# Suppressed counties in death data: report

Chapter 10.3 of ZIP Code Destiny, by Vishal Singh (NYU Stern). Generated from the chapter's data files; the reading version is at https://vishalsingh.org/zipcode/suppressed-counties-in-death-data. Table n of this report is figure n of the chapter.

## Identification

- Title: Suppressed counties in death data
- Label: The counties that don't count
- Chapter: 10.3 (Part X, How the estimates are made; Methods and sources)
- Question: Which counties have death counts withheld for privacy, and how does the withholding bias comparisons between counties?
- Dek: CDC WONDER withheld the death count in 47.1% to 57.9% of county-years for overdose, alcohol-induced deaths and suicide from 2018 to 2023, and the counties it published in every year are selected on their death rates.
- Grain: counties
- Status: published
- Published: 2026-10-09
- Updated: not revised
- Data sources:
  - CDC WONDER underlying cause of death. CDC WONDER underlying cause of death, county files for drug poisoning (overdose), alcohol-induced causes and suicide, 2018 to 2024, and state files for the same causes; years: 2018-2024; weights: none (full counts of deaths; crude rates); WONDER county population
  - CDC WONDER natality. CDC WONDER natality, county totals 2018 to 2024: births in the counties that WONDER names and in the pooled Unidentified Counties rows; years: 2018-2024; weights: none (full counts of births)
  - CDC WONDER linked birth and infant death. CDC WONDER linked birth and infant death, county totals 2018 to 2022: births in the counties that WONDER names and in the pooled rows; years: 2018-2022; weights: none (full counts of births)
  - CDC injury and violence mapping. CDC Mapping Injury, Overdose, and Violence county file: modeled overdose and suicide death rates, annual 2019 to 2023; years: 2019-2024 for counties, 2022-2024 for tracts (data as of 2026-05-14); weights: mean WONDER population of each county
  - County Health Rankings. County Health Rankings 2024: counties with no rate for overdose, suicide, homicide, firearm deaths and premature death, and race and ethnicity shares of residents (Census Population Estimates); years: 2024 release; weights: county population in County Health Rankings
  - Area Deprivation Index. Neighborhood Atlas Area Deprivation Index 2023, tract national rank averaged to counties; years: 2023 release (version 4.0.1; built on ACS 2019-2023); weights: 2019-2023 tract population
  - Rural-Urban Continuum Codes. USDA Rural-Urban Continuum Codes 2023, county; years: 2023; weights: none (classification)
  - American Community Survey. Total population of 2020 tracts, 2019-2023, summed to counties as population for deprivation and for the shares of residents in the table; years: 2019-2023 (5-year); weights: none (full count)
- Canonical URL: https://vishalsingh.org/zipcode/suppressed-counties-in-death-data
- Report: https://vishalsingh.org/zipcode/suppressed-counties-in-death-data/report
- Markdown: https://vishalsingh.org/zipcode/suppressed-counties-in-death-data/report.md
- BibTeX key: singh2026suppressedcountiesindeathdata

```bibtex
@misc{singh2026suppressedcountiesindeathdata,
  author = {Singh, Vishal},
  title = {Suppressed counties in death data},
  year = {2026},
  url = {https://vishalsingh.org/zipcode/suppressed-counties-in-death-data},
  note = {In ZIP Code Destiny. Published 9 October 2026.}
}
```

## Principal estimates

The facts the dek and the opening prose cite, in order of appearance.

| Estimand | Population | Period | Value | Interval | n | Weights | Source | Fact id |
| --- | --- | --- | ---: | --- | ---: | --- | --- | --- |
| share of county-years whose drug overdose count WONDER withholds | county-years in the CDC WONDER county files, each kind of death counted separately | county-years in 2018 to 2023 | 47.1% |   | 18,852 county-years | none (full count) | CDC WONDER underlying cause of death | w_wh_od |
| share of county-years whose alcohol-induced count WONDER withholds | county-years in the CDC WONDER county files, each kind of death counted separately | county-years in 2018 to 2023 | 57.9% |   | 18,852 county-years | none (full count) | CDC WONDER underlying cause of death | w_wh_alc |
| share of county-years whose suicide count WONDER withholds | county-years in the CDC WONDER county files, each kind of death counted separately | county-years in 2018 to 2023 | 57.5% |   | 18,852 county-years | none (full count) | CDC WONDER underlying cause of death | w_wh_su |
| share of the summed county populations that sit in county-years whose drug overdose count is withheld (WONDER publishes the population) | residents counted in the county-years of the WONDER county files | county-years in 2018 to 2023 | 10.1% |   |   | none (full count) | CDC WONDER underlying cause of death | w_pop_od |
| share of the summed county populations that sit in county-years whose alcohol-induced count is withheld (WONDER publishes the population) | residents counted in the county-years of the WONDER county files | county-years in 2018 to 2023 | 14.8% |   |   | none (full count) | CDC WONDER underlying cause of death | w_pop_alc |
| share of the summed county populations that sit in county-years whose suicide count is withheld (WONDER publishes the population) | residents counted in the county-years of the WONDER county files | county-years in 2018 to 2023 | 12.2% |   |   | none (full count) | CDC WONDER underlying cause of death | w_pop_su |
| definition: WONDER withholds a county-year count above zero and below this number | county-years in the CDC WONDER county files, each kind of death counted separately | not applicable (definition) | 10 |   |   | none (definition) | CDC WONDER underlying cause of death | w_floor |

## Findings

CDC WONDER, the federal database of death certificates, withheld the death count for 47.1% of county-years for drug overdose from 2018 to 2023, 57.9% for alcohol-induced deaths and 57.5% for suicide. The withheld county-years hold only 10.1%, 14.8% and 12.2% of residents, so the blanks cover many places and few people. They are also a selected set of places. WONDER publishes a county-year count when it is zero or at least 10 deaths, so a county enters the published data in the years when its count is high. A rate pooled over those years is biased. Here that means it differs from the county's true rate in a systematic direction that depends on the size of the county. It falls below the rate in CDC's modeled injury and violence panel in the smallest counties and rises above it in counties of middling small size.

This chapter explains the mechanism behind a rule that every chapter using WONDER follows. A withheld cell is counted and left out of both the numerator and the denominator of a rate, and the book never fills it in. It discloses only the largest share of deaths that the withheld cells could hold at the public limit. County rates in other chapters use complete counties, those whose counts are published in every year, or a modeled source. The sections below take up the rule, the counties it removes, the bias it produces and a second rule, which decides which counties WONDER names at all in its birth products. The cause maps belong to Chapter 8.2, Overdose, alcohol and suicide (https://vishalsingh.org/zipcode/overdose-alcohol-and-suicide), the birth outcomes to Chapter 2.1, Birthweight and preterm birth (https://vishalsingh.org/zipcode/birthweight-and-preterm-birth), and a figure of suppressed cells by birthweight class to Chapter 10.1, Gradients, slopes and variance (https://vishalsingh.org/zipcode/gradients-slopes-and-variance).

### WONDER withholds small counts and publishes zeros on request

The county files of WONDER's Underlying Cause of Death database show a count above zero and below 10 as Suppressed, and the database's terms bar users from presenting a death count of 9 or fewer, or a rate built on one. A suppressed cell says only that the count is small. It is missing, and a count of zero is published as zero. Zeros appear only when a query asks for them. A default WONDER query omits county-years with no deaths, and the pulls behind this book used the option that shows zero values, so a zero here is a published count and not an absent row.

Agencies withhold small counts for two reasons that are easy to confuse.[1] One is confidentiality, which sets the limit of 10 for deaths and births in subnational tables.[2] The other is reliability. Until recently NCHS suppressed or flagged any rate based on fewer than 20 events, the count at which the relative standard error of a Poisson count reaches 22.4%. Its current standard asks for at least 10 events and a 95% confidence interval no wider than 160% of the estimate.[2] The first rule protects the people counted, and the second protects the reader of the rate.

Maps in this book keep the earlier floor of 20 pooled deaths for every year, so that every map follows one rule that is stricter than the current NCHS minimum. Gradients in other chapters use no floor and weight each place by its population.

Publication clears WONDER's limit and not the reliability bar. Among county-years that WONDER publishes with at least 10 deaths, 35.4% for overdose, 43.8% for alcohol-induced deaths and 44.8% for suicide have fewer than 20 deaths.

This chapter uses the county files of the Underlying Cause of Death database for 2018 to 2024 (single race), which carry a row for each of 3,142 counties and each year, for three kinds of death. They are drug poisoning of any intent, which the chapter calls overdose, alcohol-induced deaths and suicide. Over 2018 to 2023 that is 18,852 county-years for each kind of death. Rates are crude. Every year from 2018 to 2024 is final in the June 2026 pull, although North Carolina's 2023 overdose counts predate the state's amended death certificates and are low. WONDER publishes a county's population whether or not it withholds the deaths, which makes it possible to measure how many residents live in a county-year with a blank.

Table 1. In every year from 2018 to 2024 WONDER withheld between 44.6% and 59.9% of county-year death counts, in county-years that hold between 8.6% and 17.4% of residents

In every year from 2018 to 2024 the withheld share ran from 44.6% to 59.9% of county-years across the three kinds of death, and the withheld county-years held between 8.6% and 17.4% of residents.

The share of residents fell for overdose, from 12.3% in 2018 to 8.6% in its lowest year, and for alcohol-induced deaths, from 17.4% to 12.5%, while for suicide it stayed between 11.8% and 12.7%.

A blank is not a zero. Once a query asks for zeros, they are a large part of what WONDER publishes. Counts of zero are 30.0% of the published overdose county-years, 34.2% of the alcohol-induced ones and 24.7% of the suicide ones.

A rate pooled over a county's published years keeps its years with no deaths and drops its years with a few, which is the bias that the later sections measure. For suicide, the pooled rate is 0.18 (95% CI 0.00 to 0.42) times the panel's rate in counties under 10,000 residents and 1.51 (95% CI 1.47 to 1.55) times in counties of 25,000 to 50,000 residents (Table 7).

### Withholding is heaviest in counties of middling small size

How often a count is withheld depends on how many deaths a county expects. Table 2 sorts counties by their mean population over 2018 to 2023 into six classes, with boundaries at 10,000, 25,000, 50,000, 100,000 and 250,000 residents. The last two are the populations at which WONDER names a county in its birth products, taken up below.

Table 2. WONDER withholds 82.3% of overdose county-years in counties of 10,000 to 25,000 residents and 45.2% in smaller counties, where 54.7% are published as zero

Counties of 10,000 to 25,000 residents are withheld most often, in 82.3% of overdose county-years, 84.3% of alcohol-induced county-years and 93.1% of suicide county-years.

Counties under 10,000 residents are withheld less, in 45.2%, 54.9% and 61.3%, because many of their county-years have no deaths and WONDER publishes the zero. Published zeros are 54.7%, 44.8% and 38.5% of their county-years.

At the large end, counties of 100,000 to 250,000 residents are withheld in 2.5% of overdose county-years, 9.7% of alcohol-induced county-years and 1.5% of suicide county-years. Counties of 250,000 or more are withheld in 0.0% of overdose, 0.1% of alcohol-induced and 0.0% of suicide county-years. A county that expects more than a handful of deaths in a year but fewer than the limit is withheld in most years, and the section on bias below works out how much that selects.

### Withheld years are fewest in the Northeast and the Pacific states

Table 3 counts, for each county, the years from 2018 to 2023 in which its count is withheld. A county published in every year has a count, possibly zero, and a population in each of those years. That is a complete county. Other than Connecticut's counties there are 942 for overdose, 644 for alcohol-induced deaths and 745 for suicide. At the other end, 591 counties for overdose, 782 for alcohol-induced deaths and 919 for suicide are withheld in every year.

The overdose map shades 950 counties at no withheld year. They are the 942 complete counties and Connecticut's 8 counties, which have deaths but no population in 2022 and 2023 and so are not complete. The alcohol-induced and suicide maps shade 652 and 752 counties at no withheld year, again the complete counties and the Connecticut counties with no withheld year.

Table 3. WONDER withheld the overdose count in every year from 2018 to 2023 in 591 counties and in no year in 950

Counties in New England, the Middle Atlantic and the Pacific division average fewer withheld years than counties in any other Census division, for each kind of death. For suicide counts, 32.7% of counties in the South and 31.1% in the Midwest are withheld in every year, against 22.5% in the West and 12.0% in the Northeast. The map shows where blanks occur, and it says nothing about whether the deaths behind a blank are many or few.

### Residents of withheld counties live in smaller, more rural and more deprived places

The counties fall into three groups by how often WONDER withholds their count: in every year, in some years or in no year. Take overdose. The 942 counties published in every year hold 83.8% of the residents of the 3,134 counties other than Connecticut's.

The 1,601 counties withheld in some years are 51.1% of counties and hold 12.1% of residents. The 591 counties withheld in every year hold 4.1% (Table 4).

Table 4. Counties whose overdose count WONDER publishes in every year hold 83.8% of residents, and counties withheld in every year hold 4.1% and are smaller, more rural and more deprived

The counties withheld in every year are small and rural. Their median county has 19,761 residents, against 134,390 in counties published every year. 75.5% (95% CI 71.2% to 79.9%) of their residents live in nonmetro counties, those with a Rural-Urban Continuum Code of 4 or higher, against 4.2% (95% CI 3.4% to 5.1%) in counties published every year. They are more deprived. The population-weighted mean Area Deprivation Index rank is 70.2 (95% CI 68.5 to 71.8) against 43.0 (95% CI 39.9 to 46.0), where a higher rank is more deprived.

By County Health Rankings' figures, residents of the counties withheld in every year are less often Hispanic or non-Hispanic Black and more often non-Hispanic white or American Indian or Alaska Native. 10.0% (95% CI 8.4% to 11.7%) are Hispanic against 21.0% (95% CI 18.2% to 24.0%), and 8.1% (95% CI 7.1% to 9.2%) are non-Hispanic Black against 13.4% (95% CI 12.1% to 14.7%). 77.2% (95% CI 75.3% to 79.1%) are non-Hispanic white against 55.3% (95% CI 52.1% to 58.5%), and 2.1% (95% CI 1.7% to 2.6%) are American Indian or Alaska Native against 1.2% (95% CI 1.0% to 1.3%).

The alcohol-induced and suicide views show differences between counties published every year and counties withheld in every year in the same direction on every measure. For alcohol-induced deaths the counties withheld in every year number 782 and hold 6.4% of residents, and for suicide they number 919 and hold 5.8%. The counties withheld in some years number 1,708 for alcohol-induced deaths and 1,470 for suicide.

These are properties of counties and of their residents, and not of the people who died (ecological inference). For a comparison of counties, the consequence is that published counts describe the larger, more urban and less deprived counties, with their higher shares of Hispanic and Black residents, and leave out the rural counties where deaths are few.

### Counties published every year have higher rates, except the smallest

Among the smallest counties the order reverses. A county's count is published when it is high, so the counties published in every year are the ones with high counts. Testing that needs a rate that does not depend on WONDER's rule. CDC's Mapping Injury, Overdose, and Violence panel supplies one for overdose and suicide. It gives modeled estimates of death rates for every county except Connecticut's, and where a count is under 10 a model that borrows from neighboring counties replaces it. A county's rate here is the mean of its annual rates for 2019 to 2023, kept when CDC publishes a stable rate in each year. This comparison uses the same years for WONDER counts, so a county counts as published every year when its count is published in each year from 2019 to 2023.

Table 5 compares the panel's rate in counties that WONDER publishes in every year with the rate in counties where it withholds the count at least once, within a size of county. The second group includes counties that WONDER never publishes.

Among counties of 25,000 to 50,000 residents the overdose rate is 52.3 (95% CI 47.3 to 57.8) deaths per hundred thousand residents where WONDER publishes every year and 22.3 (95% CI 21.5 to 23.2) where it withholds the count at least once. Among counties of 50,000 to 100,000 residents the rates are 35.8 (95% CI 33.5 to 38.5) and 17.5 (95% CI 16.5 to 18.5), and among counties of 100,000 to 250,000 residents they are 27.6 (95% CI 26.2 to 29.2) and 11.3 (95% CI 10.2 to 12.6).

For suicide the rates are 30.9 (95% CI 27.5 to 34.9) and 19.4 (95% CI 19.0 to 19.8) among counties of 25,000 to 50,000 residents, 21.6 (95% CI 20.7 to 22.5) and 17.0 (95% CI 16.6 to 17.4) among counties of 50,000 to 100,000 residents, and 17.0 (95% CI 16.4 to 17.5) and 12.4 (95% CI 11.3 to 13.7) among counties of 100,000 to 250,000 residents.

A group needs at least 10 counties to be plotted, and few counties of the middle sizes are published in every year, which is itself a result of the rule.

