{
  "alt": "Three small line charts of the average within-county change in the death rate since 2019 for overdose, alcohol-induced deaths and suicide. The overdose line is slightly below zero in 2018, zero in 2019, then rises to a plateau from 2021 to 2023 and falls toward zero in 2024. The alcohol-induced line peaks in 2021 on a smaller scale and stays above zero in 2024. The suicide line stays within a narrow band around zero. The overdose interval widens in 2024.",
  "caption": "The overdose and alcohol-induced lines rise from 2020 and the overdose line falls close to zero in 2024, while the suicide line stays close to zero. The point left of 2019 is the only pre-period: it is {fact:es_w_od_18} for overdose and {fact:es_w_alc_18} for alcohol-induced deaths, a small movement in the same direction as the later rise. Each point is the coefficient on a year in a regression with a fixed effect for every county, weighted by county population, with a 95% interval clustered by state. 2019 is the reference year.",
  "data": [
    {
      "cause": "Overdose",
      "conf_high": -0.455631,
      "conf_low": -1.63322,
      "estimate": -1.04443,
      "n_units": 889,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2018
    },
    {
      "cause": "Overdose",
      "estimate": 0,
      "n_units": 889,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2019
    },
    {
      "cause": "Overdose",
      "conf_high": 7.67744,
      "conf_low": 5.64937,
      "estimate": 6.6634,
      "n_units": 889,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2020
    },
    {
      "cause": "Overdose",
      "conf_high": 12.5242,
      "conf_low": 9.34599,
      "estimate": 10.9351,
      "n_units": 889,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2021
    },
    {
      "cause": "Overdose",
      "conf_high": 12.9513,
      "conf_low": 9.50106,
      "estimate": 11.2262,
      "n_units": 889,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2022
    },
    {
      "cause": "Overdose",
      "conf_high": 12.6412,
      "conf_low": 8.02266,
      "estimate": 10.3319,
      "n_units": 889,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2023
    },
    {
      "cause": "Overdose",
      "conf_high": 4.82289,
      "conf_low": -1.13876,
      "estimate": 1.84206,
      "n_units": 889,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2024
    },
    {
      "cause": "Alcohol-induced deaths",
      "conf_high": -0.126075,
      "conf_low": -0.706883,
      "estimate": -0.416479,
      "n_units": 629,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2018
    },
    {
      "cause": "Alcohol-induced deaths",
      "estimate": 0,
      "n_units": 629,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2019
    },
    {
      "cause": "Alcohol-induced deaths",
      "conf_high": 3.35386,
      "conf_low": 2.50583,
      "estimate": 2.92985,
      "n_units": 629,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2020
    },
    {
      "cause": "Alcohol-induced deaths",
      "conf_high": 5.00499,
      "conf_low": 3.50824,
      "estimate": 4.25662,
      "n_units": 629,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2021
    },
    {
      "cause": "Alcohol-induced deaths",
      "conf_high": 3.91406,
      "conf_low": 2.75641,
      "estimate": 3.33524,
      "n_units": 629,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2022
    },
    {
      "cause": "Alcohol-induced deaths",
      "conf_high": 2.78669,
      "conf_low": 1.83732,
      "estimate": 2.31201,
      "n_units": 629,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2023
    },
    {
      "cause": "Alcohol-induced deaths",
      "conf_high": 2.12508,
      "conf_low": 1.21226,
      "estimate": 1.66867,
      "n_units": 629,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2024
    },
    {
      "cause": "Suicide",
      "conf_high": 0.497989,
      "conf_low": 0.113504,
      "estimate": 0.305747,
      "n_units": 718,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2018
    },
    {
      "cause": "Suicide",
      "estimate": 0,
      "n_units": 718,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2019
    },
    {
      "cause": "Suicide",
      "conf_high": -0.310254,
      "conf_low": -0.902314,
      "estimate": -0.606284,
      "n_units": 718,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2020
    },
    {
