Overdose, alcohol and suicide

Among counties with a stable modeled death rate for 2019 to 2023, 68.0%68.0% percent of countiesEstimandshare of those counties in the South region (Census regions)n272 countiesWeightsnone (each county counts once)Populationcounties in the highest tenth of overdose rates among counties with a stable ratePeriodannual modeled rates for 2019 to 2023, averagedSourceCDC injury and violence mapping of the tenth with the highest overdose rates are in the South, which holds 45.7%45.7% percent of countiesEstimandshare of counties with a stable overdose rate in the South region (Census regions)n2,714 countiesWeightsnone (each county counts once)Populationcounties in CDC's county file with a stable modeled rate in each year 2019 to 2023Periodannual modeled rates for 2019 to 2023, averagedSourceCDC injury and violence mapping of counties with an overdose rate. Of the tenth with the highest suicide rates, 50.0%50.0% percent of countiesEstimandshare of those counties in the West region (Census regions)n228 countiesWeightsnone (each county counts once)Populationcounties in the highest tenth of suicide rates among counties with a stable ratePeriodannual modeled rates for 2019 to 2023, averagedSourceCDC injury and violence mapping are in the West, which holds 13.7%13.7% percent of countiesEstimandshare of counties with a stable suicide rate in the West region (Census regions)n2,273 countiesWeightsnone (each county counts once)Populationcounties in CDC's county file with a stable modeled rate in each year 2019 to 2023Periodannual modeled rates for 2019 to 2023, averagedSourceCDC injury and violence mapping of counties with a suicide rate. The counties where these two kinds of death run highest lie in different places.

Suicide rates share little with overdose or homicide rates

Anne Case and Angus Deaton grouped suicide, drug overdose and alcoholic liver disease as deaths of despair.[1] The grouping treats three kinds of death as one problem, and this chapter asks whether they share an address. A correlation measures how closely two county rates rise and fall together, and a value near zero means they do not. Across the counties with a stable modeled rate for suicide, overdose and homicide in 2019 to 2023, the overdose rate has a population-weightedPopulation-weightedAveraged so that each place counts in proportion to its number of residents, which lets a large county move the result more than a small one. An unweighted average counts every place equally. correlation of +0.13+0.13 correlation coefficientEstimandcorrelation of the county overdose and suicide rates, population-weighted; bootstrap over countiesInterval95% CI 0.05 to 0.21n1,899 countiesWeights2019-2023 ACS residentsPopulationcounties with a stable rate for all three kinds of deathPeriodannual modeled rates for 2019 to 2023, averagedSourceCDC injury and violence mapping with the suicide rate. The suicide rate has a correlation of −0.02 (95% CI −0.10 to 0.06)−0.02 correlation coefficientEstimandcorrelation of the county suicide and homicide rates, population-weighted; bootstrap over countiesInterval95% CI −0.10 to 0.06n1,899 countiesWeights2019-2023 ACS residentsPopulationcounties with a stable rate for all three kinds of deathPeriodannual modeled rates for 2019 to 2023, averagedSourceCDC injury and violence mapping with the homicide rate, an interval that includes zero. Overdose and homicide rates are more closely related, with a correlation of +0.48 (95% CI 0.35 to 0.58)+0.48 correlation coefficientEstimandcorrelation of the county overdose and homicide rates, population-weighted; bootstrap over countiesInterval95% CI 0.35 to 0.58n1,899 countiesWeights2019-2023 ACS residentsPopulationcounties with a stable rate for all three kinds of deathPeriodannual modeled rates for 2019 to 2023, averagedSourceCDC injury and violence mapping.

The three rates also follow deprivation in different ways. The chapter ranks counties by the Area Deprivation IndexArea Deprivation Index (ADI)A score that ranks neighborhoods by income, education, employment and housing conditions drawn from the American Community Survey. In this book a higher national percentile means a more deprived neighborhood. of their residents and cuts the ranking into tenths with equal numbers of counties. Weighted by population, all three rates are higher in the most deprived tenth than in the least, and the homicide and overdose lines do not rise steadily in between. The suicide line is level over the more deprived tenths. The overdose line rises to a peak among the less deprived tenths, but the interval for its lead over the most deprived tenth includes zero. A peak chosen from ten noisy means also overstates its lead. The data therefore do not show that overdose rates are higher in the middle of the ranking than at the deprived end.