Table 5. Among counties of 25,000 to 50,000 residents, the panel's overdose rate is 52.3 where WONDER publishes every year and 22.3 where it withholds the count in at least one year, and the order reverses under 10,000 residents

The order reverses in the smallest counties. A county under 10,000 residents almost never reaches 10 deaths, so it is published in every year only if its count is zero in every year. The panel's rate for those counties is 0.0 for overdose and 0.0 for suicide, against 13.0 (95% CI 11.7 to 14.3) and 14.2 (95% CI 13.2 to 15.4) where the count is withheld at least once. The rule selects on the outcome in both directions. A county of middling size has to have a high count in every year to be complete, and a very small county has to have none.

Part of each gap is a direct rate set against a model. In counties published every year the panel's overdose rates are modeled in 1.1% of county-years and its suicide rates in 0.0%, against 70.2% and 72.5% in counties where WONDER withholds the count at least once. A modeled rate borrows from neighbors, and the rates of small counties are noisy before any suppression, so a map of them can mislead on its own.[3] The comparison shows the direction and rough size of the selection. It does not give the true rate of any withheld county.

### The bias of a pooled rate follows from the rule

The rule alone fixes the sign of the bias, and the sign depends on how many deaths a county expects. Suppose a county has a constant true rate and its deaths in a year are a Poisson count, the standard model for deaths in a small population.[4][2] WONDER publishes the year when the count is zero or at least 10. Table 6 plots, for counties that share an expected number of deaths a year, the rate pooled over their published years divided by their true rate.

The ratio is far below one when a county expects only a few deaths, because nearly every published county-year is then a zero. It reaches one near 4.2 expected deaths. It peaks at 1.8 at 5.4 expected deaths, where only 5.3% of county-years are published and nearly all of them have a high count. Above 14.2 expected deaths it is within 5% of one.

Table 6. A rate pooled over published county-years is 1.8 times the true rate at 5.4 expected deaths a year, below it under 4.2 and within 5% of it above 14.2

The rate of a complete county is exact for that county, so complete counties escape the bias in their own rates. They do not escape it as a group. Under the same model the counties published in every year are a selected set whose pooled rate is the same multiple of the true rate as the rate pooled over published county-years, so the set overstates the typical county of its size.

Table 7 compares the model with data. For each size of county it divides two pooled WONDER rates for 2019 to 2023 by the panel's population-weighted rate for the same years in all counties of that size with a stable panel rate. One is the rate pooled over published county-years, and the other is the rate pooled over counties published every year. A county that WONDER never publishes adds nothing to the pooled WONDER rate and stays in the panel rate.

The data follow the sign pattern of the model. In counties under 10,000 residents the rate pooled over published county-years is 0.18 (95% CI 0.00 to 0.42) times the panel's rate for suicide and 0.05 (95% CI 0.00 to 0.13) times for overdose. Among counties of 10,000 to 25,000 residents the ratio is 0.78 (95% CI 0.50 to 1.07) for suicide and 1.63 (95% CI 1.45 to 1.77) for overdose. Overdose is above one and suicide below it, although the suicide interval reaches one, which fits the model because a county of that size expects more overdose deaths than suicides.

Among counties of 25,000 to 50,000 residents the ratios are 1.51 (95% CI 1.47 to 1.55) and 1.63 (95% CI 1.58 to 1.68), and the overdose rate pooled over counties published every year is 2.09 (95% CI 1.92 to 2.28) times the panel's. Among counties of 50,000 to 100,000 residents the ratios are 1.09 (95% CI 1.07 to 1.10) and 1.18 (95% CI 1.16 to 1.20), with 1.30 (95% CI 1.26 to 1.36) for overdose pooled over counties published every year.

Among counties of 100,000 to 250,000 residents the ratios are 1.00 (95% CI 1.00 to 1.01) and 1.07 (95% CI 1.06 to 1.08), with 1.09 (95% CI 1.07 to 1.10) for the complete counties. In counties of 250,000 or more residents, where every count is published, the overdose ratio is 1.05 (95% CI 1.05 to 1.06). That is the difference between the two definitions of overdose, since WONDER counts drug poisoning of any intent and the panel counts unintentional and undetermined-intent poisonings.

Table 7. A suicide rate pooled over published county-years is 0.18 times the panel's rate in counties under 10,000 residents and 1.51 times in counties of 25,000 to 50,000 residents

The data match the sign pattern and not the sizes of the model, which assumes one rate for every county of a given expected count. The panel is itself a model, so these ratios compare WONDER's rule with a modeled rate and not with the true rate. The panel's rates for counties that WONDER never publishes are modeled in every year. Restricting both sides to counties with at least one published county-year, the ratios among counties of 25,000 to 50,000 residents are 1.34 (95% CI 1.31 to 1.37) for suicide and 1.38 (95% CI 1.35 to 1.41) for overdose, lower than the ratios above but still over one.

### WONDER names only large counties in its birth products

The rule above acts on cells. A second rule acts on whole counties in WONDER's birth products. Natality names a county only if it has 100,000 or more residents, and linked birth and infant death only if it has 250,000 or more, as the documentation of the two products states. WONDER pools every other county in a state into one row labeled Unidentified Counties, so smaller counties have no cell at all, and there is nothing to suppress or to recover.

Natality lists 580 county identifiers, 578 of them with births, and those counties hold 79.6% of births in 2018 to 2023. It pools 2,564 counties, counting as pooled the identifiers with no births, which are described below. Linked birth and infant death lists 263 identifiers, 261 with births, which hold 64.0% of births in 2018 to 2022, and pools 2,881 counties.

A county's size class in this chapter is not the same as being named. 606 counties have a mean population of 100,000 or more, against 578 named in natality, and 277 have 250,000 or more, against 261 named in linked birth and infant death.

Cell suppression then applies inside the named counties. A count of births or infant deaths above zero and below 10 is withheld, as Chapter 10.1, Gradients, slopes and variance (https://vishalsingh.org/zipcode/gradients-slopes-and-variance) shows for birthweight classes in natality. Chapter 2.1, Birthweight and preterm birth (https://vishalsingh.org/zipcode/birthweight-and-preterm-birth) and Chapter 2.2, Infant mortality (https://vishalsingh.org/zipcode/infant-mortality) work with those files. The mortality county files differ. They name every county and rely on the cell rule alone, so a missing county there is a blank inside a named county and not a pooled row.

The line between named and pooled moves slightly. Some identifiers are listed with no births of their own in any year. In natality 2 identifiers are such counties (Cape May County NJ and Portsmouth city VA), and in linked birth and infant death 2 are (Hinds County MS and Mahoning County OH). WONDER shows their births as missing or zero in every year because it has moved them into the state's pooled row. A zero for these counties is not a count. The book's loaders set them to missing, which is why the balanced natality panel has 578 counties and not 580.

### What the book does instead

A withheld cell is counted and left out of the numerator and the denominator. It is never replaced by a value, a midpoint or the remainder of a total, because a total minus the published cells pins a withheld cell exactly wherever only one cell is withheld. Every WONDER chapter reports how many cells were withheld and the largest share of events they could hold, as Chapter 2.1, Birthweight and preterm birth (https://vishalsingh.org/zipcode/birthweight-and-preterm-birth), Chapter 2.2, Infant mortality (https://vishalsingh.org/zipcode/infant-mortality) and Chapter 8.2, Overdose, alcohol and suicide (https://vishalsingh.org/zipcode/overdose-alcohol-and-suicide) do. At the public limit of 9 deaths each, the withheld cells could hold at most 13.4% of the deaths in the county files for overdose, 29.1% for alcohol-induced deaths and 28.4% for suicide.

County death rates in those chapters use complete counties. For overdose, the 942 complete counties hold 83.8% of residents. The alcohol-induced and suicide counts give 644 counties holding 77.9% and 745 counties holding 82.0%. A rate for a complete county is exact for all its years, and the set of complete counties is selected on the outcome, so a map or gradient of complete counties says so. A map of WONDER counts needs at least 20 pooled deaths in a county to draw it.

Comparisons across all counties use a modeled source such as the CDC panel, which has no stable overdose rate in some year for 428 counties holding 2.3% of residents. National series are summed from the state files, which have no withheld cell. All 357 state-years of each kind of death are published, and the number of withheld state-years is 0.

County Health Rankings pools several years into one rate, which brings in more counties than a single county-year does. It still leaves a county without a rate when the window holds fewer than 10 deaths. That removes 716 counties for suicide and 1,244 for overdose, with 4.0% of residents. It removes 1,767 counties for homicide, with 9.7%. For premature death the floor is 20 deaths, and 55 counties have no rate.

The book does not model the withheld counts. One study treats them as censored data and estimates county rates with spatial Bayesian models, and it finds that ignoring the suppression biases inference.[5] That approach produces a value for a cell that WONDER withholds, and the modeled sources this book uses are published by CDC itself.

Table 8. In every source the counties left without a value are a larger share of counties than of residents, from 55 counties without a premature death rate to 2,881 that WONDER linked birth and infant death does not name

### What these data cannot show

The comparisons of complete counties with the rest use panel rates that are modeled for the counties WONDER withholds. They show the direction of the selection and cannot give the true rate of a withheld county. The two sources also define overdose differently. The panel counts unintentional and undetermined-intent drug poisonings, and WONDER counts drug poisoning of any intent, so levels differ a little by definition.

The calculation of the bias treats a county's deaths as Poisson counts with a constant rate and independent years. Real counts vary more than that, and rates move over time, so the curve gives direction and rough size and does not correct any estimate in this book. The sizes of county and their boundaries are choices, and the figures move with them.

Withheld counts cannot be recovered. A withheld cell is known only to lie above zero and below the limit, and the bound printed here is a ceiling set by the public limit and the published cells, and it says nothing about any one cell. The group comparisons describe counties and their residents, and County Health Rankings' shares of residents come from Census population estimates with that source's categories. Connecticut's counties are left out of every county comparison because WONDER has no population for them in 2022 and 2023. North Carolina's 2023 overdose counts predate the state's amended death certificates and are low, which enters the 2018 to 2023 window of the overdose counts. A pull that left out WONDER's option to show zero values would turn county-years with no deaths into absent rows, and the below-one ratios in the smallest counties depend on keeping them. The chapter covers three kinds of death. Kinds of death with more or fewer deaths would move the sizes of county at which the rule bites, which the Poisson calculation implies and these data do not test.

## Tables

### Table 1. In every year from 2018 to 2024 WONDER withheld between 44.6% and 59.9% of county-year death counts, in county-years that hold between 8.6% and 17.4% of residents

Share of county-years whose death count CDC WONDER withholds, and share of residents living in a withheld county-year, by year, for drug overdose, alcohol-induced causes and suicide, all counties in the county files

| cause | measure | n | value | year |
| --- | --- | ---: | ---: | ---: |
| Drug overdose | counties | 1,541 | 49.05 | 2018 |
| Drug overdose | residents | 1,541 | 12.31 | 2018 |
| Drug overdose | counties | 1,586 | 50.48 | 2019 |
| Drug overdose | residents | 1,586 | 12.32 | 2019 |
| Drug overdose | counties | 1,504 | 47.87 | 2020 |
| Drug overdose | residents | 1,504 | 10.09 | 2020 |
| Drug overdose | counties | 1,400 | 44.56 | 2021 |
| Drug overdose | residents | 1,400 | 8.79 | 2021 |
| Drug overdose | counties | 1,413 | 44.97 | 2022 |
| Drug overdose | residents | 1,413 | 8.56 | 2022 |
| Drug overdose | counties | 1,426 | 45.39 | 2023 |
| Drug overdose | residents | 1,426 | 8.64 | 2023 |
| Drug overdose | counties | 1,535 | 48.85 | 2024 |
| Drug overdose | residents | 1,535 | 10.78 | 2024 |
| Alcohol-induced | counties | 1,863 | 59.29 | 2018 |
| Alcohol-induced | residents | 1,863 | 17.42 | 2018 |
| Alcohol-induced | counties | 1,881 | 59.87 | 2019 |
| Alcohol-induced | residents | 1,881 | 16.91 | 2019 |
| Alcohol-induced | counties | 1,805 | 57.45 | 2020 |
| Alcohol-induced | residents | 1,805 | 14.26 | 2020 |
| Alcohol-induced | counties | 1,762 | 56.08 | 2021 |
| Alcohol-induced | residents | 1,762 | 12.52 | 2021 |
| Alcohol-induced | counties | 1,801 | 57.32 | 2022 |
| Alcohol-induced | residents | 1,801 | 13.68 | 2022 |
| Alcohol-induced | counties | 1,797 | 57.19 | 2023 |
| Alcohol-induced | residents | 1,797 | 14.10 | 2023 |
| Alcohol-induced | counties | 1,820 | 57.92 | 2024 |
| Alcohol-induced | residents | 1,820 | 13.96 | 2024 |
| Suicide | counties | 1,798 | 57.22 | 2018 |
| Suicide | residents | 1,798 | 12.26 | 2018 |
| Suicide | counties | 1,820 | 57.92 | 2019 |
| Suicide | residents | 1,820 | 12.42 | 2019 |
| Suicide | counties | 1,832 | 58.31 | 2020 |
| Suicide | residents | 1,832 | 12.67 | 2020 |
| Suicide | counties | 1,801 | 57.32 | 2021 |
| Suicide | residents | 1,801 | 11.90 | 2021 |
| Suicide | counties | 1,792 | 57.03 | 2022 |
| Suicide | residents | 1,792 | 12.14 | 2022 |
| Suicide | counties | 1,792 | 57.03 | 2023 |
| Suicide | residents | 1,792 | 11.97 | 2023 |
| Suicide | counties | 1,781 | 56.68 | 2024 |
| Suicide | residents | 1,781 | 11.81 | 2024 |

Views: Share of county-years (measure = counties); Share of residents (measure = residents).

Note: These are full counts of the 3,142 counties in WONDER's county files, so the lines carry no sampling interval. A county-year is withheld when its count is above zero and below 10; a count of zero is published.

Note: Residents come from the county population that WONDER publishes with every cell, withheld or not. Connecticut's 8 counties have no WONDER population in 2022 to 2024 and are left out of the resident shares in those years.

Note: Rates are not plotted. Drug overdose is drug poisoning of any intent, so an overdose recorded as a suicide is in both the drug and the suicide counts. North Carolina's 2023 overdose counts in these files predate the state's amended death certificates and are low.

Source: CDC WONDER underlying cause of death (single race), county files, 2018-2024; full counts

Data: https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/figures/withheld_by_year.json

### Table 2. WONDER withholds 82.3% of overdose county-years in counties of 10,000 to 25,000 residents and 45.2% in smaller counties, where 54.7% are published as zero

Share of county-years withheld, published as zero and published with at least 10 deaths, by size of county (mean residents 2018 to 2023), drug overdose, alcohol-induced causes and suicide

