC injury and violence mapping in 2024, and for homicide 2.1 (95% CI 1.7 to 2.5)2.1 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, homicide, change in the county death rate since 2019; county-population weights, errors clustered by stateInterval95% CI 1.7 to 2.5n2,755 countiesWeightscounty population of the yearPopulationbalanced counties with homicide countsPeriod2021 against 2019SourceCDC injury and violence mapping in 2021 and 0.2 (95% CI 0.0 to 0.5)0.2 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, homicide, change in the county death rate since 2019; county-population weights, errors clustered by stateInterval95% CI 0.0 to 0.5n2,755 countiesWeightscounty population of the yearPopulationbalanced counties with homicide countsPeriod2024 against 2019 (2024 provisional)SourceCDC injury and violence mapping in 2024.
WONDER's files reach back to 2018, so the complete-county version has a pre-period, and the 2018 coefficient is the check. It is −1.0 (95% CI −1.6 to −0.5)−1.0 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, drug overdose, change in the county death rate since 2019; county-population weights, errors clustered by stateInterval95% CI −1.6 to −0.5n889 countiesWeightscounty population of the yearPopulationcomplete counties with drug overdose countsPeriod2018 against 2019SourceCDC WONDER underlying cause of death for overdose and −0.4 (95% CI −0.7 to −0.1)−0.4 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, alcohol-induced, change in the county death rate since 2019; county-population weights, errors clustered by stateInterval95% CI −0.7 to −0.1n629 countiesWeightscounty population of the yearPopulationcomplete counties with alcohol-induced countsPeriod2018 against 2019SourceCDC WONDER underlying cause of death for alcohol-induced deaths: both rates were already rising before 2020, though by far less than in 2022. A pre-period coefficient is a check on the design and not proof of it.[5] The panel starts in 2019, so it has no pre-period.
A second version asks whether the most deprived third of counties moved differently from the least deprived third. It interacts the year indicators with membership of the most deprived third and adds year fixed effects, so each coefficient is the change since 2019 in the most deprived third minus the change in the least deprived third. This compares two groups' changes, and it supports a causal reading only if the groups would have moved alike without the shock. The chapter uses it descriptively.
Figure 7
From 2019 to 2022 the overdose rate rose 5.1 deaths per hundred thousand residents more in the most deprived third of counties with published counts than in the least deprived third, with no detectable gap in 2018
Difference in the change in the crude death rate since 2019 between the most deprived and the least deprived third of counties, deaths per 100,000 residents, counties whose count CDC WONDER publishes in every year, 2018 to 2024, errors clustered by state
Gap in the change since 2019 (deaths per 100,000)
- Overdose
- Alcohol-induced deaths
- Suicide
Show data
| cause | conf_high | conf_low | estimate | n_units | provisional | source | year |
|---|---|---|---|---|---|---|---|
| Overdose | 1.56 | −1.73 | −0.084 | 587 | no | CDC WONDER, counties with published counts in every year | 2018 |
| Overdose | n/a | n/a | 0 | 587 | no | CDC WONDER, counties with published counts in every year | 2019 |
| Overdose | 4.82 | 0.370 | 2.60 | 587 | no | CDC WONDER, counties with published counts in every year | 2020 |
| Overdose | 9.27 | 1.34 | 5.30 | 587 | no | CDC WONDER, counties with published counts in every year | 2021 |
| Overdose | 9.19 | 1.03 | 5.11 | 587 | no | CDC WONDER, counties with published counts in every year | 2022 |
| Overdose | 7.75 | −0.871 | 3.44 | 587 | no | CDC WONDER, counties with published counts in every year | 2023 |
| Overdose | 2.64 | −7.75 | −2.56 | 587 | no | CDC WONDER, counties with published counts in every year | 2024 |
| Alcohol-induced deaths | 0.459 | −0.895 | −0.218 | 415 | no | CDC WONDER, counties with published counts in every year | 2018 |
| Alcohol-induced deaths | n/a | n/a | 0 | 415 | no | CDC WONDER, counties with published counts in every year | 2019 |