      "cause": "Suicide",
      "conf_high": 0.233619,
      "conf_low": -0.461306,
      "estimate": -0.113843,
      "n_units": 718,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2021
    },
    {
      "cause": "Suicide",
      "conf_high": 0.627664,
      "conf_low": -0.0739045,
      "estimate": 0.27688,
      "n_units": 718,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2022
    },
    {
      "cause": "Suicide",
      "conf_high": 0.47885,
      "conf_low": -0.206234,
      "estimate": 0.136308,
      "n_units": 718,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2023
    },
    {
      "cause": "Suicide",
      "conf_high": 0.155633,
      "conf_low": -0.66249,
      "estimate": -0.253429,
      "n_units": 718,
      "provisional": false,
      "source": "CDC WONDER, counties with published counts in every year",
      "year": 2024
    },
    {
      "cause": "Overdose",
      "estimate": 0,
      "n_units": 2648,
      "provisional": false,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2019
    },
    {
      "cause": "Overdose",
      "conf_high": 7.45439,
      "conf_low": 5.32394,
      "estimate": 6.38917,
      "n_units": 2648,
      "provisional": false,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2020
    },
    {
      "cause": "Overdose",
      "conf_high": 12.4984,
      "conf_low": 9.27869,
      "estimate": 10.8885,
      "n_units": 2648,
      "provisional": false,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2021
    },
    {
      "cause": "Overdose",
      "conf_high": 12.6883,
      "conf_low": 9.34872,
      "estimate": 11.0185,
      "n_units": 2648,
      "provisional": false,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2022
    },
    {
      "cause": "Overdose",
      "conf_high": 12.2275,
      "conf_low": 8.01861,
      "estimate": 10.123,
      "n_units": 2648,
      "provisional": false,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2023
    },
    {
      "cause": "Overdose",
      "conf_high": 5.17644,
      "conf_low": -0.0784109,
      "estimate": 2.54901,
      "n_units": 2648,
      "provisional": true,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2024
    },
    {
      "cause": "Homicide",
      "estimate": 0,
      "n_units": 2755,
      "provisional": false,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2019
    },
    {
      "cause": "Homicide",
      "conf_high": 1.87793,
      "conf_low": 1.37838,
      "estimate": 1.62816,
      "n_units": 2755,
      "provisional": false,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2020
    },
    {
      "cause": "Homicide",
      "conf_high": 2.46634,
      "conf_low": 1.70598,
      "estimate": 2.08616,
      "n_units": 2755,
      "provisional": false,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2021
    },
    {
      "cause": "Homicide",
      "conf_high": 2.03584,
      "conf_low": 1.38492,
      "estimate": 1.71038,
      "n_units": 2755,
      "provisional": false,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2022
    },
    {
      "cause": "Homicide",
      "conf_high": 1.37307,
      "conf_low": 0.751063,
      "estimate": 1.06207,
      "n_units": 2755,
      "provisional": false,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2023
    },
    {
      "cause": "Homicide",
      "conf_high": 0.508004,
      "conf_low": -0.0117365,
      "estimate": 0.248134,
      "n_units": 2755,
      "provisional": true,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2024
    },
    {
      "cause": "Suicide",
      "estimate": 0,
      "n_units": 2184,
      "provisional": false,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2019
    },
    {
      "cause": "Suicide",
      "conf_high": -0.322488,
      "conf_low": -0.91096,
      "estimate": -0.616724,
      "n_units": 2184,
      "provisional": false,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2020
    },
    {
      "cause": "Suicide",
      "conf_high": 0.330178,
      "conf_low": -0.331261,
      "estimate": -0.000541318,
      "n_units": 2184,
      "provisional": false,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2021
    },
    {
      "cause": "Suicide",
      "conf_high": 0.652466,
      "conf_low": -0.0284359,
      "estimate": 0.312015,
      "n_units": 2184,
      "provisional": false,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2022
    },