| cause | counties | county_years | segment | share | size |
| --- | ---: | ---: | --- | ---: | --- |
| Drug overdose | 729 | 4,374 | Withheld | 45.18 | Under 10,000 |
| Drug overdose | 729 | 4,374 | Published, zero deaths | 54.66 | Under 10,000 |
| Drug overdose | 729 | 4,374 | Published, 10 or more deaths | 0.160 | Under 10,000 |
| Drug overdose | 799 | 4,794 | Withheld | 82.29 | 10,000 to 24,999 |
| Drug overdose | 799 | 4,794 | Published, zero deaths | 11.22 | 10,000 to 24,999 |
| Drug overdose | 799 | 4,794 | Published, 10 or more deaths | 6.49 | 10,000 to 24,999 |
| Drug overdose | 619 | 3,714 | Withheld | 64.38 | 25,000 to 49,999 |
| Drug overdose | 619 | 3,714 | Published, zero deaths | 1.72 | 25,000 to 49,999 |
| Drug overdose | 619 | 3,714 | Published, 10 or more deaths | 33.90 | 25,000 to 49,999 |
| Drug overdose | 389 | 2,334 | Withheld | 21.77 | 50,000 to 99,999 |
| Drug overdose | 389 | 2,334 | Published, zero deaths | 0.090 | 50,000 to 99,999 |
| Drug overdose | 389 | 2,334 | Published, 10 or more deaths | 78.15 | 50,000 to 99,999 |
| Drug overdose | 329 | 1,974 | Withheld | 2.53 | 100,000 to 249,999 |
| Drug overdose | 329 | 1,974 | Published, zero deaths | 0 | 100,000 to 249,999 |
| Drug overdose | 329 | 1,974 | Published, 10 or more deaths | 97.47 | 100,000 to 249,999 |
| Drug overdose | 277 | 1,662 | Withheld | 0 | 250,000 or more |
| Drug overdose | 277 | 1,662 | Published, zero deaths | 0 | 250,000 or more |
| Drug overdose | 277 | 1,662 | Published, 10 or more deaths | 100 | 250,000 or more |
| Alcohol-induced | 729 | 4,374 | Withheld | 54.94 | Under 10,000 |
| Alcohol-induced | 729 | 4,374 | Published, zero deaths | 44.79 | Under 10,000 |
| Alcohol-induced | 729 | 4,374 | Published, 10 or more deaths | 0.270 | Under 10,000 |
| Alcohol-induced | 799 | 4,794 | Withheld | 84.27 | 10,000 to 24,999 |
| Alcohol-induced | 799 | 4,794 | Published, zero deaths | 14.12 | 10,000 to 24,999 |
| Alcohol-induced | 799 | 4,794 | Published, 10 or more deaths | 1.61 | 10,000 to 24,999 |
| Alcohol-induced | 619 | 3,714 | Withheld | 84.17 | 25,000 to 49,999 |
| Alcohol-induced | 619 | 3,714 | Published, zero deaths | 1.99 | 25,000 to 49,999 |
| Alcohol-induced | 619 | 3,714 | Published, 10 or more deaths | 13.84 | 25,000 to 49,999 |
| Alcohol-induced | 389 | 2,334 | Withheld | 49.14 | 50,000 to 99,999 |
| Alcohol-induced | 389 | 2,334 | Published, zero deaths | 0.390 | 50,000 to 99,999 |
| Alcohol-induced | 389 | 2,334 | Published, 10 or more deaths | 50.47 | 50,000 to 99,999 |
| Alcohol-induced | 329 | 1,974 | Withheld | 9.73 | 100,000 to 249,999 |
| Alcohol-induced | 329 | 1,974 | Published, zero deaths | 0 | 100,000 to 249,999 |
| Alcohol-induced | 329 | 1,974 | Published, 10 or more deaths | 90.27 | 100,000 to 249,999 |
| Alcohol-induced | 277 | 1,662 | Withheld | 0.060 | 250,000 or more |
| Alcohol-induced | 277 | 1,662 | Published, zero deaths | 0 | 250,000 or more |
| Alcohol-induced | 277 | 1,662 | Published, 10 or more deaths | 99.94 | 250,000 or more |
| Suicide | 729 | 4,374 | Withheld | 61.34 | Under 10,000 |
| Suicide | 729 | 4,374 | Published, zero deaths | 38.45 | Under 10,000 |
| Suicide | 729 | 4,374 | Published, 10 or more deaths | 0.210 | Under 10,000 |
| Suicide | 799 | 4,794 | Withheld | 93.12 | 10,000 to 24,999 |
| Suicide | 799 | 4,794 | Published, zero deaths | 5.74 | 10,000 to 24,999 |
| Suicide | 799 | 4,794 | Published, 10 or more deaths | 1.15 | 10,000 to 24,999 |
| Suicide | 619 | 3,714 | Withheld | 80.67 | 25,000 to 49,999 |
| Suicide | 619 | 3,714 | Published, zero deaths | 0.590 | 25,000 to 49,999 |
| Suicide | 619 | 3,714 | Published, 10 or more deaths | 18.74 | 25,000 to 49,999 |
| Suicide | 389 | 2,334 | Withheld | 28.36 | 50,000 to 99,999 |
| Suicide | 389 | 2,334 | Published, zero deaths | 0.040 | 50,000 to 99,999 |
| Suicide | 389 | 2,334 | Published, 10 or more deaths | 71.59 | 50,000 to 99,999 |
| Suicide | 329 | 1,974 | Withheld | 1.52 | 100,000 to 249,999 |
| Suicide | 329 | 1,974 | Published, zero deaths | 0 | 100,000 to 249,999 |
| Suicide | 329 | 1,974 | Published, 10 or more deaths | 98.48 | 100,000 to 249,999 |
| Suicide | 277 | 1,662 | Withheld | 0 | 250,000 or more |
| Suicide | 277 | 1,662 | Published, zero deaths | 0 | 250,000 or more |
| Suicide | 277 | 1,662 | Published, 10 or more deaths | 100 | 250,000 or more |

Views: Drug overdose (cause = Drug overdose); Alcohol-induced (cause = Alcohol-induced); Suicide (cause = Suicide).

Note: Size is a county's mean WONDER population over 2018 to 2023. The boundaries are 10,000, 25,000, 50,000, 100,000 and 250,000 residents; the last two are the populations at which WONDER names a county in its birth products, although a county's class here and its being named do not coincide exactly.

Note: These are shares of all county-years in each class, including Connecticut's 8 counties, so the bars are full counts with no interval. A published zero is a real zero; a withheld count is missing.

Source: CDC WONDER underlying cause of death (single race), county files, 2018-2023; full counts

Data: https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/figures/withheld_by_size.json

### Table 3. WONDER withheld the overdose count in every year from 2018 to 2023 in 591 counties and in no year in 950

Number of years from 2018 to 2023 in which CDC WONDER withholds a county's death count, by county, for drug overdose, alcohol-induced causes and suicide

No inline rows: the values of Table 3 are in https://vishalsingh.org/zipcode/data/suppressed-counties-in-death-data/years_withheld_od.json.

Views: Drug overdose (every row); Alcohol-induced (every row); Suicide (every row).

Note: A count is withheld when it is above zero and below 10, and the key counts the years it is withheld out of the years from 2018 to 2023. A county with no withheld year can still have a count of zero in some years.

Note: The overdose view shades 950 counties at no withheld year: the 942 complete counties and Connecticut's 8, which have deaths but no population in 2022 and 2023.

Note: WONDER codes Valdez-Cordova AK as one county, so its counts are drawn on both successor areas, Chugach and Copper River; Kusilvak AK and Oglala Lakota SD are drawn under their current codes. Connecticut's 8 counties are drawn from their legacy codes, and WONDER has no population for them in 2022 and 2023. Puerto Rico is not drawn.

Source: CDC WONDER underlying cause of death (single race), county files, 2018-2023; full counts

Data: https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/figures/years_withheld_map.json

### Table 4. Counties whose overdose count WONDER publishes in every year hold 83.8% of residents, and counties withheld in every year hold 4.1% and are smaller, more rural and more deprived

Counties by how many years from 2018 to 2023 WONDER withholds the death count: share of counties and residents, median size, nonmetro residents, Area Deprivation Index rank and race and ethnicity of residents, other than Connecticut's counties

| cause | estimate | group | measure | n_units |
| --- | ---: | --- | --- | ---: |
| Drug overdose | 30.06 | Published every year | Share of counties (%) | 942 |
| Drug overdose | 83.81 | Published every year | Share of residents (%) | 942 |
| Drug overdose | 134.4 | Published every year | Median county residents (thousands) | 942 |
| Drug overdose | 4.16 | Published every year | Residents in nonmetro counties (%) | 942 |
| Drug overdose | 43.04 | Published every year | Mean Area Deprivation Index rank (1 least, 100 most deprived) | 942 |
| Drug overdose | 20.97 | Published every year | Residents who are Hispanic (%) | 942 |
| Drug overdose | 13.37 | Published every year | Residents who are non-Hispanic Black (%) | 942 |
| Drug overdose | 55.34 | Published every year | Residents who are non-Hispanic white (%) | 942 |
| Drug overdose | 1.18 | Published every year | Residents who are American Indian or Alaska Native (%) | 942 |
| Drug overdose | 51.08 | Withheld in some years | Share of counties (%) | 1,601 |
| Drug overdose | 12.09 | Withheld in some years | Share of residents (%) | 1,601 |
| Drug overdose | 16.08 | Withheld in some years | Median county residents (thousands) | 1,601 |
| Drug overdose | 61.06 | Withheld in some years | Residents in nonmetro counties (%) | 1,601 |
| Drug overdose | 67.71 | Withheld in some years | Mean Area Deprivation Index rank (1 least, 100 most deprived) | 1,601 |
| Drug overdose | 9.66 | Withheld in some years | Residents who are Hispanic (%) | 1,601 |
| Drug overdose | 9.38 | Withheld in some years | Residents who are non-Hispanic Black (%) | 1,601 |
| Drug overdose | 75.91 | Withheld in some years | Residents who are non-Hispanic white (%) | 1,601 |
| Drug overdose | 2.12 | Withheld in some years | Residents who are American Indian or Alaska Native (%) | 1,601 |
| Drug overdose | 18.86 | Withheld in every year | Share of counties (%) | 591 |
| Drug overdose | 4.10 | Withheld in every year | Share of residents (%) | 591 |
| Drug overdose | 19.76 | Withheld in every year | Median county residents (thousands) | 591 |
| Drug overdose | 75.52 | Withheld in every year | Residents in nonmetro counties (%) | 591 |
| Drug overdose | 70.17 | Withheld in every year | Mean Area Deprivation Index rank (1 least, 100 most deprived) | 591 |
| Drug overdose | 10.00 | Withheld in every year | Residents who are Hispanic (%) | 591 |
| Drug overdose | 8.11 | Withheld in every year | Residents who are non-Hispanic Black (%) | 591 |
| Drug overdose | 77.24 | Withheld in every year | Residents who are non-Hispanic white (%) | 591 |
| Drug overdose | 2.13 | Withheld in every year | Residents who are American Indian or Alaska Native (%) | 591 |
| Alcohol-induced | 20.55 | Published every year | Share of counties (%) | 644 |
| Alcohol-induced | 77.87 | Published every year | Share of residents (%) | 644 |
| Alcohol-induced | 207.1 | Published every year | Median county residents (thousands) | 644 |
| Alcohol-induced | 2.07 | Published every year | Residents in nonmetro counties (%) | 644 |
| Alcohol-induced | 41.45 | Published every year | Mean Area Deprivation Index rank (1 least, 100 most deprived) | 644 |
| Alcohol-induced | 22.08 | Published every year | Residents who are Hispanic (%) | 644 |
| Alcohol-induced | 13.34 | Published every year | Residents who are non-Hispanic Black (%) | 644 |
| Alcohol-induced | 53.77 | Published every year | Residents who are non-Hispanic white (%) | 644 |
| Alcohol-induced | 1.26 | Published every year | Residents who are American Indian or Alaska Native (%) | 644 |
| Alcohol-induced | 54.50 | Withheld in some years | Share of counties (%) | 1,708 |
| Alcohol-induced | 15.76 | Withheld in some years | Share of residents (%) | 1,708 |
| Alcohol-induced | 15.46 | Withheld in some years | Median county residents (thousands) | 1,708 |
| Alcohol-induced | 50.04 | Withheld in some years | Residents in nonmetro counties (%) | 1,708 |
| Alcohol-induced | 65.48 | Withheld in some years | Mean Area Deprivation Index rank (1 least, 100 most deprived) | 1,708 |
| Alcohol-induced | 8.85 | Withheld in some years | Residents who are Hispanic (%) | 1,708 |
| Alcohol-induced | 10.62 | Withheld in some years | Residents who are non-Hispanic Black (%) | 1,708 |
| Alcohol-induced | 75.66 | Withheld in some years | Residents who are non-Hispanic white (%) | 1,708 |
| Alcohol-induced | 1.54 | Withheld in some years | Residents who are American Indian or Alaska Native (%) | 1,708 |
| Alcohol-induced | 24.95 | Withheld in every year | Share of counties (%) | 782 |
| Alcohol-induced | 6.37 | Withheld in every year | Share of residents (%) | 782 |
| Alcohol-induced | 23.70 | Withheld in every year | Median county residents (thousands) | 782 |
| Alcohol-induced | 70.16 | Withheld in every year | Residents in nonmetro counties (%) | 782 |
| Alcohol-induced | 71.23 | Withheld in every year | Mean Area Deprivation Index rank (1 least, 100 most deprived) | 782 |
| Alcohol-induced | 8.84 | Withheld in every year | Residents who are Hispanic (%) | 782 |
| Alcohol-induced | 9.60 | Withheld in every year | Residents who are non-Hispanic Black (%) | 782 |
| Alcohol-induced | 77.47 | Withheld in every year | Residents who are non-Hispanic white (%) | 782 |
| Alcohol-induced | 1.62 | Withheld in every year | Residents who are American Indian or Alaska Native (%) | 782 |
| Suicide | 23.77 | Published every year | Share of counties (%) | 745 |
| Suicide | 81.97 | Published every year | Share of residents (%) | 745 |
| Suicide | 176.5 | Published every year | Median county residents (thousands) | 745 |
| Suicide | 2.89 | Published every year | Residents in nonmetro counties (%) | 745 |
| Suicide | 42.37 | Published every year | Mean Area Deprivation Index rank (1 least, 100 most deprived) | 745 |
| Suicide | 21.38 | Published every year | Residents who are Hispanic (%) | 745 |
| Suicide | 13.36 | Published every year | Residents who are non-Hispanic Black (%) | 745 |
| Suicide | 54.77 | Published every year | Residents who are non-Hispanic white (%) | 745 |
| Suicide | 1.22 | Published every year | Residents who are American Indian or Alaska Native (%) | 745 |
| Suicide | 46.90 | Withheld in some years | Share of counties (%) | 1,470 |
| Suicide | 12.23 | Withheld in some years | Share of residents (%) | 1,470 |
| Suicide | 16.53 | Withheld in some years | Median county residents (thousands) | 1,470 |
| Suicide | 60.19 | Withheld in some years | Residents in nonmetro counties (%) | 1,470 |
| Suicide | 67.54 | Withheld in some years | Mean Area Deprivation Index rank (1 least, 100 most deprived) | 1,470 |
| Suicide | 9.02 | Withheld in some years | Residents who are Hispanic (%) | 1,470 |
| Suicide | 9.58 | Withheld in some years | Residents who are non-Hispanic Black (%) | 1,470 |
| Suicide | 76.38 | Withheld in some years | Residents who are non-Hispanic white (%) | 1,470 |
| Suicide | 1.89 | Withheld in some years | Residents who are American Indian or Alaska Native (%) | 1,470 |
| Suicide | 29.32 | Withheld in every year | Share of counties (%) | 919 |
| Suicide | 5.80 | Withheld in every year | Share of residents (%) | 919 |
| Suicide | 18.89 | Withheld in every year | Median county residents (thousands) | 919 |
| Suicide | 73.05 | Withheld in every year | Residents in nonmetro counties (%) | 919 |
| Suicide | 71.44 | Withheld in every year | Mean Area Deprivation Index rank (1 least, 100 most deprived) | 919 |
| Suicide | 9.12 | Withheld in every year | Residents who are Hispanic (%) | 919 |
| Suicide | 9.38 | Withheld in every year | Residents who are non-Hispanic Black (%) | 919 |
| Suicide | 77.41 | Withheld in every year | Residents who are non-Hispanic white (%) | 919 |
| Suicide | 1.72 | Withheld in every year | Residents who are American Indian or Alaska Native (%) | 919 |

Views: Drug overdose (cause = Drug overdose); Alcohol-induced (cause = Alcohol-induced); Suicide (cause = Suicide).

Note: Shares of counties and residents and the median are full counts of the 3,134 counties other than Connecticut's 8 and carry no interval. Residents are the mean WONDER population over 2018 to 2023. The other panels are population-weighted means across counties, so an interval describes the spread of county values.

Note: Deprivation is the mean of the Area Deprivation Index national ranks of a county's tracts, weighted by 2019-2023 tract population, and the index understates deprivation in high-cost counties. Nonmetro counties have a Rural-Urban Continuum Code of 4 or higher.

Note: Race and ethnicity shares come from County Health Rankings 2024 (Census Population Estimates) and use that source's categories: Hispanic of any race, and non-Hispanic Black and white. They describe a county's residents, not the people who died.

Source: CDC WONDER underlying cause of death, county files, 2018-2023, Area Deprivation Index 2023, Rural-Urban Continuum Codes 2023 and County Health Rankings 2024; full counts and population-weighted means

Data: https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/figures/who_lives_in_withheld.json

### Table 5. Among counties of 25,000 to 50,000 residents, the panel's overdose rate is 52.3 where WONDER publishes every year and 22.3 where it withholds the count in at least one year, and the order reverses under 10,000 residents

CDC modeled death rate per 100,000 residents, mean of annual rates for 2019 to 2023, in counties whose WONDER count is published in each year 2019 to 2023 and in counties where it is withheld in at least one of those years, including counties never published, by size of county, population-weighted

| cause | estimate | n_units | size | status |
| --- | ---: | ---: | --- | --- |
| Drug overdose | 0 | 128 | Under 10,000 | Published in every year |
| Drug overdose | 12.97 | 326 | Under 10,000 | Withheld in at least one year |
| Drug overdose | 78.76 | 11 | 10,000 to 24,999 | Published in every year |
| Drug overdose | 20.98 | 662 | 10,000 to 24,999 | Withheld in at least one year |
| Drug overdose | 52.28 | 66 | 25,000 to 49,999 | Published in every year |
| Drug overdose | 22.33 | 536 | 25,000 to 49,999 | Withheld in at least one year |
| Drug overdose | 35.83 | 227 | 50,000 to 99,999 | Published in every year |
| Drug overdose | 17.54 | 160 | 50,000 to 99,999 | Withheld in at least one year |
| Drug overdose | 27.63 | 306 | 100,000 to 249,999 | Published in every year |
| Drug overdose | 11.26 | 19 | 100,000 to 249,999 | Withheld in at least one year |
| Drug overdose | 28.41 | 273 | 250,000 or more | Published in every year |
| Suicide | 0 | 41 | Under 10,000 | Published in every year |
| Suicide | 14.23 | 365 | Under 10,000 | Withheld in at least one year |
| Suicide | 18.27 | 406 | 10,000 to 24,999 | Withheld in at least one year |
| Suicide | 30.91 | 12 | 25,000 to 49,999 | Published in every year |
| Suicide | 19.41 | 472 | 25,000 to 49,999 | Withheld in at least one year |
| Suicide | 21.57 | 145 | 50,000 to 99,999 | Published in every year |
| Suicide | 17.03 | 234 | 50,000 to 99,999 | Withheld in at least one year |
| Suicide | 17.01 | 304 | 100,000 to 249,999 | Published in every year |
| Suicide | 12.40 | 21 | 100,000 to 249,999 | Withheld in at least one year |
| Suicide | 12.54 | 273 | 250,000 or more | Published in every year |

Views: Drug overdose (cause = Drug overdose); Suicide (cause = Suicide).