| Alcohol-induced deaths | 1.99 | 0.163 | 1.08 | 415 | no | CDC WONDER, counties with published counts in every year | 2020 |
| Alcohol-induced deaths | 2.78 | −0.172 | 1.30 | 415 | no | CDC WONDER, counties with published counts in every year | 2021 |
| Alcohol-induced deaths | 2.54 | 0.072 | 1.31 | 415 | no | CDC WONDER, counties with published counts in every year | 2022 |
| Alcohol-induced deaths | 1.44 | −0.370 | 0.535 | 415 | no | CDC WONDER, counties with published counts in every year | 2023 |
| Alcohol-induced deaths | 1.56 | −0.033 | 0.765 | 415 | no | CDC WONDER, counties with published counts in every year | 2024 |
| Suicide | 1.30 | 0.286 | 0.793 | 477 | no | CDC WONDER, counties with published counts in every year | 2018 |
| Suicide | n/a | n/a | 0 | 477 | no | CDC WONDER, counties with published counts in every year | 2019 |
| Suicide | 1.67 | 0.241 | 0.956 | 477 | no | CDC WONDER, counties with published counts in every year | 2020 |
| Suicide | 1.79 | 0.368 | 1.08 | 477 | no | CDC WONDER, counties with published counts in every year | 2021 |
| Suicide | 2.16 | 0.615 | 1.39 | 477 | no | CDC WONDER, counties with published counts in every year | 2022 |
| Suicide | 2.42 | 1.06 | 1.74 | 477 | no | CDC WONDER, counties with published counts in every year | 2023 |
| Suicide | 2.17 | 0.760 | 1.46 | 477 | no | CDC WONDER, counties with published counts in every year | 2024 |
| Overdose | n/a | n/a | 0 | 1,757 | no | CDC panel, counties with a stable rate in every year | 2019 |
| Overdose | 4.49 | −1.25 | 1.62 | 1,757 | no | CDC panel, counties with a stable rate in every year | 2020 |
| Overdose | 9.36 | −0.291 | 4.53 | 1,757 | no | CDC panel, counties with a stable rate in every year | 2021 |
| Overdose | 7.60 | −0.007 | 3.80 | 1,757 | no | CDC panel, counties with a stable rate in every year | 2022 |
| Overdose | 8.49 | −0.678 | 3.91 | 1,757 | no | CDC panel, counties with a stable rate in every year | 2023 |
| Overdose | 4.55 | −2.45 | 1.05 | 1,757 | yes | CDC panel, counties with a stable rate in every year | 2024 |
| Homicide | n/a | n/a | 0 | 1,828 | no | CDC panel, counties with a stable rate in every year | 2019 |
| Homicide | 1.86 | −0.372 | 0.744 | 1,828 | no | CDC panel, counties with a stable rate in every year | 2020 |
| Homicide | 2.66 | −0.687 | 0.987 | 1,828 | no | CDC panel, counties with a stable rate in every year | 2021 |
| Homicide | 2.27 | −0.172 | 1.05 | 1,828 | no | CDC panel, counties with a stable rate in every year | 2022 |
| Homicide | 2.33 | −0.073 | 1.13 | 1,828 | no | CDC panel, counties with a stable rate in every year | 2023 |
| Homicide | 2.13 | −0.388 | 0.869 | 1,828 | yes | CDC panel, counties with a stable rate in every year | 2024 |
| Suicide | n/a | n/a | 0 | 1,450 | no | CDC panel, counties with a stable rate in every year | 2019 |
| Suicide | 1.44 | 0.146 | 0.792 | 1,450 | no | CDC panel, counties with a stable rate in every year | 2020 |
| Suicide | 2.03 | 0.357 | 1.20 | 1,450 | no | CDC panel, counties with a stable rate in every year | 2021 |
| Suicide | 1.65 | 0.161 | 0.906 | 1,450 | no | CDC panel, counties with a stable rate in every year | 2022 |
| Suicide | 1.92 | 0.530 | 1.23 | 1,450 | no | CDC panel, counties with a stable rate in every year | 2023 |
| Suicide | 1.79 | 0.320 | 1.05 | 1,450 | yes | CDC panel, counties with a stable rate in every year | 2024 |
In complete counties the overdose rate rose 5.1 (95% CI 1.0 to 9.2)5.1 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, drug overdose, change since 2019 in the most deprived third minus the same change in the least deprived third; county-population weights, errors clustered by stateInterval95% CI 1.0 to 9.2n587 countiesWeightscounty population of the yearPopulationcomplete counties with drug overdose countsPeriod2022 against 2019SourceCDC WONDER underlying cause of death deaths per hundred thousand residents more in the most deprived third than in the least deprived third between 2019 and 2022, and the 2018 coefficient, −0.1 (95% CI −1.7 to 1.6)−0.1 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, drug overdose, change since 2019 in the most deprived third minus the same change in the least deprived third; county-population weights, errors clustered by stateInterval95% CI −1.7 to 1.6n587 