How we know

The rates come from the county file of CDC's injury and violence dashboard, which carries modeled estimatesModeled 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. of death rates and leaves out Connecticut's counties. A model borrows strength across counties where deaths are few, so a small county's rate is partly its neighbors' rate. A county is counted when CDC publishes a stable rate in each year from 2019 to 2023, and its rate is the mean of the five annual rates. Every rate is 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., deaths per hundred thousand residents with no adjustment for age. The panel counts only unintentional and undetermined-intent drug poisonings as overdose, so an overdose recorded as a suicide appears in the suicide rate and not in the overdose rate. Statistics across counties are computed both ways, weighted by residents and counting every county once, and several results differ between the two. The report gives every estimate with its interval and sample size.

Weighted rises in suicide and overdose come from larger counties

The tenths hold equal numbers of counties, so the most deprived tenth is mostly small rural counties. Weighted by population, the larger counties in each tenth carry more of its average. The weighted rise in suicide and overdose comes from the larger counties, and the small counties that make up most of the most deprived tenth do not show it.

Drug and alcohol deaths, counted in a selected set of counties

Alcohol-induced deaths appear in this chapter only through CDC WONDER, which counts deaths by the underlying cause on the death certificate. WONDER withholdsSuppressionThe 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. any county-year count above zero and below 1010 deaths in a county-yearEstimanddefinition: WONDER withholds a county-year count above zero and below this numberWeightsnone (definition)Populationcounty-years in CDC WONDERPerioddeaths in 2018 to 2024SourceCDC WONDER underlying cause of death. The chapter therefore uses only 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., whose counts are published in every year from 2018 to 2024, so that the rate pooled over those years is exact. Complete counties are selected on the outcome as well as on size. Among counties of 30,00030,000 residentsEstimanddefinition: lower end of the county size bandWeightsnone (definition)Populationcounties in the comparison of complete counties with the restPeriod2019-2023 ACS residentsSourceAmerican Community Survey to 60,00060,000 residentsEstimanddefinition: upper end of the county size bandWeightsnone (definition)Populationcounties in the comparison of complete counties with the restPeriod2019-2023 ACS residentsSourceAmerican Community Survey residents, counted once each, the panel's mean overdose rate is 50.9 (95% CI 46.1 to 56.4)50.9 deaths per 100,000 residentsEstimandmean of the CDC panel's modeled county overdose rates, counting every county once; bootstrap over countiesInterval95% CI 46.1 to 56.4n73 countiesWeightsnone (each county counts once)Populationcounties of 30,000 to 60,000 residents whose WONDER overdose count is published in every yearPeriodannual modeled rates for 2019 to 2023, averagedSourceCDC injury and violence mapping deaths per hundred thousand residents where the WONDER overdose count is published in every year. In the rest it is 22.5 (95% CI 21.5 to 23.4)22.5 deaths per 100,000 residentsEstimandmean of the CDC panel's modeled county overdose rates, counting every county once; bootstrap over countiesInterval95% CI 21.5 to 23.4n480 countiesWeightsnone (each county counts once)Populationcounties of 30,000 to 60,000 residents whose WONDER overdose count is not published in every yearPeriodannual modeled rates for 2019 to 2023, averagedSourceCDC injury and violence mapping.

In WONDER, drug deaths are drug poisonings of any intent, and alcohol-induced deaths include alcoholic liver disease and alcohol poisoning. Figure 2 maps the ratio of the two crude rates in the 545545 countiesEstimandcount of mapped countiesWeightsnone (full count)Populationcounties complete for drug and alcohol with at least 20 pooled deaths of eachPerioddeaths in 2018 to 2024SourceCDC WONDER underlying cause of death counties that are complete for both drug and alcohol counts and have enough pooled deaths of each to be drawn. The overdose rate is the higher one in 479479 countiesEstimandcount of mapped counties with a higher crude overdose than alcohol-induced death raten545 countiesWeightsnone (full count)Populationmapped countiesPerioddeaths in 2018 to 2024SourceCDC WONDER underlying cause of death of them. Drug and alcohol deaths separate as well, but the counts behind that result come from this selected set of counties.