Note: The comparison uses CDC's injury and violence panel because its rates do not depend on WONDER's publication rule. They are modeled estimates, built partly from neighboring counties where deaths are few. Where WONDER withholds a county-year, 70.2% of the panel's overdose county-years are modeled, against 1.1% in counties published every year, so part of each gap is a direct rate against a model.

Note: A group of fewer than 10 counties is not plotted, and an interval is absent where every county has a rate of zero. Overdose in the panel is unintentional or undetermined-intent drug overdose. Connecticut is not in the panel. WONDER counts and panel rates both cover 2019 to 2023, and the group withheld in at least one year includes counties that WONDER never publishes in those years.

Note: In the smallest counties, counties published every year are the counties with no deaths in any year, because a count of 10 is almost out of reach there.

Source: CDC WONDER underlying cause of death, county files, 2019-2023, and CDC Mapping Injury, Overdose, and Violence county file, 2019-2023; crude rates, modeled estimates, population-weighted

Data: https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/figures/panel_rate_by_status.json

### Table 6. A rate pooled over published county-years is 1.8 times the true rate at 5.4 expected deaths a year, below it under 4.2 and within 5% of it above 14.2

Expected pooled rate over the county-years WONDER publishes (counts of zero and of at least 10) divided by the true rate, against the expected number of deaths in a county-year, Poisson counts and a constant rate

| lam | published | ratio |
| ---: | ---: | ---: |
| 0.100 | 90.48 | 0 |
| 0.200 | 81.87 | 0 |
| 0.300 | 74.08 | 0 |
| 0.400 | 67.03 | 0 |
| 0.500 | 60.65 | 0 |
| 0.600 | 54.88 | 0 |
| 0.700 | 49.66 | 0 |
| 0.800 | 44.93 | 0 |
| 0.900 | 40.66 | 0 |
| 1 | 36.79 | 0 |
| 1.10 | 33.29 | 0 |
| 1.20 | 30.12 | 0 |
| 1.30 | 27.25 | 0 |
| 1.40 | 24.66 | 0.000 |
| 1.50 | 22.31 | 0.000 |
| 1.60 | 20.19 | 0.000 |
| 1.70 | 18.27 | 0.000 |
| 1.80 | 16.53 | 0.001 |
| 1.90 | 14.96 | 0.001 |
| 2 | 13.54 | 0.002 |
| 2.10 | 12.25 | 0.003 |
| 2.20 | 11.09 | 0.004 |
| 2.30 | 10.04 | 0.006 |
| 2.40 | 9.09 | 0.009 |
| 2.50 | 8.24 | 0.014 |
| 2.60 | 7.46 | 0.020 |
| 2.70 | 6.77 | 0.028 |
| 2.80 | 6.15 | 0.040 |
| 2.90 | 5.59 | 0.055 |
| 3 | 5.09 | 0.075 |
| 3.10 | 4.64 | 0.101 |
| 3.20 | 4.25 | 0.134 |
| 3.30 | 3.91 | 0.177 |
| 3.40 | 3.61 | 0.230 |
| 3.50 | 3.35 | 0.295 |
| 3.60 | 3.13 | 0.372 |
| 3.70 | 2.96 | 0.463 |
| 3.80 | 2.82 | 0.567 |
| 3.90 | 2.71 | 0.683 |
| 4 | 2.65 | 0.808 |
| 4.10 | 2.61 | 0.938 |
| 4.20 | 2.61 | 1.07 |
| 4.30 | 2.65 | 1.20 |
| 4.40 | 2.72 | 1.32 |
| 4.50 | 2.82 | 1.43 |
| 4.60 | 2.96 | 1.52 |
| 4.70 | 3.13 | 1.61 |
| 4.80 | 3.34 | 1.67 |
| 4.90 | 3.58 | 1.73 |
| 5 | 3.86 | 1.77 |
| 5.10 | 4.17 | 1.79 |
| 5.20 | 4.52 | 1.81 |
| 5.30 | 4.91 | 1.82 |
| 5.40 | 5.33 | 1.83 |
| 5.50 | 5.79 | 1.83 |
| 5.60 | 6.28 | 1.82 |
| 5.70 | 6.82 | 1.81 |
| 5.80 | 7.39 | 1.80 |
| 5.90 | 8.00 | 1.78 |
| 6 | 8.64 | 1.77 |
| 6.10 | 9.32 | 1.75 |
| 6.20 | 10.04 | 1.73 |
| 6.30 | 10.80 | 1.72 |
| 6.40 | 11.59 | 1.70 |
| 6.50 | 12.41 | 1.68 |
| 6.60 | 13.27 | 1.66 |
| 6.70 | 14.17 | 1.64 |
| 6.80 | 15.09 | 1.62 |
| 6.90 | 16.05 | 1.61 |
| 7 | 17.04 | 1.59 |
| 7.10 | 18.06 | 1.57 |
| 7.20 | 19.11 | 1.56 |
| 7.30 | 20.19 | 1.54 |
| 7.40 | 21.29 | 1.52 |
| 7.50 | 22.41 | 1.51 |
| 7.60 | 23.57 | 1.49 |
| 7.70 | 24.74 | 1.48 |
| 7.80 | 25.93 | 1.46 |
| 7.90 | 27.14 | 1.45 |
| 8 | 28.37 | 1.44 |
| 8.10 | 29.62 | 1.42 |
| 8.20 | 30.88 | 1.41 |
| 8.30 | 32.15 | 1.40 |
| 8.40 | 33.43 | 1.39 |
| 8.50 | 34.72 | 1.37 |
| 8.60 | 36.02 | 1.36 |
| 8.70 | 37.33 | 1.35 |
| 8.80 | 38.64 | 1.34 |
| 8.90 | 39.96 | 1.33 |
| 9 | 41.27 | 1.32 |
| 9.10 | 42.59 | 1.31 |
| 9.20 | 43.90 | 1.30 |
| 9.30 | 45.22 | 1.29 |
| 9.40 | 46.52 | 1.28 |
| 9.50 | 47.83 | 1.27 |
| 9.60 | 49.12 | 1.26 |
| 9.70 | 50.41 | 1.25 |
| 9.80 | 51.69 | 1.25 |
| 9.90 | 52.95 | 1.24 |
| 10 | 54.21 | 1.23 |
| 10.10 | 55.46 | 1.22 |
| 10.20 | 56.69 | 1.22 |
| 10.30 | 57.90 | 1.21 |
| 10.40 | 59.10 | 1.20 |
| 10.50 | 60.29 | 1.20 |
| 10.60 | 61.46 | 1.19 |
| 10.70 | 62.61 | 1.18 |
| 10.80 | 63.74 | 1.18 |
| 10.90 | 64.86 | 1.17 |
| 11 | 65.95 | 1.16 |
| 11.10 | 67.03 | 1.16 |
| 11.20 | 68.08 | 1.15 |
| 11.30 | 69.11 | 1.15 |
| 11.40 | 70.13 | 1.14 |
| 11.50 | 71.12 | 1.14 |
| 11.60 | 72.09 | 1.13 |
| 11.70 | 73.04 | 1.13 |
| 11.80 | 73.97 | 1.12 |
| 11.90 | 74.88 | 1.12 |
| 12 | 75.76 | 1.12 |
| 12.10 | 76.62 | 1.11 |
| 12.20 | 77.47 | 1.11 |
| 12.30 | 78.28 | 1.10 |
| 12.40 | 79.08 | 1.10 |
| 12.50 | 79.86 | 1.10 |
| 12.60 | 80.61 | 1.09 |
| 12.70 | 81.34 | 1.09 |
| 12.80 | 82.06 | 1.09 |
| 12.90 | 82.75 | 1.08 |
| 13 | 83.42 | 1.08 |
| 13.10 | 84.07 | 1.08 |
| 13.20 | 84.70 | 1.07 |
| 13.30 | 85.31 | 1.07 |
| 13.40 | 85.90 | 1.07 |
| 13.50 | 86.47 | 1.07 |
| 13.60 | 87.03 | 1.06 |
| 13.70 | 87.56 | 1.06 |
| 13.80 | 88.08 | 1.06 |
| 13.90 | 88.58 | 1.06 |
| 14 | 89.06 | 1.05 |
| 14.10 | 89.53 | 1.05 |
| 14.20 | 89.97 | 1.05 |
| 14.30 | 90.41 | 1.05 |
| 14.40 | 90.82 | 1.04 |
| 14.50 | 91.22 | 1.04 |
| 14.60 | 91.61 | 1.04 |
| 14.70 | 91.98 | 1.04 |
| 14.80 | 92.34 | 1.04 |
| 14.90 | 92.68 | 1.04 |
| 15 | 93.02 | 1.03 |
| 15.10 | 93.33 | 1.03 |
| 15.20 | 93.64 | 1.03 |
| 15.30 | 93.93 | 1.03 |
| 15.40 | 94.21 | 1.03 |
| 15.50 | 94.48 | 1.03 |
| 15.60 | 94.74 | 1.03 |
| 15.70 | 94.99 | 1.03 |
| 15.80 | 95.22 | 1.02 |
| 15.90 | 95.45 | 1.02 |
| 16 | 95.67 | 1.02 |
| 16.10 | 95.88 | 1.02 |
| 16.20 | 96.08 | 1.02 |
| 16.30 | 96.27 | 1.02 |
| 16.40 | 96.45 | 1.02 |
| 16.50 | 96.63 | 1.02 |
| 16.60 | 96.79 | 1.02 |
| 16.70 | 96.95 | 1.02 |
| 16.80 | 97.10 | 1.02 |
| 16.90 | 97.25 | 1.01 |
| 17 | 97.39 | 1.01 |
| 17.10 | 97.52 | 1.01 |
| 17.20 | 97.65 | 1.01 |
| 17.30 | 97.77 | 1.01 |
| 17.40 | 97.88 | 1.01 |
| 17.50 | 97.99 | 1.01 |
| 17.60 | 98.09 | 1.01 |
| 17.70 | 98.19 | 1.01 |
| 17.80 | 98.29 | 1.01 |
| 17.90 | 98.38 | 1.01 |
| 18 | 98.46 | 1.01 |
| 18.10 | 98.54 | 1.01 |
| 18.20 | 98.62 | 1.01 |
| 18.30 | 98.69 | 1.01 |
| 18.40 | 98.76 | 1.01 |
| 18.50 | 98.83 | 1.01 |
| 18.60 | 98.89 | 1.01 |
| 18.70 | 98.95 | 1.01 |
| 18.80 | 99.01 | 1.01 |
| 18.90 | 99.06 | 1.01 |
| 19 | 99.11 | 1.00 |
| 19.10 | 99.16 | 1.00 |
| 19.20 | 99.21 | 1.00 |
| 19.30 | 99.25 | 1.00 |
| 19.40 | 99.29 | 1.00 |
| 19.50 | 99.33 | 1.00 |
| 19.60 | 99.37 | 1.00 |
| 19.70 | 99.41 | 1.00 |
| 19.80 | 99.44 | 1.00 |
| 19.90 | 99.47 | 1.00 |
| 20 | 99.50 | 1.00 |
| 20.10 | 99.53 | 1.00 |
| 20.20 | 99.56 | 1.00 |
| 20.30 | 99.58 | 1.00 |
| 20.40 | 99.61 | 1.00 |
| 20.50 | 99.63 | 1.00 |
| 20.60 | 99.65 | 1.00 |
| 20.70 | 99.67 | 1.00 |
| 20.80 | 99.69 | 1.00 |
| 20.90 | 99.71 | 1.00 |
| 21 | 99.72 | 1.00 |
| 21.10 | 99.74 | 1.00 |
| 21.20 | 99.75 | 1.00 |
| 21.30 | 99.77 | 1.00 |
| 21.40 | 99.78 | 1.00 |
| 21.50 | 99.80 | 1.00 |
| 21.60 | 99.81 | 1.00 |
| 21.70 | 99.82 | 1.00 |
| 21.80 | 99.83 | 1.00 |
| 21.90 | 99.84 | 1.00 |
| 22 | 99.85 | 1.00 |
| 22.10 | 99.86 | 1.00 |
| 22.20 | 99.87 | 1.00 |
| 22.30 | 99.88 | 1.00 |
| 22.40 | 99.88 | 1.00 |
| 22.50 | 99.89 | 1.00 |
| 22.60 | 99.90 | 1.00 |
| 22.70 | 99.90 | 1.00 |
| 22.80 | 99.91 | 1.00 |
| 22.90 | 99.91 | 1.00 |
| 23 | 99.92 | 1.00 |
| 23.10 | 99.92 | 1.00 |
| 23.20 | 99.93 | 1.00 |
| 23.30 | 99.93 | 1.00 |
| 23.40 | 99.94 | 1.00 |
| 23.50 | 99.94 | 1.00 |
| 23.60 | 99.94 | 1.00 |
| 23.70 | 99.95 | 1.00 |
| 23.80 | 99.95 | 1.00 |
| 23.90 | 99.95 | 1.00 |
| 24 | 99.96 | 1.00 |
| 24.10 | 99.96 | 1.00 |
| 24.20 | 99.96 | 1.00 |
| 24.30 | 99.97 | 1.00 |
| 24.40 | 99.97 | 1.00 |
| 24.50 | 99.97 | 1.00 |
| 24.60 | 99.97 | 1.00 |
| 24.70 | 99.97 | 1.00 |
| 24.80 | 99.97 | 1.00 |
| 24.90 | 99.98 | 1.00 |
| 25 | 99.98 | 1.00 |
| 25.10 | 99.98 | 1.00 |
| 25.20 | 99.98 | 1.00 |
| 25.30 | 99.98 | 1.00 |
| 25.40 | 99.98 | 1.00 |
| 25.50 | 99.98 | 1.00 |
| 25.60 | 99.98 | 1.00 |
| 25.70 | 99.99 | 1.00 |
| 25.80 | 99.99 | 1.00 |
| 25.90 | 99.99 | 1.00 |
| 26 | 99.99 | 1.00 |
| 26.10 | 99.99 | 1.00 |
| 26.20 | 99.99 | 1.00 |
| 26.30 | 99.99 | 1.00 |
| 26.40 | 99.99 | 1.00 |
| 26.50 | 99.99 | 1.00 |
| 26.60 | 99.99 | 1.00 |
| 26.70 | 99.99 | 1 |
| 26.80 | 99.99 | 1 |
| 26.90 | 99.99 | 1 |
| 27 | 99.99 | 1 |
| 27.10 | 100.00 | 1 |
| 27.20 | 100.00 | 1 |
| 27.30 | 100.00 | 1 |
| 27.40 | 100.00 | 1 |
| 27.50 | 100.00 | 1 |
| 27.60 | 100.00 | 1 |
| 27.70 | 100.00 | 1 |
| 27.80 | 100.00 | 1 |
| 27.90 | 100.00 | 1 |
| 28 | 100.00 | 1 |
| 28.10 | 100.00 | 1 |
| 28.20 | 100.00 | 1 |
| 28.30 | 100.00 | 1 |
| 28.40 | 100.00 | 1 |
| 28.50 | 100.00 | 1 |
| 28.60 | 100.00 | 1 |
| 28.70 | 100.00 | 1 |
| 28.80 | 100.00 | 1 |
| 28.90 | 100.00 | 1 |
| 29 | 100.00 | 1 |
| 29.10 | 100.00 | 1 |
| 29.20 | 100.00 | 1 |
| 29.30 | 100.00 | 1 |
| 29.40 | 100.00 | 1 |
| 29.50 | 100.00 | 1 |
| 29.60 | 100.00 | 1 |
| 29.70 | 100.00 | 1 |
| 29.80 | 100.00 | 1 |
| 29.90 | 100.00 | 1 |
| 30 | 100.00 | 1 |
| 30.10 | 100.00 | 1 |
| 30.20 | 100.00 | 1 |
| 30.30 | 100.00 | 1 |
| 30.40 | 100.00 | 1 |
| 30.50 | 100 | 1 |
| 30.60 | 100 | 1 |
| 30.70 | 100 | 1 |
| 30.80 | 100 | 1 |
| 30.90 | 100 | 1 |
| 31 | 100 | 1 |
| 31.10 | 100 | 1 |
| 31.20 | 100 | 1 |
| 31.30 | 100 | 1 |
| 31.40 | 100 | 1 |
| 31.50 | 100 | 1 |
| 31.60 | 100 | 1 |
| 31.70 | 100 | 1 |
| 31.80 | 100 | 1 |
| 31.90 | 100 | 1 |
| 32 | 100 | 1 |
| 32.10 | 100 | 1 |
| 32.20 | 100 | 1 |
| 32.30 | 100 | 1 |
| 32.40 | 100 | 1 |
| 32.50 | 100 | 1 |
| 32.60 | 100 | 1 |
| 32.70 | 100 | 1 |
| 32.80 | 100 | 1 |
| 32.90 | 100 | 1 |
| 33 | 100 | 1 |
| 33.10 | 100 | 1 |
| 33.20 | 100 | 1 |
| 33.30 | 100 | 1 |
| 33.40 | 100 | 1 |
| 33.50 | 100 | 1 |
| 33.60 | 100 | 1 |
| 33.70 | 100 | 1 |
| 33.80 | 100 | 1 |
| 33.90 | 100 | 1 |
| 34 | 100 | 1 |
| 34.10 | 100 | 1 |
| 34.20 | 100 | 1 |
| 34.30 | 100 | 1 |
| 34.40 | 100 | 1 |
| 34.50 | 100 | 1 |
| 34.60 | 100 | 1 |
| 34.70 | 100 | 1 |
| 34.80 | 100 | 1 |
| 34.90 | 100 | 1 |
| 35 | 100 | 1 |
| 35.10 | 100 | 1 |
| 35.20 | 100 | 1 |
| 35.30 | 100 | 1 |
| 35.40 | 100 | 1 |
| 35.50 | 100 | 1 |
| 35.60 | 100 | 1 |
| 35.70 | 100 | 1 |
| 35.80 | 100 | 1 |
| 35.90 | 100 | 1 |
| 36 | 100 | 1 |
| 36.10 | 100 | 1 |
| 36.20 | 100 | 1 |
| 36.30 | 100 | 1 |
| 36.40 | 100 | 1 |
| 36.50 | 100 | 1 |
| 36.60 | 100 | 1 |
| 36.70 | 100 | 1 |
| 36.80 | 100 | 1 |
| 36.90 | 100 | 1 |
| 37 | 100 | 1 |
| 37.10 | 100 | 1 |
| 37.20 | 100 | 1 |
| 37.30 | 100 | 1 |
| 37.40 | 100 | 1 |
| 37.50 | 100 | 1 |
| 37.60 | 100 | 1 |
| 37.70 | 100 | 1 |
| 37.80 | 100 | 1 |
| 37.90 | 100 | 1 |
| 38 | 100 | 1 |
| 38.10 | 100 | 1 |
| 38.20 | 100 | 1 |
| 38.30 | 100 | 1 |
| 38.40 | 100 | 1 |
| 38.50 | 100 | 1 |
| 38.60 | 100 | 1 |
| 38.70 | 100 | 1 |
| 38.80 | 100 | 1 |
| 38.90 | 100 | 1 |
| 39 | 100 | 1 |
| 39.10 | 100 | 1 |
| 39.20 | 100 | 1 |
| 39.30 | 100 | 1 |
| 39.40 | 100 | 1 |
| 39.50 | 100 | 1 |
| 39.60 | 100 | 1 |
| 39.70 | 100 | 1 |
| 39.80 | 100 | 1 |
| 39.90 | 100 | 1 |
| 40 | 100 | 1 |