countiesWeightscounty population of the yearPopulationcomplete counties with drug overdose countsPeriod2018 against 2019SourceCDC WONDER underlying cause of death, shows no detectable gap before 2020. The proportional rises in the least and most deprived thirds are alike (see the previous section), so the absolute gap reflects the different 2019 bases, 28.928.9 deaths per 100,000 residentsEstimandpooled drug overdose rate of the most deprived third of counties; bootstrap over countiesInterval95% CI 24.9 to 32.3n293 countiesWeightsnone (crude rates from counts)Populationresidents of the most deprived third of counties whose count is published in every year (drug overdose)Period2019SourceCDC WONDER underlying cause of death deaths per hundred thousand residents in the most deprived third against 19.619.6 deaths per 100,000 residentsEstimandpooled drug overdose rate of the least deprived third of counties; bootstrap over countiesInterval95% CI 18.1 to 21.2n294 countiesWeightsnone (crude rates from counts)Populationresidents of the least deprived third of counties whose count is published in every year (drug overdose)Period2019SourceCDC WONDER underlying cause of death in the least deprived. The alcohol-induced gap in 2022 was 1.3 (95% CI 0.1 to 2.5)1.3 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, alcohol-induced, change since 2019 in the most deprived third minus the same change in the least deprived third; county-population weights, errors clustered by stateInterval95% CI 0.1 to 2.5n415 countiesWeightscounty population of the yearPopulationcomplete counties with alcohol-induced countsPeriod2022 against 2019SourceCDC WONDER underlying cause of death, with a 2018 coefficient of −0.2 (95% CI −0.9 to 0.5)−0.2 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, alcohol-induced, change since 2019 in the most deprived third minus the same change in the least deprived third; county-population weights, errors clustered by stateInterval95% CI −0.9 to 0.5n415 countiesWeightscounty population of the yearPopulationcomplete counties with alcohol-induced countsPeriod2018 against 2019SourceCDC WONDER underlying cause of death. For suicide the 2018 coefficient is already 0.8 (95% CI 0.3 to 1.3)0.8 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, suicide, change since 2019 in the most deprived third minus the same change in the least deprived third; county-population weights, errors clustered by stateInterval95% CI 0.3 to 1.3n477 countiesWeightscounty population of the yearPopulationcomplete counties with suicide countsPeriod2018 against 2019SourceCDC WONDER underlying cause of death, close in size to the 2020 coefficient of 1.0 (95% CI 0.2 to 1.7)1.0 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, suicide, change since 2019 in the most deprived third minus the same change in the least deprived third; county-population weights, errors clustered by stateInterval95% CI 0.2 to 1.7n477 countiesWeightscounty population of the yearPopulationcomplete counties with suicide countsPeriod2020 against 2019SourceCDC WONDER underlying cause of death. The difference in suicide rates between the thirds was as large in 2018 as in 2020, with 2019 the low point, so the later coefficients cannot be read as a response to the pandemic. In the panel the overdose gap in 2022 is 3.8 (95% CI 0.0 to 7.6)3.8 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, drug overdose, change since 2019 in the most deprived third minus the same change in the least deprived third; county-population weights, errors clustered by stateInterval95% CI 0.0 to 7.6n1,757 countiesWeightscounty population of the yearPopulationbalanced counties with drug overdose countsPeriod2022 against 2019SourceCDC injury and violence mapping and the homicide gap is 1.0 (95% CI −0.2 to 2.3)1.0 deaths per 100,000 residentsEstimandtwo-way fixed-effects coefficient, homicide, change since 2019 in the most deprived third minus the same change in the least deprived third; county-population weights, errors clustered by stateInterval95% CI −0.2 to 2.3n1,828 countiesWeightscounty population of the yearPopulationbalanced counties with homicide countsPeriod2022 against 2019SourceCDC injury and violence mapping, both with intervals that reach zero.