What the county rates mean, and what they do not

Suicide and homicide also differ by type of county. The chapter groups counties by the 2023 Rural-Urban Continuum Code. Weighted by population, suicide is higher in more urban nonmetro counties than in large metro counties, and homicide is higher in large metro counties than in the least urban nonmetro counties. Counting every county once, both contrasts hold.

In these county rates, suicide, overdose and homicide are highest in different counties, and suicide is the most separate of the three. These are patterns among places. A county rate is an average over all of its residents, so it cannot say who died, and a correlation across counties does not describe 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 count deaths and do not measure despair. Whether people in these counties feel despair is a person-level question, taken up in Chapter 6.3, Life evaluation and daily feelings.

What this cannot tell you

Rates are crude, so a county with an older population has a higher rate for the same risk at each age, and comparisons of rural and urban counties carry that difference. The Area Deprivation Index understates deprivation in high-cost cities, so a high-cost county can sit in a less deprived tenth than its tracts would suggest. The WONDER results describe complete counties only, and the withheld county-years could hold at most 13.7%13.7% percent of deaths in the county filesEstimandlargest share of the county file's drug overdose deaths that the withheld cells could hold, at the largest withheld count eachWeightsnone (bound from the public threshold)Populationdeaths in county-years in CDC WONDERPeriod2018 to 2024SourceCDC WONDER underlying cause of death of the drug-poisoning deaths and 29.0%29.0% percent of deaths in the county filesEstimandlargest share of the county file's alcohol-induced deaths that the withheld cells could hold, at the largest withheld count eachWeightsnone (bound from the public threshold)Populationdeaths in county-years in CDC WONDERPeriod2018 to 2024SourceCDC WONDER underlying cause of death of the alcohol-induced deaths in WONDER's county files. A suicide by drug poisoning is counted in WONDER as both a suicide and a drug death.

Go deeper

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

Same question at another grain:

• Despair
  • Chapter 6.3, Life evaluation and daily feelings Individuals

Reading paths that include this chapter:

• Outcomes that do not follow the gradient

Data sources

• CDC injury and violence mappingCDC Mapping Injury, Overdose, and Violence county file: modeled overdose, suicide and homicide death rates, annual 2019 to 2023Years: 2019-2024 for counties, 2022-2024 for tracts (data as of 2026-05-14) · Weights: 2019-2023 ACS residents of each county, and every county once · License: Public domain (CDC, U.S. Department of Health and Human Services)
• CDC WONDER underlying cause of deathCDC WONDER underlying cause of death: drug poisoning (overdose), alcohol-induced causes and suicide, counties 2018 to 2024Years: 2018-2024 · Weights: none (crude rates from counts); WONDER county population · License: Public domain (NCHS, CDC); WONDER data-use restrictions apply
• American Community SurveyTotal population of 2020 tracts, 2019-2023, summed to counties as weights for the panel's county ratesYears: 2019-2023 (5-year) · Weights: none (full count) · License: Public domain (U.S. Census Bureau)
• 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 tract population · License: Free for non-commercial use; cite the Neighborhood Atlas and Kind and Buckingham
• Rural-Urban Continuum CodesUSDA Rural-Urban Continuum Codes 2023, countyYears: 2023 · Weights: none (classification) · License: Public domain (U.S. federal)
• County Health RankingsCounty Health Rankings 2024, share of residents who are American Indian or Alaska Native (Census Population Estimates 2022)Years: 2024 release · Weights: none (published county measure) · License: CC BY 4.0 (University of Wisconsin Population Health Institute)

All data sources

References

1. Case, Anne; Deaton, Angus (2020). Deaths of Despair and the Future of Capitalism. Princeton University Press.

How to cite

@misc{singh2026overdosealcoholandsuicide,
  author = {Singh, Vishal},
  title = {Overdose, alcohol and suicide},
  year = {2026},
  url = {https://vishalsingh.org/zipcode/overdose-alcohol-and-suicide},
  note = {In ZIP Code Destiny. Published 9 October 2026.}
}