Views: Bias of the pooled rate (every row); Share of county-years published (every row).

Note: A county-year with a given expected number of deaths is published when its Poisson count is zero or at least 10. The ratio is the average death count in published county-years divided by the average count in all county-years, which is the ratio of the pooled rate to the true rate when counties share a population.

Note: The model assumes a constant rate in each county, independent years and Poisson counts. Real counts vary more than Poisson counts, so the curve gives direction and rough size, and it is not used to correct any estimate in this book.

Source: Calculation from the publication rule of the CDC WONDER county files, 2018-2024, applied to Poisson counts; full counts of the model, no sampling error, equal weight for every county-year

Data: https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/figures/bias_curve.json

### Table 7. A suicide rate pooled over published county-years is 0.18 times the panel's rate in counties under 10,000 residents and 1.51 times in counties of 25,000 to 50,000 residents

Death rate pooled over the county-years CDC WONDER publishes, 2019 to 2023, divided by the CDC panel's population-weighted modeled rate for 2019 to 2023 in all counties of each size with a stable panel rate, suicide and drug overdose

| cause | conf_high | conf_low | estimate | n_units | series | size |
| --- | ---: | ---: | ---: | ---: | --- | --- |
| Suicide | 0.419 | 0 | 0.182 | 406 | Pooled over published county-years | Under 10,000 |
| Suicide | n/a | n/a | 0 | 41 | Pooled over counties published every year | Under 10,000 |
| Suicide | 1.07 | 0.496 | 0.781 | 406 | Pooled over published county-years | 10,000 to 24,999 |
| Suicide | 1.55 | 1.47 | 1.51 | 484 | Pooled over published county-years | 25,000 to 49,999 |
| Suicide | 1.76 | 1.39 | 1.56 | 12 | Pooled over counties published every year | 25,000 to 49,999 |
| Suicide | 1.10 | 1.07 | 1.08 | 379 | Pooled over published county-years | 50,000 to 99,999 |
| Suicide | 1.18 | 1.11 | 1.14 | 145 | Pooled over counties published every year | 50,000 to 99,999 |
| Suicide | 1.01 | 1.00 | 1.00 | 325 | Pooled over published county-years | 100,000 to 249,999 |
| Suicide | 1.02 | 1.01 | 1.01 | 304 | Pooled over counties published every year | 100,000 to 249,999 |
| Suicide | 1.00 | 1.00 | 1.00 | 273 | Pooled over published county-years | 250,000 or more |
| Suicide | 1.00 | 1.00 | 1.00 | 273 | Pooled over counties published every year | 250,000 or more |
| Drug overdose | 0.130 | 0 | 0.051 | 454 | Pooled over published county-years | Under 10,000 |
| Drug overdose | n/a | n/a | 0 | 128 | Pooled over counties published every year | Under 10,000 |
| Drug overdose | 1.77 | 1.45 | 1.63 | 673 | Pooled over published county-years | 10,000 to 24,999 |
| Drug overdose | 4.43 | 2.82 | 3.63 | 11 | Pooled over counties published every year | 10,000 to 24,999 |
| Drug overdose | 1.68 | 1.58 | 1.63 | 602 | Pooled over published county-years | 25,000 to 49,999 |
| Drug overdose | 2.29 | 1.92 | 2.09 | 66 | Pooled over counties published every year | 25,000 to 49,999 |
| Drug overdose | 1.20 | 1.16 | 1.18 | 387 | Pooled over published county-years | 50,000 to 99,999 |
| Drug overdose | 1.36 | 1.26 | 1.30 | 227 | Pooled over counties published every year | 50,000 to 99,999 |
| Drug overdose | 1.08 | 1.06 | 1.07 | 325 | Pooled over published county-years | 100,000 to 249,999 |
| Drug overdose | 1.10 | 1.07 | 1.09 | 306 | Pooled over counties published every year | 100,000 to 249,999 |
| Drug overdose | 1.05 | 1.05 | 1.05 | 273 | Pooled over published county-years | 250,000 or more |
| Drug overdose | 1.05 | 1.05 | 1.05 | 273 | Pooled over counties published every year | 250,000 or more |

Views: Suicide (cause = Suicide); Drug overdose (cause = Drug overdose).

Note: The panel is a model, so these ratios compare WONDER's rule with a modeled rate and not with the true rate. The panel's rates for small counties borrow from neighboring counties. WONDER counts and panel rates both cover 2019 to 2023. In counties of 50,000 to 100,000 residents the ratios are 1.09 for suicide and 1.18 for overdose, and in counties of 100,000 to 250,000 residents 1.00 and 1.07.

Note: Counties are all counties with a stable panel rate in every year 2019 to 2023, other than Connecticut's. A county that WONDER never publishes adds nothing to the pooled WONDER rate and stays in the panel rate. Restricting both sides to counties with a published county-year, the ratios for counties of 25,000 to 50,000 residents are 1.34 for suicide and 1.38 for overdose. A series is plotted for a size of county only when it has at least 10 counties; where every complete county has a rate of zero, the ratio is zero and has no interval.

Note: Overdose in the panel is unintentional or undetermined-intent drug overdose and in WONDER drug poisoning of any intent, so the levels differ by definition. In counties of 250,000 or more residents, where every count is published, the overdose ratio is 1.05, which measures that difference.

Source: CDC WONDER underlying cause of death, county files, 2019-2023, and CDC Mapping Injury, Overdose, and Violence county file, 2019-2023; crude rates, modeled estimates, population-weighted

Data: https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/figures/naive_vs_panel.json

### Table 8. In every source the counties left without a value are a larger share of counties than of residents, from 55 counties without a premature death rate to 2,881 that WONDER linked birth and infant death does not name

Counties with no value in each source and measure, with the share of counties and the share of residents in them, for WONDER mortality, County Health Rankings, the CDC panel and the counties WONDER names in its birth products

| Source | Measure | Years | Rule that leaves a county out | Counties left out | Share of counties (%) | Share of residents (%) |
| --- | --- | --- | --- | ---: | ---: | ---: |
| CDC WONDER mortality, one county-year | Drug overdose | 2023 | Count of 1 to 9 deaths withheld | 1,426 | 45.4 | 8.6 |
| CDC WONDER mortality, one county-year | Suicide | 2023 | Count of 1 to 9 deaths withheld | 1,792 | 57.0 | 12.0 |
| CDC WONDER mortality, counties published every year | Drug overdose | 2018 to 2023 | Any county-year withheld, or no population | 2,200 | 70.0 | 17.1 |
| CDC WONDER mortality, counties published every year | Suicide | 2018 to 2023 | Any county-year withheld, or no population | 2,397 | 76.3 | 18.9 |
| County Health Rankings, pooled window | Drug overdose | 2019 to 2021 | Fewer than 10 deaths in the window | 1,244 | 39.6 | 4.0 |
| County Health Rankings, pooled window | Suicide | 2017 to 2021 | Fewer than 10 deaths in the window | 716 | 22.8 | 1.3 |
| County Health Rankings, pooled window | Homicide | 2015 to 2021 | Fewer than 10 deaths in the window | 1,767 | 56.2 | 9.7 |
| County Health Rankings, pooled window | Firearm deaths | 2017 to 2021 | Fewer than 10 deaths in the window | 864 | 27.5 | 2.0 |
| County Health Rankings, pooled window | Premature death | 2019 to 2021 | Fewer than 20 deaths in the window | 55 | 1.7 | 0.0 |
| CDC injury and violence panel, modeled | Drug overdose | 2019 to 2023 | No stable rate in some year | 428 | 13.6 | 2.3 |
| CDC injury and violence panel, modeled | Suicide | 2019 to 2023 | No stable rate in some year | 869 | 27.7 | 5.1 |
| CDC WONDER natality, counties named | Births | 2018 to 2024 | Counties under 100,000 residents pooled | 2,564 | 81.6 | 21.0 |
| CDC WONDER linked birth and infant death, counties named | Infant deaths | 2018 to 2022 | Counties under 250,000 residents pooled | 2,881 | 91.7 | 37.1 |

Note: Counties left out are those with no value. The share of counties uses each source's own count of counties (3,142 in WONDER, one more in County Health Rankings). Residents use WONDER's population for the WONDER mortality rows, County Health Rankings' for its rows and 2019-2023 American Community Survey residents for the rest.

Note: County Health Rankings windows are those of its 2024 release for each measure and the floors are the smallest published counts. The CDC panel row counts counties without a stable rate in every year, including Connecticut's 8, which the panel does not carry. Naming thresholds are 100,000 and 250,000 residents.

Source: CDC WONDER mortality, natality and linked birth and infant death, County Health Rankings 2024 and the CDC injury and violence panel, 2018-2024; full counts, crude rates and modeled estimates

Data: https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/figures/sources_compared.json

## All estimates

Every fact in facts.json (160), sorted by id.