The fall since 2022 reached most counties with deaths, with little difference by deprivation and a large one by region
Between 2022 and 2024 the panel's overdose rate fell in 2,1042,104 countiesEstimandcount of counties whose rate was lower in 2024 than in 2022n2,624 countiesWeightsnone (full count)Populationcounties with a stable modeled overdose rate in both 2022 and 2024 and at least one overdose death in one of the two yearsPeriod2022 to 2024SourceCDC injury and violence mapping of the 2,6242,624 countiesEstimandcount of countiesWeightsnone (full count)Populationcounties with a stable modeled overdose rate in both 2022 and 2024 and at least one overdose death in one of the two yearsPeriod2022 and 2024SourceCDC injury and violence mapping counties that have a stable rate in both years and at least one overdose death in one of them, or 80.2% (95% CI 78.7% to 81.7%)80.2% percent of countiesEstimandshare of counties whose modeled overdose rate was lower in 2024 than in 2022; bootstrap over countiesInterval95% CI 78.7% to 81.7%n2,624 countiesWeightsnone (each county counts once)Populationcounties with a stable modeled overdose rate in both 2022 and 2024 and at least one overdose death in one of the two yearsPeriod2022 to 2024SourceCDC injury and violence mapping of them (Figure 8). The file has 3,1353,135 countiesEstimandcount of counties in the fileWeightsnone (full count)Populationcounties in CDC's county filePeriod2022 and 2024SourceCDC injury and violence mapping counties, and 2,9272,927 countiesEstimandcount of counties with a stable modeled overdose rate in both yearsWeightsnone (full count)Populationcounties in CDC's county filePeriod2022 and 2024SourceCDC injury and violence mapping have a stable rate in both years. The other 303303 countiesEstimandcount of counties with a rate of zero in both years (no overdose deaths in either), left out of every share because their change has no directionn2,927 countiesWeightsnone (full count)Populationcounties with a stable modeled overdose rate in both 2022 and 2024Period2022 and 2024SourceCDC injury and violence mapping have a rate of zero in both years, with no deaths, so their change has no direction; they are gray on the map and left out of every share. They are concentrated in the most deprived third (164164 countiesEstimandcount of counties with a rate of zero in both yearsWeightsnone (full count)Populationcounties in the most deprived third of those with a stable modeled overdose rate in both yearsPeriod2022 and 2024SourceCDC injury and violence mapping counties against 3030 countiesEstimandcount of counties with a rate of zero in both yearsWeightsnone (full count)Populationcounties in the least deprived third of those with a stable modeled overdose rate in both yearsPeriod2022 and 2024SourceCDC injury and violence mapping in the least deprived), and counting them as not lower would build a deprivation gradient out of counties with no deaths. Weighted by population, the county rate changed by −8.6 (95% CI −9.4 to −7.8)−8.6 deaths per 100,000 residentsEstimandweighted mean of county overdose rates in 2024 minus the same in 2022; bootstrap over countiesInterval95% CI −9.4 to −7.8n2,624 countiesWeightsWONDER county population of the yearPopulationresidents of counties with a stable modeled overdose rate in both 2022 and 2024 and at least one overdose death in one of the two yearsPeriod2024 minus 2022 (2024 provisional)SourceCDC injury and violence mapping deaths per hundred thousand residents, and 86.0% (95% CI 82.5% to 89.1%)86.0% percent of residentsEstimandshare of residents living in counties whose modeled overdose rate was lower in 2024 than in 2022; bootstrap over countiesInterval95% CI 82.5% to 89.1%n2,624 countiesWeightsWONDER county populationPopulationresidents of counties with a stable modeled overdose rate in both 2022 and 2024 and at least one overdose death in one of the two yearsPeriod2022 populationSourceCDC injury and violence mapping of residents live in counties where it fell. The share of counties with a fall was 80.0% (95% CI 77.4% to 82.5%)80.0% percent of countiesEstimandshare of counties whose modeled overdose rate was lower in 2024 than in 2022; bootstrap over countiesInterval95% CI 77.4% to 82.5%n941 countiesWeightsnone (each county counts once)Populationcounties in the least deprived third of those with a stable modeled overdose rate in both 2022 and 2024 and at least one overdose death in one of the two yearsPeriod2022 to 2024SourceCDC injury and violence mapping in the least deprived third, 82.6% (95% CI 80.0% to 85.0%)82.6% percent of countiesEstimandshare of counties whose modeled overdose rate was lower in 2024 than in 2022; bootstrap over countiesInterval95% CI 80.0% to 85.0%n874 countiesWeightsnone (each county counts once)Populationcounties in the middle third of those with a stable modeled overdose rate in both 2022 and 2024 and at least one overdose death in one of the two yearsPeriod2022 to 2024SourceCDC injury and violence mapping in the middle third and 77.8% (95% CI 75.0% to 80.7%)77.8% percent of countiesEstimandshare of counties whose modeled overdose rate was