    {
      "cause": "Suicide",
      "conf_high": 0.523004,
      "conf_low": -0.128911,
      "estimate": 0.197047,
      "n_units": 2184,
      "provisional": false,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2023
    },
    {
      "cause": "Suicide",
      "conf_high": 0.47425,
      "conf_low": -0.374229,
      "estimate": 0.0500104,
      "n_units": 2184,
      "provisional": true,
      "source": "CDC panel, counties with a stable rate in every year",
      "year": 2024
    }
  ],
  "id": "event_study",
  "notes": [
    "The event is the arrival of the pandemic in 2020, treated as one common shock: every county is exposed in the same year, so there is no unexposed comparison group, and the coefficients describe how county death rates moved and not what any one thing did. County fixed effects remove each county's own level, and the weights are county populations of the year.",
    "The WONDER tab covers {fact:wc_od_n} counties for overdose, {fact:wc_alc_n} for alcohol-induced deaths and {fact:wc_su_n} for suicide, in {fact:es_states} state clusters (DC counts as one). The panel tab covers the counties with a stable modeled rate in every year ({fact:p_od_nb}, {fact:p_hm_nb} and {fact:p_su_nb}) and starts in 2019, so it has no pre-period. Clustering by county gives intervals about {fact:es_se_ratio} times narrower for the 2022 overdose coefficient than clustering by state, and the chapter reports the wider ones.",
    "The panel's 2024 values are provisional (open circles); WONDER's 2024 counts are final.",
    "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. The WONDER overdose tab includes the counties of that state."
  ],
  "source": "CDC WONDER underlying cause of death, 2018-2024, and CDC Mapping Injury, Overdose, and Violence county file, 2019-2024; crude rates, modeled estimates, population-weighted regressions",
  "spec": {
    "annotations": [
      {
        "label": "2019 level",
        "type": "y-rule",
        "y": 0
      },
      {
        "label": "First pandemic year",
        "type": "x-rule",
        "x": 2020
      }
    ],
    "bandSeries": [
      "Overdose",
      "Alcohol-induced deaths",
      "Suicide",
      "Homicide"
    ],
    "colors": {
      "Alcohol-induced deaths": "alcohol",
      "Homicide": "homicide",
      "Overdose": "overdose",
      "Suicide": "suicide"
    },
    "facet": "cause",
    "facetColumns": 3,
    "hi": "conf_high",
    "hollow": "provisional",
    "lo": "conf_low",
    "n": "n_units",
    "series": "cause",
    "x": "year",
    "xDomain": [
      2018,
      2024
    ],
    "xLabel": "Year",
    "xTicks": "data",
    "y": "estimate",
    "yDomain": [
      -3,
      14
    ],
    "yFormat": {
      "digits": 1
    },
    "yLabel": "Change in deaths per 100,000 residents since 2019"
  },
  "subtitle": "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",
  "title": "Within the same counties, the overdose rate in 2022 was {fact:es_w_od_22} deaths per hundred thousand residents above its 2019 level and the alcohol-induced rate in 2021 {fact:es_w_alc_21} above, while suicide rates never moved by more than about {fact:es_w_su_max} deaths per hundred thousand residents",
  "type": "line",
  "views": [
    {
      "filter": {
        "source": "CDC WONDER, counties with published counts in every year"
      },
      "id": "wonder",
      "label": "CDC WONDER, 2018 to 2024"
    },
    {
      "caption": "Overdose and homicide rise from 2020, homicide peaks a year before overdose and its interval reaches zero in 2024, and the suicide line is below zero in 2020 and close to zero after. The panel starts in 2019, so no pre-period can be checked. Each point is the coefficient on a year in a regression with a fixed effect for every county, weighted by county population, with a 95% interval clustered by state.",
      "filter": {
        "source": "CDC panel, counties with a stable rate in every year"
      },
      "id": "panel",
      "label": "CDC panel, 2019 to 2024",
      "spec": {
        "yDomain": [
          -3,
          14
        ]
      },
      "title": "In the modeled panel, the overdose rate in 2022 was {fact:es_p_od_22} deaths per hundred thousand residents above its 2019 level within the same counties and the homicide rate in 2021 {fact:es_p_hm_21} above, and the 2024 intervals for both reach zero"
    }
  ],
  "width": "full"
}