| Fact id | Value | Unit | Estimand | Population | Period | Interval | n | Weights | Source | Note |
| --- | ---: | --- | --- | --- | --- | --- | ---: | --- | --- | --- |
| chr_hom_n | 1,767 | counties | count of counties with no homicide rate because the window holds too few deaths | counties in County Health Rankings 2024 | pooled window of the 2024 release |   |   | none (full count) | County Health Rankings |   |
| chr_hom_pop | 9.7% | percent of residents | share of residents living in counties with no homicide rate | residents of the counties in County Health Rankings 2024 | pooled window of the 2024 release |   |   | county population in County Health Rankings | County Health Rankings |   |
| chr_od_n | 1,244 | counties | count of counties with no overdose rate because the window holds too few deaths | counties in County Health Rankings 2024 | pooled window of the 2024 release |   |   | none (full count) | County Health Rankings |   |
| chr_od_pop | 4.0% | percent of residents | share of residents living in counties with no overdose rate | residents of the counties in County Health Rankings 2024 | pooled window of the 2024 release |   |   | county population in County Health Rankings | County Health Rankings |   |
| chr_pmm_floor | 20 | deaths in the window | definition: County Health Rankings leaves out a premature death rate when the window holds fewer deaths than this (checked: the smallest published count is 20) | counties in County Health Rankings 2024 | pooled window of the 2024 release |   |   | none (definition) | County Health Rankings |   |
| chr_pmm_n | 55 | counties | count of counties with no premature death rate because the window holds too few deaths | counties in County Health Rankings 2024 | pooled window of the 2024 release |   |   | none (full count) | County Health Rankings |   |
| chr_su_n | 716 | counties | count of counties with no suicide rate because the window holds too few deaths | counties in County Health Rankings 2024 | pooled window of the 2024 release |   |   | none (full count) | County Health Rankings |   |
| ct_n | 8 | counties | count of Connecticut counties; WONDER has no population for them in 2022 to 2024 | Connecticut's legacy counties in the CDC WONDER county files | 2018 to 2024 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| cv_od_2 | 2.09 | ratio | the overdose rate pooled over counties published in each year 2019 to 2023, divided by the panel's population-weighted rate in all counties of the class; bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023 and 25,000 to 49,999 | county-years in 2019 to 2023 against annual modeled rates for 2019 to 2023 | 95% CI 1.92 to 2.28 | 602 counties | person-years (numerator); mean WONDER population 2019 to 2023 (panel) | CDC injury and violence mapping |   |
| cv_od_3 | 1.30 | ratio | the overdose rate pooled over counties published in each year 2019 to 2023, divided by the panel's population-weighted rate in all counties of the class; bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023 and 50,000 to 99,999 | county-years in 2019 to 2023 against annual modeled rates for 2019 to 2023 | 95% CI 1.26 to 1.36 | 387 counties | person-years (numerator); mean WONDER population 2019 to 2023 (panel) | CDC injury and violence mapping |   |
| cv_od_4 | 1.09 | ratio | the overdose rate pooled over counties published in each year 2019 to 2023, divided by the panel's population-weighted rate in all counties of the class; bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023 and 100,000 to 249,999 | county-years in 2019 to 2023 against annual modeled rates for 2019 to 2023 | 95% CI 1.07 to 1.10 | 325 counties | person-years (numerator); mean WONDER population 2019 to 2023 (panel) | CDC injury and violence mapping |   |
| lam_tol | 5% | percent | definition: how close to the true rate the pooled rate has to be to count as unbiased | the model of the publication rule | not applicable (definition) |   |   | none (definition) | CDC WONDER underlying cause of death |   |
| lbd_births | 64.0% | percent of live births | share of births in counties that WONDER linked birth and infant death names | live births in the United States | 2018 to 2022 |   |   | none (full count) | CDC WONDER linked birth and infant death |   |
| lbd_named | 263 | county identifiers | count of county identifiers other than the pooled Unidentified Counties rows | county identifiers that CDC WONDER linked birth and infant death lists in every year | 2018 to 2022 |   |   | none (full count) | CDC WONDER linked birth and infant death |   |
| lbd_real | 261 | counties | count of counties with births in every year | counties that CDC WONDER linked birth and infant death names and that have births in every year | 2018 to 2022 |   |   | none (full count) | CDC WONDER linked birth and infant death |   |
| lbd_thr | 250,000 | residents | definition: the population at which WONDER linked birth and infant death names a county (and a boundary between county size classes) | counties that WONDER linked birth and infant death names | 2018 to 2022 |   |   | none (definition) | CDC WONDER linked birth and infant death |   |
| lbd_unnamed | 2,881 | counties | count of counties that WONDER linked birth and infant death does not name, the two empty shells counted as pooled | counties and county equivalents in the CDC WONDER county files | 2018 to 2022 |   |   | none (full count) | CDC WONDER linked birth and infant death |   |
| m_cross | 4.2 | expected deaths a year | least expected number of deaths, before the peak, at which the ratio reaches one | counties that share one expected number of deaths a year under the model of the publication rule | not applicable (definition) |   |   | none (model) | CDC WONDER underlying cause of death |   |
| m_flat | 14.2 | expected deaths a year | least expected number of deaths, after the peak, at which the ratio is within the tolerance of one | counties that share one expected number of deaths a year under the model of the publication rule | not applicable (definition) |   |   | none (model) | CDC WONDER underlying cause of death |   |
| m_peak | 1.8 | ratio of the pooled rate to the true rate | largest value of the ratio of the expected pooled rate over published county-years to the true rate, Poisson counts and a constant rate | counties that share one expected number of deaths a year under the model of the publication rule | not applicable (definition) |   |   | none (model) | CDC WONDER underlying cause of death |   |
| m_peak_at | 5.4 | expected deaths a year | expected number of deaths at which the ratio is largest | counties that share one expected number of deaths a year under the model of the publication rule | not applicable (definition) |   |   | none (model) | CDC WONDER underlying cause of death |   |
| m_pub_peak | 5.3% | percent of county-years | share of county-years that WONDER publishes at the expected number of deaths where the ratio peaks | counties that share one expected number of deaths a year under the model of the publication rule | not applicable (definition) |   |   | none (model) | CDC WONDER underlying cause of death |   |
| map_floor | 20 | pooled deaths | definition: the least number of pooled deaths for a county to be mapped | a county drawn on a map of WONDER counts | not applicable (definition) |   |   | none (definition) | CDC WONDER underlying cause of death |   |
| min_group | 10 | counties | definition: the least number of counties for a group to be plotted | groups of counties plotted with an interval | not applicable (definition) |   |   | none (definition) | CDC WONDER underlying cause of death |   |
| mod_od_comp | 1.1% | percent of county-years that are modeled | share of county-years with a rate that CDC marks as modeled and not direct | county-years of the panel's overdose rates in counties whose WONDER count is published in each year 2019 to 2023 | annual modeled rates for 2019 to 2023, averaged |   | 1,011 counties | none (full count) | CDC injury and violence mapping |   |
| mod_od_other | 70.2% | percent of county-years that are modeled | share of county-years with a rate that CDC marks as modeled and not direct | county-years of the panel's overdose rates in counties whose WONDER count is withheld in at least one of those years | annual modeled rates for 2019 to 2023, averaged |   | 1,703 counties | none (full count) | CDC injury and violence mapping |   |
| mod_su_comp | 0.0% | percent of county-years that are modeled | share of county-years with a rate that CDC marks as modeled and not direct | county-years of the panel's suicide rates in counties whose WONDER count is published in each year 2019 to 2023 | annual modeled rates for 2019 to 2023, averaged |   | 775 counties | none (full count) | CDC injury and violence mapping |   |
| mod_su_other | 72.5% | percent of county-years that are modeled | share of county-years with a rate that CDC marks as modeled and not direct | county-years of the panel's suicide rates in counties whose WONDER count is withheld in at least one of those years | annual modeled rates for 2019 to 2023, averaged |   | 1,498 counties | none (full count) | CDC injury and violence mapping |   |
| n_100k | 606 | counties | count of counties with a mean population at or above the natality naming threshold | counties and county equivalents in the CDC WONDER county files | mean WONDER population 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| n_250k | 277 | counties | count of counties with a mean population at or above the linked birth and infant death naming threshold | counties and county equivalents in the CDC WONDER county files | mean WONDER population 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| n_counties | 3,142 | counties | count of counties in the county files (Valdez-Cordova AK is one county under its old code) | counties and county equivalents in the CDC WONDER county files | 2018 to 2024 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| n_scope | 3,134 | counties | count of counties in the comparisons of county groups | counties in the CDC WONDER county files other than Connecticut's | 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| nat_births | 79.6% | percent of live births | share of births in counties that WONDER natality names | live births in the United States | 2018 to 2023 |   |   | none (full count) | CDC WONDER natality |   |
| nat_named | 580 | county identifiers | count of county identifiers other than the pooled Unidentified Counties rows | county identifiers that CDC WONDER natality lists in every year | 2018 to 2024 |   |   | none (full count) | CDC WONDER natality |   |
| nat_real | 578 | counties | count of counties with births in every year (the balanced panel) | counties that CDC WONDER natality names and that have births in every year | 2018 to 2024 |   |   | none (full count) | CDC WONDER natality |   |
| nat_thr | 100,000 | residents | definition: the population at which WONDER natality names a county (and a boundary between county size classes) | counties that WONDER natality names | 2018 to 2024 |   |   | none (definition) | CDC WONDER natality |   |
| nat_unnamed | 2,564 | counties | count of counties that WONDER natality does not name, the two empty shells counted as pooled | counties and county equivalents in the CDC WONDER county files | 2018 to 2024 |   |   | none (full count) | CDC WONDER natality |   |
| nchs_ciw | 160% | percent of the estimate | definition: the widest relative width of the 95% interval at which NCHS presents a rate or count (Parker et al. 2023, Table A) | rates and counts that NCHS presents | not applicable (definition) |   |   | none (definition) | Published estimates from cited studies |   |
| nchs_min | 10 | events | definition: the least number of events for NCHS to present a rate or count (Parker et al. 2023, Table A) | rates and counts that NCHS presents | not applicable (definition) |   |   | none (definition) | Published estimates from cited studies |   |
| ns_od_2 | 1.38 | ratio | the overdose rate pooled over county-years WONDER publishes, divided by the panel's population-weighted rate in the same counties (those with a published county-year); bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023, 25,000 to 49,999 and at least one published county-year | county-years in 2019 to 2023 against annual modeled rates for 2019 to 2023 | 95% CI 1.35 to 1.41 | 412 counties | county-years with a published count (numerator); mean WONDER population 2019 to 2023 (panel) | CDC injury and violence mapping |   |
| ns_su_2 | 1.34 | ratio | the suicide rate pooled over county-years WONDER publishes, divided by the panel's population-weighted rate in the same counties (those with a published county-year); bootstrap over counties | counties with a stable panel suicide rate in every year 2019 to 2023, 25,000 to 49,999 and at least one published county-year | county-years in 2019 to 2023 against annual modeled rates for 2019 to 2023 | 95% CI 1.31 to 1.37 | 263 counties | county-years with a published count (numerator); mean WONDER population 2019 to 2023 (panel) | CDC injury and violence mapping |   |
| nv_od_0 | 0.05 | ratio | the overdose rate pooled over county-years WONDER publishes (a county never published adds nothing), divided by the panel's population-weighted rate in all counties of the class; bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023 and under 10,000 | county-years in 2019 to 2023 against annual modeled rates for 2019 to 2023 | 95% CI 0.00 to 0.13 | 454 counties | county-years with a published count (numerator); mean WONDER population 2019 to 2023 (panel) | CDC injury and violence mapping |   |
| nv_od_1 | 1.63 | ratio | the overdose rate pooled over county-years WONDER publishes (a county never published adds nothing), divided by the panel's population-weighted rate in all counties of the class; bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023 and 10,000 to 24,999 | county-years in 2019 to 2023 against annual modeled rates for 2019 to 2023 | 95% CI 1.45 to 1.77 | 673 counties | county-years with a published count (numerator); mean WONDER population 2019 to 2023 (panel) | CDC injury and violence mapping |   |
| nv_od_2 | 1.63 | ratio | the overdose rate pooled over county-years WONDER publishes (a county never published adds nothing), divided by the panel's population-weighted rate in all counties of the class; bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023 and 25,000 to 49,999 | county-years in 2019 to 2023 against annual modeled rates for 2019 to 2023 | 95% CI 1.58 to 1.68 | 602 counties | county-years with a published count (numerator); mean WONDER population 2019 to 2023 (panel) | CDC injury and violence mapping |   |
| nv_od_3 | 1.18 | ratio | the overdose rate pooled over county-years WONDER publishes (a county never published adds nothing), divided by the panel's population-weighted rate in all counties of the class; bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023 and 50,000 to 99,999 | county-years in 2019 to 2023 against annual modeled rates for 2019 to 2023 | 95% CI 1.16 to 1.20 | 387 counties | county-years with a published count (numerator); mean WONDER population 2019 to 2023 (panel) | CDC injury and violence mapping |   |
| nv_od_4 | 1.07 | ratio | the overdose rate pooled over county-years WONDER publishes (a county never published adds nothing), divided by the panel's population-weighted rate in all counties of the class; bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023 and 100,000 to 249,999 | county-years in 2019 to 2023 against annual modeled rates for 2019 to 2023 | 95% CI 1.06 to 1.08 | 325 counties | county-years with a published count (numerator); mean WONDER population 2019 to 2023 (panel) | CDC injury and violence mapping |   |
| nv_od_5 | 1.05 | ratio | the overdose rate pooled over county-years WONDER publishes (a county never published adds nothing), divided by the panel's population-weighted rate in all counties of the class; bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023 and 250,000 or more | county-years in 2019 to 2023 against annual modeled rates for 2019 to 2023 | 95% CI 1.05 to 1.06 | 273 counties | county-years with a published count (numerator); mean WONDER population 2019 to 2023 (panel) | CDC injury and violence mapping |   |
| nv_su_0 | 0.18 | ratio | the suicide rate pooled over county-years WONDER publishes (a county never published adds nothing), divided by the panel's population-weighted rate in all counties of the class; bootstrap over counties | counties with a stable panel suicide rate in every year 2019 to 2023 and under 10,000 | county-years in 2019 to 2023 against annual modeled rates for 2019 to 2023 | 95% CI 0.00 to 0.42 | 406 counties | county-years with a published count (numerator); mean WONDER population 2019 to 2023 (panel) | CDC injury and violence mapping |   |
| nv_su_1 | 0.78 | ratio | the suicide rate pooled over county-years WONDER publishes (a county never published adds nothing), divided by the panel's population-weighted rate in all counties of the class; bootstrap over counties | counties with a stable panel suicide rate in every year 2019 to 2023 and 10,000 to 24,999 | county-years in 2019 to 2023 against annual modeled rates for 2019 to 2023 | 95% CI 0.50 to 1.07 | 406 counties | county-years with a published count (numerator); mean WONDER population 2019 to 2023 (panel) | CDC injury and violence mapping |   |
| nv_su_2 | 1.51 | ratio | the suicide rate pooled over county-years WONDER publishes (a county never published adds nothing), divided by the panel's population-weighted rate in all counties of the class; bootstrap over counties | counties with a stable panel suicide rate in every year 2019 to 2023 and 25,000 to 49,999 | county-years in 2019 to 2023 against annual modeled rates for 2019 to 2023 | 95% CI 1.47 to 1.55 | 484 counties | county-years with a published count (numerator); mean WONDER population 2019 to 2023 (panel) | CDC injury and violence mapping |   |
| nv_su_3 | 1.09 | ratio | the suicide rate pooled over county-years WONDER publishes (a county never published adds nothing), divided by the panel's population-weighted rate in all counties of the class; bootstrap over counties | counties with a stable panel suicide rate in every year 2019 to 2023 and 50,000 to 99,999 | county-years in 2019 to 2023 against annual modeled rates for 2019 to 2023 | 95% CI 1.07 to 1.10 | 379 counties | county-years with a published count (numerator); mean WONDER population 2019 to 2023 (panel) | CDC injury and violence mapping |   |
| nv_su_4 | 1.00 | ratio | the suicide rate pooled over county-years WONDER publishes (a county never published adds nothing), divided by the panel's population-weighted rate in all counties of the class; bootstrap over counties | counties with a stable panel suicide rate in every year 2019 to 2023 and 100,000 to 249,999 | county-years in 2019 to 2023 against annual modeled rates for 2019 to 2023 | 95% CI 1.00 to 1.01 | 325 counties | county-years with a published count (numerator); mean WONDER population 2019 to 2023 (panel) | CDC injury and violence mapping |   |
| od_c_adi | 43.0 | national rank of the Area Deprivation Index, 1 least and 100 most deprived | population-weighted mean of the county values (mean rank); bootstrap over counties | counties whose overdose count WONDER publishes in every year | ADI 2023 | 95% CI 39.9 to 46.0 | 942 counties | mean WONDER population 2018 to 2023 | Area Deprivation Index |   |
| od_c_aian | 1.2% | percent of residents | population-weighted mean of the county values (who are American Indian or Alaska Native); bootstrap over counties | counties whose overdose count WONDER publishes in every year | Census Population Estimates as reported by County Health Rankings 2024 | 95% CI 1.0% to 1.3% | 942 counties | mean WONDER population 2018 to 2023 | County Health Rankings |   |
| od_c_black | 13.4% | percent of residents | population-weighted mean of the county values (who are non-Hispanic Black); bootstrap over counties | counties whose overdose count WONDER publishes in every year | Census Population Estimates as reported by County Health Rankings 2024 | 95% CI 12.1% to 14.7% | 942 counties | mean WONDER population 2018 to 2023 | County Health Rankings |   |
| od_c_hisp | 21.0% | percent of residents | population-weighted mean of the county values (who are Hispanic of any race); bootstrap over counties | counties whose overdose count WONDER publishes in every year | Census Population Estimates as reported by County Health Rankings 2024 | 95% CI 18.2% to 24.0% | 942 counties | mean WONDER population 2018 to 2023 | County Health Rankings |   |
| od_c_med | 134,390 | residents | median county population | counties whose overdose count WONDER publishes in every year | mean WONDER population 2018 to 2023 |   | 942 counties | none (each county counts once) | CDC WONDER underlying cause of death |   |
| od_c_nonmetro | 4.2% | percent of residents | population-weighted mean of the county values (living in nonmetro counties); bootstrap over counties | counties whose overdose count WONDER publishes in every year | 2023 codes | 95% CI 3.4% to 5.1% | 942 counties | mean WONDER population 2018 to 2023 | Rural-Urban Continuum Codes |   |
| od_c_white | 55.3% | percent of residents | population-weighted mean of the county values (who are non-Hispanic white); bootstrap over counties | counties whose overdose count WONDER publishes in every year | Census Population Estimates as reported by County Health Rankings 2024 | 95% CI 52.1% to 58.5% | 942 counties | mean WONDER population 2018 to 2023 | County Health Rankings |   |
| od_n_adi | 70.2 | national rank of the Area Deprivation Index, 1 least and 100 most deprived | population-weighted mean of the county values (mean rank); bootstrap over counties | counties whose overdose count WONDER withholds in every year | ADI 2023 | 95% CI 68.5 to 71.8 | 591 counties | mean WONDER population 2018 to 2023 | Area Deprivation Index |   |
| od_n_aian | 2.1% | percent of residents | population-weighted mean of the county values (who are American Indian or Alaska Native); bootstrap over counties | counties whose overdose count WONDER withholds in every year | Census Population Estimates as reported by County Health Rankings 2024 | 95% CI 1.7% to 2.6% | 591 counties | mean WONDER population 2018 to 2023 | County Health Rankings |   |
| od_n_black | 8.1% | percent of residents | population-weighted mean of the county values (who are non-Hispanic Black); bootstrap over counties | counties whose overdose count WONDER withholds in every year | Census Population Estimates as reported by County Health Rankings 2024 | 95% CI 7.1% to 9.2% | 591 counties | mean WONDER population 2018 to 2023 | County Health Rankings |   |
| od_n_hisp | 10.0% | percent of residents | population-weighted mean of the county values (who are Hispanic of any race); bootstrap over counties | counties whose overdose count WONDER withholds in every year | Census Population Estimates as reported by County Health Rankings 2024 | 95% CI 8.4% to 11.7% | 591 counties | mean WONDER population 2018 to 2023 | County Health Rankings |   |
| od_n_med | 19,761 | residents | median county population | counties whose overdose count WONDER withholds in every year | mean WONDER population 2018 to 2023 |   | 591 counties | none (each county counts once) | CDC WONDER underlying cause of death |   |
| od_n_nonmetro | 75.5% | percent of residents | population-weighted mean of the county values (living in nonmetro counties); bootstrap over counties | counties whose overdose count WONDER withholds in every year | 2023 codes | 95% CI 71.2% to 79.9% | 591 counties | mean WONDER population 2018 to 2023 | Rural-Urban Continuum Codes |   |
| od_n_white | 77.2% | percent of residents | population-weighted mean of the county values (who are non-Hispanic white); bootstrap over counties | counties whose overdose count WONDER withholds in every year | Census Population Estimates as reported by County Health Rankings 2024 | 95% CI 75.3% to 79.1% | 591 counties | mean WONDER population 2018 to 2023 | County Health Rankings |   |
| pan_od_n | 428 | counties | count of counties with no stable panel overdose rate in some year (Connecticut included) | counties and county equivalents in the CDC WONDER county files | annual modeled rates for 2019 to 2023, averaged |   |   | none (full count) | CDC injury and violence mapping |   |
| pan_od_pop | 2.3% | percent of residents | share of residents living in counties with no stable panel overdose rate in some year | residents of the counties in the CDC WONDER county files | annual modeled rates for 2019 to 2023, averaged |   |   | 2019-2023 ACS residents | CDC injury and violence mapping |   |
| reg_su_mw | 31.1% | percent of counties | share of counties whose suicide count WONDER withholds in every year | counties in the Midwest Census region | county-years in 2018 to 2023 |   | 1,055 counties | none (each county counts once) | CDC WONDER underlying cause of death |   |
| reg_su_ne | 12.0% | percent of counties | share of counties whose suicide count WONDER withholds in every year | counties in the Northeast Census region | county-years in 2018 to 2023 |   | 209 counties | none (each county counts once) | CDC WONDER underlying cause of death |   |
| reg_su_south | 32.7% | percent of counties | share of counties whose suicide count WONDER withholds in every year | counties in the South Census region | county-years in 2018 to 2023 |   | 1,422 counties | none (each county counts once) | CDC WONDER underlying cause of death |   |
| reg_su_west | 22.5% | percent of counties | share of counties whose suicide count WONDER withholds in every year | counties in the West Census region | county-years in 2018 to 2023 |   | 448 counties | none (each county counts once) | CDC WONDER underlying cause of death |   |
| rse_floor | 22.4% | percent of the count | relative standard error of a Poisson count at the map floor: 100 divided by the square root of the count | a death count at the map floor | not applicable (definition) |   |   | none (definition) | CDC WONDER underlying cause of death |   |
| rucc_cut | 4 | Rural-Urban Continuum Code | definition: the lowest code of a nonmetro county | counties in the 2023 Rural-Urban Continuum Code | 2023 |   |   | none (definition) | Rural-Urban Continuum Codes |   |
| sc_od_0 | 0.0 | deaths per 100,000 residents | population-weighted mean of the panel's county overdose rates (every county has a rate of zero in every year) | counties with a stable panel overdose rate in every year 2019 to 2023 and under 10,000, whose WONDER count is published in each year 2019 to 2023 | annual modeled rates for 2019 to 2023, averaged |   | 128 counties | mean WONDER population 2019 to 2023 | CDC injury and violence mapping |   |