lower in 2024 than in 2022; bootstrap over countiesInterval95% CI 75.0% to 80.7%n807 countiesWeightsnone (each county counts once)Populationcounties in the most deprived third of those with a stable modeled overdose rate in both 2022 and 2024 and at least one overdose death in one of the two yearsPeriod2022 to 2024SourceCDC injury and violence mapping in the most deprived third, so the differences by deprivation are small and the intervals of the least and most deprived thirds overlap. The difference by region is large: the share was lowest in the West, at 62.7% (95% CI 57.8% to 67.7%)62.7% percent of countiesEstimandshare of counties whose modeled overdose rate was lower in 2024 than in 2022; bootstrap over countiesInterval95% CI 57.8% to 67.7%n365 countiesWeightsnone (each county counts once)Populationcounties in the West Census region with a stable modeled overdose rate in both 2022 and 2024 and at least one overdose death in one of the two yearsPeriod2022 to 2024SourceCDC injury and violence mapping, and highest in the Northeast, at 91.8% (95% CI 87.9% to 95.2%)91.8% percent of countiesEstimandshare of counties whose modeled overdose rate was lower in 2024 than in 2022; bootstrap over countiesInterval95% CI 87.9% to 95.2%n207 countiesWeightsnone (each county counts once)Populationcounties in the Northeast Census region with a stable modeled overdose rate in both 2022 and 2024 and at least one overdose death in one of the two yearsPeriod2022 to 2024SourceCDC injury and violence mapping.
Figure 8
The modeled overdose death rate was lower in 2024 than in 2022 in 80.2% of counties with any overdose deaths in 2022 or 2024, from 62.7% in the West to 91.8% in the Northeast
Change in the CDC panel's modeled overdose death rate per 100,000 residents from 2022 to 2024 (2024 provisional), counties with a stable rate in both years and at least one death
Loading county values
Change in the overdose death rate, 2022 to 2024 (deaths per 100,000 residents)
Rate fellRate rose
Values outside −30.0 to +30.0 take the end colors.
No data (3,143 counties)
Select a class to show only those places.
Hover or tap a county for its value, or search by name. Zoom with the buttons on the map, then drag to move it.
The count depends on the model. CDC models the rate of a county with few deaths, and the change for such a county is a model's change. Among the 986986 countiesEstimandcount of countiesn2,624 countiesWeightsnone (full count)Populationcounties whose overdose rate is direct (from 10 or more deaths) in both 2022 and 2024, with at least one overdose deathPeriod2022 and 2024SourceCDC injury and violence mapping counties with direct rates in both years, a rate lower in 2024 holds for 84.1% (95% CI 81.7% to 86.3%)84.1% percent of countiesEstimandshare of counties whose rate was lower in 2024 than in 2022; bootstrap over countiesInterval95% CI 81.7% to 86.3%n986 countiesWeightsnone (each county counts once)Populationcounties whose overdose rate is direct (from 10 or more deaths) in both 2022 and 2024, with at least one overdose deathPeriod2022 to 2024SourceCDC injury and violence mapping, against 77.8% (95% CI 75.7% to 79.8%)77.8% percent of countiesEstimandshare of counties whose rate was lower in 2024 than in 2022; bootstrap over countiesInterval95% CI 75.7% to 79.8%n1,638 countiesWeightsnone (each county counts once)Populationcounties whose overdose rate is modeled in at least one of 2022 and 2024, with at least one overdose deathPeriod2022 to 2024SourceCDC injury and violence mapping of the 1,6381,638 countiesEstimandcount of countiesn2,624 countiesWeightsnone (full count)Populationcounties whose overdose rate is modeled in at least one of 2022 and 2024, with at least one overdose deathPeriod2022 and 2024SourceCDC injury and violence mapping with a modeled rate in at least one year, so the modeled counties do not inflate the share. A county with the same positive rate in both years counts as no fall, which applies to 1212 countiesEstimandcount of counties whose rate was the same positive number in both years; counted as not lowern2,624 countiesWeightsnone (full count)Populationcounties with a stable modeled overdose rate in both 2022 and 2024 and at least one overdose death in one of the two yearsPeriod2022 to 2024SourceCDC injury and violence mapping counties, and 1414 countiesEstimandcount of those counties with no Area Deprivation Index value, left out of the thirdsn2,927 countiesWeightsnone (full count)Populationcounties with a stable modeled overdose rate in both 2022 and 2024Period2022 and 2024SourceCDC injury and violence mapping counties have no deprivation value and are left out of the thirds. A study of death records describes the fall in overdose deaths from 2023 to 2024 as concentrated in deaths involving fentanyl, while deaths involving stimulants without fentanyl continued to make up a growing share of overdose deaths.[6] That description is national and says nothing about which counties the fall reached, and no analysis here explains it. Chapter 6.3, Overdose, alcohol and suicide summarizes the studies of state naloxone access laws, whose results are mixed.