| sc_od_2 | 52.3 | deaths per 100,000 residents | population-weighted mean of the panel's county overdose rates; bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023 and 25,000 to 49,999, whose WONDER count is published in each year 2019 to 2023 | annual modeled rates for 2019 to 2023, averaged | 95% CI 47.3 to 57.8 | 66 counties | mean WONDER population 2019 to 2023 | CDC injury and violence mapping |   |
| sc_od_3 | 35.8 | deaths per 100,000 residents | population-weighted mean of the panel's county overdose rates; bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023 and 50,000 to 99,999, whose WONDER count is published in each year 2019 to 2023 | annual modeled rates for 2019 to 2023, averaged | 95% CI 33.5 to 38.5 | 227 counties | mean WONDER population 2019 to 2023 | CDC injury and violence mapping |   |
| sc_od_4 | 27.6 | deaths per 100,000 residents | population-weighted mean of the panel's county overdose rates; bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023 and 100,000 to 249,999, whose WONDER count is published in each year 2019 to 2023 | annual modeled rates for 2019 to 2023, averaged | 95% CI 26.2 to 29.2 | 306 counties | mean WONDER population 2019 to 2023 | CDC injury and violence mapping |   |
| sc_su_0 | 0.0 | deaths per 100,000 residents | population-weighted mean of the panel's county suicide rates (every county has a rate of zero in every year) | counties with a stable panel suicide rate in every year 2019 to 2023 and under 10,000, whose WONDER count is published in each year 2019 to 2023 | annual modeled rates for 2019 to 2023, averaged |   | 41 counties | mean WONDER population 2019 to 2023 | CDC injury and violence mapping |   |
| sc_su_2 | 30.9 | deaths per 100,000 residents | population-weighted mean of the panel's county suicide rates; bootstrap over counties | counties with a stable panel suicide rate in every year 2019 to 2023 and 25,000 to 49,999, whose WONDER count is published in each year 2019 to 2023 | annual modeled rates for 2019 to 2023, averaged | 95% CI 27.5 to 34.9 | 12 counties | mean WONDER population 2019 to 2023 | CDC injury and violence mapping |   |
| sc_su_3 | 21.6 | deaths per 100,000 residents | population-weighted mean of the panel's county suicide rates; bootstrap over counties | counties with a stable panel suicide rate in every year 2019 to 2023 and 50,000 to 99,999, whose WONDER count is published in each year 2019 to 2023 | annual modeled rates for 2019 to 2023, averaged | 95% CI 20.7 to 22.5 | 145 counties | mean WONDER population 2019 to 2023 | CDC injury and violence mapping |   |
| sc_su_4 | 17.0 | deaths per 100,000 residents | population-weighted mean of the panel's county suicide rates; bootstrap over counties | counties with a stable panel suicide rate in every year 2019 to 2023 and 100,000 to 249,999, whose WONDER count is published in each year 2019 to 2023 | annual modeled rates for 2019 to 2023, averaged | 95% CI 16.4 to 17.5 | 304 counties | mean WONDER population 2019 to 2023 | CDC injury and violence mapping |   |
| shell_lbd_n | 2 | counties | count of empty-shell counties (Hinds MS and Mahoning OH) | counties that WONDER linked birth and infant death lists with no births of their own | 2018 to 2022 |   |   | none (full count) | CDC WONDER linked birth and infant death |   |
| shell_n | 2 | counties | count of empty-shell counties (Cape May NJ and Portsmouth VA) | counties that WONDER natality lists with no births of their own | 2018 to 2024 |   |   | none (full count) | CDC WONDER natality |   |
| so_od_0 | 13.0 | deaths per 100,000 residents | population-weighted mean of the panel's county overdose rates; bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023 and under 10,000, whose WONDER count is withheld in at least one of those years, including counties never published | annual modeled rates for 2019 to 2023, averaged | 95% CI 11.7 to 14.3 | 326 counties | mean WONDER population 2019 to 2023 | CDC injury and violence mapping |   |
| so_od_2 | 22.3 | deaths per 100,000 residents | population-weighted mean of the panel's county overdose rates; bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023 and 25,000 to 49,999, whose WONDER count is withheld in at least one of those years, including counties never published | annual modeled rates for 2019 to 2023, averaged | 95% CI 21.5 to 23.2 | 536 counties | mean WONDER population 2019 to 2023 | CDC injury and violence mapping |   |
| so_od_3 | 17.5 | deaths per 100,000 residents | population-weighted mean of the panel's county overdose rates; bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023 and 50,000 to 99,999, whose WONDER count is withheld in at least one of those years, including counties never published | annual modeled rates for 2019 to 2023, averaged | 95% CI 16.5 to 18.5 | 160 counties | mean WONDER population 2019 to 2023 | CDC injury and violence mapping |   |
| so_od_4 | 11.3 | deaths per 100,000 residents | population-weighted mean of the panel's county overdose rates; bootstrap over counties | counties with a stable panel overdose rate in every year 2019 to 2023 and 100,000 to 249,999, whose WONDER count is withheld in at least one of those years, including counties never published | annual modeled rates for 2019 to 2023, averaged | 95% CI 10.2 to 12.6 | 19 counties | mean WONDER population 2019 to 2023 | CDC injury and violence mapping |   |
| so_su_0 | 14.2 | deaths per 100,000 residents | population-weighted mean of the panel's county suicide rates; bootstrap over counties | counties with a stable panel suicide rate in every year 2019 to 2023 and under 10,000, whose WONDER count is withheld in at least one of those years, including counties never published | annual modeled rates for 2019 to 2023, averaged | 95% CI 13.2 to 15.4 | 365 counties | mean WONDER population 2019 to 2023 | CDC injury and violence mapping |   |
| so_su_2 | 19.4 | deaths per 100,000 residents | population-weighted mean of the panel's county suicide rates; bootstrap over counties | counties with a stable panel suicide rate in every year 2019 to 2023 and 25,000 to 49,999, whose WONDER count is withheld in at least one of those years, including counties never published | annual modeled rates for 2019 to 2023, averaged | 95% CI 19.0 to 19.8 | 472 counties | mean WONDER population 2019 to 2023 | CDC injury and violence mapping |   |
| so_su_3 | 17.0 | deaths per 100,000 residents | population-weighted mean of the panel's county suicide rates; bootstrap over counties | counties with a stable panel suicide rate in every year 2019 to 2023 and 50,000 to 99,999, whose WONDER count is withheld in at least one of those years, including counties never published | annual modeled rates for 2019 to 2023, averaged | 95% CI 16.6 to 17.4 | 234 counties | mean WONDER population 2019 to 2023 | CDC injury and violence mapping |   |
| so_su_4 | 12.4 | deaths per 100,000 residents | population-weighted mean of the panel's county suicide rates; bootstrap over counties | counties with a stable panel suicide rate in every year 2019 to 2023 and 100,000 to 249,999, whose WONDER count is withheld in at least one of those years, including counties never published | annual modeled rates for 2019 to 2023, averaged | 95% CI 11.3 to 13.7 | 21 counties | mean WONDER population 2019 to 2023 | CDC injury and violence mapping |   |
| state_cells | 357 | state-years | count of state-years for each kind of death | the 50 states and DC in the WONDER state files, for one kind of death | 2018 to 2024 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| state_withheld | 0 | state-years | count of state-years whose death count WONDER withholds | the 50 states and DC in the WONDER state files, for the three kinds of death | 2018 to 2024 |   | 1,071 state-years | none (full count) | CDC WONDER underlying cause of death |   |
| sz_c1 | 10,000 | residents | definition: a boundary between county size classes | counties in the size classes of this chapter | mean WONDER population 2018 to 2023 |   |   | none (definition) | CDC WONDER underlying cause of death |   |
| sz_c2 | 25,000 | residents | definition: a boundary between county size classes | counties in the size classes of this chapter | mean WONDER population 2018 to 2023 |   |   | none (definition) | CDC WONDER underlying cause of death |   |
| sz_c3 | 50,000 | residents | definition: a boundary between county size classes | counties in the size classes of this chapter | mean WONDER population 2018 to 2023 |   |   | none (definition) | CDC WONDER underlying cause of death |   |
| sz_wh_alc_0 | 54.9% | percent of county-years | share of county-years whose alcohol-induced count WONDER withholds | county-years of counties in the size class under 10,000 | county-years in 2018 to 2023 |   | 4,374 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| sz_wh_alc_1 | 84.3% | percent of county-years | share of county-years whose alcohol-induced count WONDER withholds | county-years of counties in the size class 10,000 to 24,999 | county-years in 2018 to 2023 |   | 4,794 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| sz_wh_alc_4 | 9.7% | percent of county-years | share of county-years whose alcohol-induced count WONDER withholds | county-years of counties in the size class 100,000 to 249,999 | county-years in 2018 to 2023 |   | 1,974 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| sz_wh_alc_5 | 0.1% | percent of county-years | share of county-years whose alcohol-induced count WONDER withholds | county-years of counties in the size class 250,000 or more | county-years in 2018 to 2023 |   | 1,662 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| sz_wh_od_0 | 45.2% | percent of county-years | share of county-years whose drug overdose count WONDER withholds | county-years of counties in the size class under 10,000 | county-years in 2018 to 2023 |   | 4,374 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| sz_wh_od_1 | 82.3% | percent of county-years | share of county-years whose drug overdose count WONDER withholds | county-years of counties in the size class 10,000 to 24,999 | county-years in 2018 to 2023 |   | 4,794 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| sz_wh_od_4 | 2.5% | percent of county-years | share of county-years whose drug overdose count WONDER withholds | county-years of counties in the size class 100,000 to 249,999 | county-years in 2018 to 2023 |   | 1,974 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| sz_wh_od_5 | 0.0% | percent of county-years | share of county-years whose drug overdose count WONDER withholds | county-years of counties in the size class 250,000 or more | county-years in 2018 to 2023 |   | 1,662 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| sz_wh_su_0 | 61.3% | percent of county-years | share of county-years whose suicide count WONDER withholds | county-years of counties in the size class under 10,000 | county-years in 2018 to 2023 |   | 4,374 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| sz_wh_su_1 | 93.1% | percent of county-years | share of county-years whose suicide count WONDER withholds | county-years of counties in the size class 10,000 to 24,999 | county-years in 2018 to 2023 |   | 4,794 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| sz_wh_su_4 | 1.5% | percent of county-years | share of county-years whose suicide count WONDER withholds | county-years of counties in the size class 100,000 to 249,999 | county-years in 2018 to 2023 |   | 1,974 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| sz_wh_su_5 | 0.0% | percent of county-years | share of county-years whose suicide count WONDER withholds | county-years of counties in the size class 250,000 or more | county-years in 2018 to 2023 |   | 1,662 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| sz_zero_alc_0 | 44.8% | percent of county-years | share of county-years whose alcohol-induced count WONDER publishes as zero | county-years of counties under the smallest boundary | county-years in 2018 to 2023 |   | 4,374 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| sz_zero_od_0 | 54.7% | percent of county-years | share of county-years whose drug overdose count WONDER publishes as zero | county-years of counties under the smallest boundary | county-years in 2018 to 2023 |   | 4,374 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| sz_zero_su_0 | 38.5% | percent of county-years | share of county-years whose suicide count WONDER publishes as zero | county-years of counties under the smallest boundary | county-years in 2018 to 2023 |   | 4,374 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| w_1019_alc | 43.8% | percent of published county-years with 10 or more deaths | share of those county-years with fewer deaths than the map floor | county-years whose alcohol-induced count WONDER publishes at the floor or above | county-years in 2018 to 2023 |   | 5,224 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| w_1019_od | 35.4% | percent of published county-years with 10 or more deaths | share of those county-years with fewer deaths than the map floor | county-years whose drug overdose count WONDER publishes at the floor or above | county-years in 2018 to 2023 |   | 6,987 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| w_1019_su | 44.8% | percent of published county-years with 10 or more deaths | share of those county-years with fewer deaths than the map floor | county-years whose suicide count WONDER publishes at the floor or above | county-years in 2018 to 2023 |   | 6,037 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| w_cell_max | 9 | deaths in a county-year | definition: the largest county-year count that WONDER withholds | county-years in the CDC WONDER county files, each kind of death counted separately | not applicable (definition) |   |   | none (definition) | CDC WONDER underlying cause of death |   |
| w_cells | 18,852 | county-years | count of county-years for each kind of death | counties and county equivalents in the CDC WONDER county files | 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| w_comp_alc | 644 | counties | count of counties with no withheld county-year (complete counties) | counties whose alcohol-induced count WONDER publishes in every year 2018 to 2023, other than Connecticut's | county-years in 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| w_comp_od | 942 | counties | count of counties with no withheld county-year (complete counties) | counties whose drug overdose count WONDER publishes in every year 2018 to 2023, other than Connecticut's | county-years in 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| w_comp_pop_alc | 77.9% | percent of residents | share of residents living in counties whose alcohol-induced count is published in every year | residents of counties other than Connecticut's | county-years in 2018 to 2023 |   |   | mean WONDER population 2018 to 2023 | CDC WONDER underlying cause of death |   |
| w_comp_pop_od | 83.8% | percent of residents | share of residents living in counties whose drug overdose count is published in every year | residents of counties other than Connecticut's | county-years in 2018 to 2023 |   |   | mean WONDER population 2018 to 2023 | CDC WONDER underlying cause of death |   |
| w_comp_pop_su | 82.0% | percent of residents | share of residents living in counties whose suicide count is published in every year | residents of counties other than Connecticut's | county-years in 2018 to 2023 |   |   | mean WONDER population 2018 to 2023 | CDC WONDER underlying cause of death |   |
| w_comp_su | 745 | counties | count of counties with no withheld county-year (complete counties) | counties whose suicide count WONDER publishes in every year 2018 to 2023, other than Connecticut's | county-years in 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| w_floor | 10 | deaths in a county-year | definition: WONDER withholds a county-year count above zero and below this number | county-years in the CDC WONDER county files, each kind of death counted separately | not applicable (definition) |   |   | none (definition) | CDC WONDER underlying cause of death |   |
| w_max_alc | 29.1% | percent of deaths in the county files | largest share of the county files' alcohol-induced deaths that the withheld cells could hold at the largest withheld count each; the public limit and the published cells only | deaths in county-years in the CDC WONDER county files | county-years in 2018 to 2023 |   |   | none (bound from the public limit) | CDC WONDER underlying cause of death |   |
| w_max_od | 13.4% | percent of deaths in the county files | largest share of the county files' drug overdose deaths that the withheld cells could hold at the largest withheld count each; the public limit and the published cells only | deaths in county-years in the CDC WONDER county files | county-years in 2018 to 2023 |   |   | none (bound from the public limit) | CDC WONDER underlying cause of death |   |
| w_max_su | 28.4% | percent of deaths in the county files | largest share of the county files' suicide deaths that the withheld cells could hold at the largest withheld count each; the public limit and the published cells only | deaths in county-years in the CDC WONDER county files | county-years in 2018 to 2023 |   |   | none (bound from the public limit) | CDC WONDER underlying cause of death |   |
| w_never_alc | 782 | counties | count of counties with every county-year withheld | counties whose alcohol-induced count WONDER withholds in every year 2018 to 2023, other than Connecticut's | county-years in 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| w_never_od | 591 | counties | count of counties with every county-year withheld | counties whose drug overdose count WONDER withholds in every year 2018 to 2023, other than Connecticut's | county-years in 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| w_never_pop_alc | 6.4% | percent of residents | share of residents living in counties whose alcohol-induced count is withheld in every year | residents of counties other than Connecticut's | county-years in 2018 to 2023 |   |   | mean WONDER population 2018 to 2023 | CDC WONDER underlying cause of death |   |
| w_never_pop_od | 4.1% | percent of residents | share of residents living in counties whose drug overdose count is withheld in every year | residents of counties other than Connecticut's | county-years in 2018 to 2023 |   |   | mean WONDER population 2018 to 2023 | CDC WONDER underlying cause of death |   |
| w_never_pop_su | 5.8% | percent of residents | share of residents living in counties whose suicide count is withheld in every year | residents of counties other than Connecticut's | county-years in 2018 to 2023 |   |   | mean WONDER population 2018 to 2023 | CDC WONDER underlying cause of death |   |
| w_never_su | 919 | counties | count of counties with every county-year withheld | counties whose suicide count WONDER withholds in every year 2018 to 2023, other than Connecticut's | county-years in 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| w_nowh_alc | 652 | counties | count of counties shaded at zero withheld years on the map (complete counties plus Connecticut's, which have no population in 2022 and 2023) | counties with no withheld alcohol-induced county-year 2018 to 2023, Connecticut's included | county-years in 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| w_nowh_od | 950 | counties | count of counties shaded at zero withheld years on the map (complete counties plus Connecticut's, which have no population in 2022 and 2023) | counties with no withheld drug overdose county-year 2018 to 2023, Connecticut's included | county-years in 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| w_nowh_su | 752 | counties | count of counties shaded at zero withheld years on the map (complete counties plus Connecticut's, which have no population in 2022 and 2023) | counties with no withheld suicide county-year 2018 to 2023, Connecticut's included | county-years in 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| w_pop_alc | 14.8% | percent of residents | share of the summed county populations that sit in county-years whose alcohol-induced count is withheld (WONDER publishes the population) | residents counted in the county-years of the WONDER county files | county-years in 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| w_pop_od | 10.1% | percent of residents | share of the summed county populations that sit in county-years whose drug overdose count is withheld (WONDER publishes the population) | residents counted in the county-years of the WONDER county files | county-years in 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| w_pop_su | 12.2% | percent of residents | share of the summed county populations that sit in county-years whose suicide count is withheld (WONDER publishes the population) | residents counted in the county-years of the WONDER county files | county-years in 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| w_some_alc | 1,708 | counties | count of counties with some county-years withheld | counties whose alcohol-induced count WONDER withholds in some but not all years 2018 to 2023, other than Connecticut's | county-years in 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| w_some_od | 1,601 | counties | count of counties with some county-years withheld | counties whose drug overdose count WONDER withholds in some but not all years 2018 to 2023, other than Connecticut's | county-years in 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| w_some_pop_od | 12.1% | percent of residents | share of residents living in counties whose overdose count is withheld in some but not all years | residents of counties other than Connecticut's | county-years in 2018 to 2023 |   |   | mean WONDER population 2018 to 2023 | CDC WONDER underlying cause of death |   |
| w_some_sc_od | 51.1% | percent of counties | share of counties whose overdose count is withheld in some but not all years | counties other than Connecticut's | county-years in 2018 to 2023 |   |   | none (each county counts once) | CDC WONDER underlying cause of death |   |
| w_some_su | 1,470 | counties | count of counties with some county-years withheld | counties whose suicide count WONDER withholds in some but not all years 2018 to 2023, other than Connecticut's | county-years in 2018 to 2023 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| w_wh_alc | 57.9% | percent of county-years | share of county-years whose alcohol-induced count WONDER withholds | county-years in the CDC WONDER county files, each kind of death counted separately | county-years in 2018 to 2023 |   | 18,852 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| w_wh_od | 47.1% | percent of county-years | share of county-years whose drug overdose count WONDER withholds | county-years in the CDC WONDER county files, each kind of death counted separately | county-years in 2018 to 2023 |   | 18,852 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| w_wh_su | 57.5% | percent of county-years | share of county-years whose suicide count WONDER withholds | county-years in the CDC WONDER county files, each kind of death counted separately | county-years in 2018 to 2023 |   | 18,852 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| w_zero_alc | 34.2% | percent of published county-years | share of published county-years with a count of zero | county-years whose alcohol-induced count WONDER publishes | county-years in 2018 to 2023 |   | 7,943 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| w_zero_od | 30.0% | percent of published county-years | share of published county-years with a count of zero | county-years whose drug overdose count WONDER publishes | county-years in 2018 to 2023 |   | 9,982 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| w_zero_su | 24.7% | percent of published county-years | share of published county-years with a count of zero | county-years whose suicide count WONDER publishes | county-years in 2018 to 2023 |   | 8,017 county-years | none (full count) | CDC WONDER underlying cause of death |   |
| yr_alc_pop_2018 | 17.4% | percent of residents | share of residents in county-years whose alcohol-induced count is withheld, in 2018 | residents counted in the county-years of the WONDER county files | county-years in 2018 to 2024 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| yr_alc_pop_min | 12.5% | percent of residents | share of residents in county-years whose alcohol-induced count is withheld, in its lowest year | residents counted in the county-years of the WONDER county files | county-years in 2018 to 2024 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| yr_od_pop_2018 | 12.3% | percent of residents | share of residents in county-years whose drug overdose count is withheld, in 2018 | residents counted in the county-years of the WONDER county files | county-years in 2018 to 2024 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| yr_od_pop_min | 8.6% | percent of residents | share of residents in county-years whose drug overdose count is withheld, in its lowest year | residents counted in the county-years of the WONDER county files | county-years in 2018 to 2024 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| yr_pop_max | 17.4% | percent of residents | largest share of residents in withheld county-years in any year and for any of the three kinds of death | residents counted in the county-years of the WONDER county files | county-years in 2018 to 2024 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| yr_pop_min | 8.6% | percent of residents | smallest share of residents in withheld county-years in any year and for any of the three kinds of death | residents counted in the county-years of the WONDER county files | county-years in 2018 to 2024 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| yr_share_max | 59.9% | percent of county-years | largest share of county-years withheld in any year and for any of the three kinds of death | county-years in the CDC WONDER county files, each kind of death counted separately | county-years in 2018 to 2024 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| yr_share_min | 44.6% | percent of county-years | smallest share of county-years withheld in any year and for any of the three kinds of death | county-years in the CDC WONDER county files, each kind of death counted separately | county-years in 2018 to 2024 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| yr_su_pop_max | 12.7% | percent of residents | share of residents in county-years whose suicide count is withheld, in its highest year | residents counted in the county-years of the WONDER county files | county-years in 2018 to 2024 |   |   | none (full count) | CDC WONDER underlying cause of death |   |
| yr_su_pop_min | 11.8% | percent of residents | share of residents in county-years whose suicide count is withheld, in its lowest year | residents counted in the county-years of the WONDER county files | county-years in 2018 to 2024 |   |   | none (full count) | CDC WONDER underlying cause of death |   |