What these data cannot show
Every figure describes counties and the nation. 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. The event studies describe how rates moved in the same counties around 2020 and 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. The data do not include COVID deaths.
The panel's 2024 values are provisional and may change, and WONDER's 2024 population estimate comes from a new vintage; WONDER's 2024 counts are final, but its 2023 overdose count is low for North Carolina. The size of the fall in overdose deaths in 2024 may therefore change. WONDER's county series cover complete counties, which are selected on their counts (large enough to reach the threshold every year, or very small with no deaths), and WONDER's withheld counts are not recoverable; the panel covers nearly every county but models the rates of counties with few deaths, so its rate for a small county is partly its neighbors' rate. Where WONDER publishes every year the two sources agree on the overdose rise by deprivation. In the counties WONDER withholds, only the panel has a rate, and the data cannot test whether its larger rise in the most deprived third is real or the model smoothing small counties toward their neighbors. The difference between WONDER's and the panel's national rises is consistent with the intent definitions, but the files used here do not record intent, so it is not proved.
Rates are crude, and a county with an older population has a higher rate for the same risk at each age. Thirds of counties are relative to the counties in each figure, and county deprivation is measured once, from the Area Deprivation Index, which understates deprivation in high-cost cities (Chapter 10.2, The anatomy of a deprivation index). The event study has one pre-period year at most, and the differential version for suicide fails that check. Homicide is available only from the panel and counts every method, so it differs from the firearm homicide in Chapter 6.2, Gun homicide and the causes of early death. Alcohol-induced deaths are deaths whose underlying cause is alcohol, and they leave out deaths from other conditions in which alcohol played a part. Outside the studies cited, nothing in this chapter supports a claim about what raised or lowered any of these death rates.
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
Methods
This chapter follows death rates from overdose, alcohol-induced causes and suicide for the nation and for counties, 2018 to 2024, from two sources: CDC WONDER death counts and CDC's modeled county injury and violence panel. WONDER withholds small county-year counts, so its county series use only complete counties, those with a published count in every year, and these counties are selected on the outcome as well as on size. The panel's rates for small counties are modeled and its 2024 values are provisional, while WONDER's 2024 counts are final; Connecticut's counties are in neither county series. County deprivation is grouped in thirds, and rates pooled over counties are weighted by the county population of the year.
National series and the age of the data
National series for CDC WONDER sum the 51 state rows, which have no withheld cell, and divide by the sum of WONDER's state populations. Rates are crude, per 100,000 residents.
The 2022 suicide count is 49,476, as CDC reports. WONDER's 2024 counts are final, and the panel's 2024 values are provisional. North Carolina amended many 2023 overdose death certificates after WONDER's final 2023 file, so WONDER's 2023 overdose counts for that state, and the 2023 overdose points built from them, are low.
Which counties the WONDER county series cover
WONDER withholds a county-year count above zero and below 10 and publishes a count of 0, so a rate pooled over the published years of a county is biased. Nothing is imputed, bounded or derived from totals.
County series use complete counties, those whose count is published in every year 2018 to 2024, as a count of zero or at least 10, and that have a population in every year: 889 for overdose, 629 for alcohol-induced deaths and 718 for suicide. The chapters on overdose, alcohol and suicide and on suppressed counties in death data use the window 2018 to 2023, so their sets of complete counties are larger than these, which also require 2024.
Complete counties are selected on the outcome as well as on size, and they include counties with zero deaths in all seven years: 99 for overdose, 39 for alcohol-induced deaths and 24 for suicide. Connecticut's eight counties have no WONDER population for 2022 to 2024 and are never complete.
CDC's modeled county panel
The CDC injury and violence panel (county file, data as of May 2026) carries a modeled rate for nearly every county except Connecticut's; overdose is unintentional or undetermined-intent drug overdose, and suicide and homicide include every method. A county counts toward a panel series in a year when CDC publishes a stable rate. The panel's national series is the mean of county rates weighted by WONDER's county population of the year, over the counties with a stable rate that year. Event studies and thirds use the balanced counties, those with a stable rate in all six years.
The change in the overdose rate from 2022 to 2024 uses counties with a stable rate in both years; a county with no deaths in either year (303 counties) has no direction of change and is left out of every share and mean, and thirds are cut before that exclusion.
Population weights and county deprivation
Weights for rates pooled over counties are WONDER's county populations of the year, with Chugach and Copper River (WONDER's Valdez-Cordova) sharing its population by 2019-2023 ACS residents. The panel's implied deaths are the county rate times that population over 100,000. The population benchmark for 2024 uses the yearly changes of 2019 to 2023.
County deprivation is the mean of the Area Deprivation Index national ranks of a county's tracts, weighted by 2019-2023 ACS tract population, with Connecticut tracts assigned to the eight legacy counties; thirds hold equal numbers of counties among those in each series that have a value, and counties without one are left out of the thirds (9 of the complete overdose counties, 13 of the panel's balanced overdose counties and 14 counties in the map).
How uncertainty is measured
Intervals use gamma limits under 100 deaths and a normal approximation on the count above that; an index divides two rates and takes a normal interval on the log of the ratio of the two death counts.
Rates pooled over counties, ratios and differences of pooled rates, and shares of counties have 95% percentile intervals from a bootstrap that resamples whole counties (2,000 replicates, seed 12345), with shared draws across years.
Event studies and excess deaths
Event studies are two-way fixed-effects regressions of the county death rate on year indicators, with a fixed effect for every county, weights equal to the county population of the year and errors clustered by state (50 clusters: the states and DC), fitted with pyfixest; the reference year is 2019, and the differential versions interact the year indicators with an indicator for the most deprived third, against the least deprived third, with year fixed effects.
Excess deaths subtract the 2019 crude rate times each year's population from the year's deaths; their interval treats the 2019 count and each year's count as Poisson.
References
- Case, Anne; Deaton, Angus (2020). Deaths of Despair and the Future of Capitalism. Princeton University Press.
- 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
- White, Aaron M.; Castle, I-Jen P.; Powell, Patricia A.; Hingson, Ralph W.; Koob, George F. (2022). Alcohol-related deaths during the COVID-19 pandemic. JAMA 327(17): 1704-1706. doi:10.1001/jama.2022.4308
- Kegler, Scott R.; Simon, Thomas R.; Zwald, Marissa L.; Chen, May S.; Mercy, James A.; Jones, Christopher M.; Mercado-Crespo, Melissa C.; Blair, Janet M.; Stone, Deborah M.; Ottley, Phyllis G.; Dills, Jennifer (2022). Vital Signs: Changes in firearm homicide and suicide rates, United States, 2019-2020. MMWR Morbidity and Mortality Weekly Report 71(19): 656-663. doi:10.15585/mmwr.mm7119e1
- Roth, Jonathan; Sant'Anna, Pedro H. C.; Bilinski, Alyssa; Poe, John (2023). What's trending in difference-in-differences? A synthesis of the recent econometrics literature. Journal of Econometrics 235(2): 2218-2244. doi:10.1016/j.jeconom.2023.03.008
- Friedman, Joseph R.; Palamar, Joseph J.; Ciccarone, Daniel; Gaines, Tommi L.; Borquez, Annick; Shover, Chelsea L.; Strathdee, Steffanie A. (2026). Charting the decline of the fourth wave: US overdose deaths by race, ethnicity and substance involvement. Addiction 121(9): 2552-2558. doi:10.1111/add.70472
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.}
}