## Definitions

- Complete county: A 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.
- Suppression: The 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.
- Crude rate: Deaths 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.
- Area 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.
- Ecological inference: Drawing conclusions about individuals from data about places or groups. A pattern across counties need not hold for the people inside them.
- Modeled estimate: A 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.

## Methods

This chapter examines which county-years CDC WONDER withholds in its death counts for drug poisoning of any intent, alcohol-induced causes and suicide, 2018 to 2024, across 3,142 counties. A withheld cell is left out of both the numerator and the denominator of a rate and nothing is imputed, and county groups are formed on whether WONDER publishes the count, which depends on the death count itself, so every comparison between groups is a comparison between selected sets of counties. The comparison rate is CDC's modeled county panel for 2019 to 2023, which is mostly modeled in the counties WONDER withholds, so a gap between a WONDER rate and the panel rate sets a direct rate against a model. Connecticut's counties are left out of the group comparisons, and rates are crude, not age-adjusted.

### Which death counts and years are used

County-year counts come from the consolidated county files of CDC WONDER underlying cause of death for 2018 to 2024: drug poisoning of any intent, alcohol-induced causes and suicide, 3,142 counties by year. WONDER publishes a count of zero and counts of 10 or more and withholds counts above zero and below 10; the county population is published for every cell. The county statistics use 2018 to 2023, the window of the chapter on overdose, alcohol and suicide, and the by-year figure uses all seven years, which are final in the June 2026 pull. North Carolina's 2023 overdose counts in these files predate the state's amended death certificates and are low.

A default WONDER query omits county-years with no deaths, so zeros appear only because the pulls asked for them (Show Zero Values).

Explains Table 1.

### How withheld cells and complete counties are handled

A withheld cell is counted and left out of both the numerator and the denominator of a rate. Nothing is imputed, derived from a total or bounded cell by cell; the one bound printed is the largest share of the county files' deaths that withheld cells could hold at 9 each, computed from the public limit and the published cells.

A complete county has a published count and a population in every year 2018 to 2023. The comparisons with the panel use 2019 to 2023 on both sides, the panel's years (its 2024 values are provisional), and call a county complete there when its count is published in each of those years. Connecticut's 8 counties have deaths but no WONDER population in 2022 to 2024 and are left out of the group comparisons and of every county rate.

### County size, groups and characteristics

County size is the mean WONDER population over 2018 to 2023, in classes bounded at 10,000, 25,000, 50,000, 100,000 and 250,000 residents, and the results move with these boundaries.

County groups are formed on whether WONDER publishes the count, which depends on the death count itself, so every comparison between groups is a comparison between selected sets of counties.

County deprivation is the mean of tract Area Deprivation Index national ranks weighted by 2019-2023 tract population (Connecticut tracts assigned to the eight legacy counties), county type is the Rural-Urban Continuum Code (nonmetro from code 4), and race and ethnicity shares are County Health Rankings' figures from Census Population Estimates.

Explains Table 2 and Table 4.

### Counties named in the birth products

Counties named by WONDER natality and linked birth and infant death are the identifiers other than the pooled Unidentified Counties rows, and identifiers with no births of their own, which WONDER has moved into the pooled rows, count as pooled; they (2 in natality, Cape May NJ and Portsmouth VA, and 2 in linked birth and infant death, Hinds MS and Mahoning OH) are set to missing.

Explains Table 8.

### The comparison rate and the bias calculation

The comparison rate is the mean of CDC's annual modeled county rates for 2019 to 2023 from the injury and violence panel, kept only when CDC marks the rate stable in every year, weighted by mean county population over the same years; the panel is modeled where counts are small, and it is mostly modeled in the counties WONDER withholds. The rate pooled over published county-years is deaths over person-years in the published cells only, and a county never published adds nothing to it while it stays in the panel rate.

Bias here means a difference from the rate in a systematic direction. The calculation of the bias of that rate treats a county's yearly deaths as Poisson counts with a constant rate and is a calculation from the rule, not an estimate.

The counts of counties without a value in other sources use County Health Rankings' numerators (a county has no rate when the window holds fewer than 10 deaths, or 20 for premature death) and the panel's stable-rate flag.

Explains Table 5, Table 6 and Table 7.

### Uncertainty, maps and rate type

Means across counties are population-weighted with a 95% interval from a bootstrap that resamples whole counties (2,000 replicates, seed 12345); ratios and pooled rates use shared draws.

Maps of WONDER counts would need at least 20 pooled deaths; the map here counts withheld years and needs no floor. Rates are crude, not age-adjusted.

Explains Table 3.

## What these data cannot show

The comparisons of complete counties with the rest use panel rates that are modeled for the counties WONDER withholds. They show the direction of the selection and cannot give the true rate of a withheld county. The two sources also define overdose differently. The panel counts unintentional and undetermined-intent drug poisonings, and WONDER counts drug poisoning of any intent, so levels differ a little by definition.

The calculation of the bias treats a county's deaths as Poisson counts with a constant rate and independent years. Real counts vary more than that, and rates move over time, so the curve gives direction and rough size and does not correct any estimate in this book. The sizes of county and their boundaries are choices, and the figures move with them.

Withheld counts cannot be recovered. A withheld cell is known only to lie above zero and below the limit, and the bound printed here is a ceiling set by the public limit and the published cells, and it says nothing about any one cell. The group comparisons describe counties and their residents, and County Health Rankings' shares of residents come from Census population estimates with that source's categories. Connecticut's counties are left out of every county comparison because WONDER has no population for them in 2022 and 2023. North Carolina's 2023 overdose counts predate the state's amended death certificates and are low, which enters the 2018 to 2023 window of the overdose counts. A pull that left out WONDER's option to show zero values would turn county-years with no deaths into absent rows, and the below-one ratios in the smallest counties depend on keeping them. The chapter covers three kinds of death. Kinds of death with more or fewer deaths would move the sizes of county at which the rule bites, which the Poisson calculation implies and these data do not test.

## References

1. Klein, Richard J.; Proctor, Suzanne E.; Boudreault, Manon A.; Turczyn, Kathleen M. (2002). Healthy People 2010 criteria for data suppression. Healthy People 2010 Statistical Notes, No. 24 (National Center for Health Statistics). https://www.cdc.gov/nchs/data/statnt/statnt24.pdf
2. Parker, Jennifer D.; Talih, Makram; Irimata, Katherine E.; Zhang, Guangyu; Branum, Amy M.; Davis, Danielle; Das, Barnali; Hamilton, Brady E.; Kochanek, Kenneth D.; McCarty, Frances; Strashny, Alexander (2023). National Center for Health Statistics data presentation standards for rates and counts. Vital and Health Statistics, Series 2, No. 200 (National Center for Health Statistics). https://doi.org/10.15620/cdc:124368
3. Gelman, Andrew; Price, Phillip N. (1999). All maps of parameter estimates are misleading. Statistics in Medicine 18(23): 3221-3234. https://doi.org/10.1002/(sici)1097-0258(19991215)18:23<3221::aid-sim312>3.0.co;2-m
4. Brillinger, David R. (1986). The natural variability of vital rates and associated statistics. Biometrics 42(4): 693-734. https://doi.org/10.2307/2530689
5. Quick, Harrison (2019). Estimating county-level mortality rates using highly censored data from CDC WONDER. Preventing Chronic Disease 16: 180441. https://doi.org/10.5888/pcd16.180441

## Provenance

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| data/analytic/tract_atlas.parquet | 39,659,925 | 29d5e4d943552d54aeb6ba92aadc939d9bd15bdea553c78357dbd516757be627 | 1e10d1ecf722340f23ee2212d4999a90250f85b65fa89b39e32db06d9472e22e |
| data/staged/births/wonder_natality_county_total_2018_2024.parquet | 41,774 | e85d351fa72c022a05415d332185113b6badcaff1119da1d6f45c76ffe16d86d | e85d351fa72c022a05415d332185113b6badcaff1119da1d6f45c76ffe16d86d |
| data/staged/crosswalks/ct_tract2020_to_old_county.parquet | 15,842 | 961ef39f31596ef65fca2c67d5f2f63e533c5dc9b49745d3bb6437844e4b831d | 961ef39f31596ef65fca2c67d5f2f63e533c5dc9b49745d3bb6437844e4b831d |
| data/staged/crosswalks/ers_rucc_county_2023.parquet | 67,278 | ad01d36a53664a2bfafbcbebb0f5a921f5b81122ffa80cf96333db23b41c191e | ad01d36a53664a2bfafbcbebb0f5a921f5b81122ffa80cf96333db23b41c191e |
| data/staged/health/chr_county_2024.parquet | 8,776,933 | 619795f7ecfec8aff10694b649eaee5e421dbeffbe4be47af4161b51ceefa5cd | c69357f1bcf630407bb9716cb445618838999558c019aaaf77d4681b6bf45c56 |
| data/staged/mortality/injury_violence_county.parquet | 722,427 | d0dfd060a3ab9eaa3a87b35d1b24b5a1e9f21af3513c10367edb651c46f40403 | d0dfd060a3ab9eaa3a87b35d1b24b5a1e9f21af3513c10367edb651c46f40403 |
| data/staged/mortality/wonder_lbd_county_total_2018_2022.parquet | 29,903 | 8e0f2604f2be86d6d86c2d206fa4486b2479411c88a6bb9b1595f3d945a4e5b8 | 8e0f2604f2be86d6d86c2d206fa4486b2479411c88a6bb9b1595f3d945a4e5b8 |
| data/staged/mortality/wonder_ucd_alcohol_county_2018_2024.parquet | 289,631 | 478b6b5f8ffa061bcca1df84162d1e169babeb7832bc9818379af9be382a778f | 478b6b5f8ffa061bcca1df84162d1e169babeb7832bc9818379af9be382a778f |
| data/staged/mortality/wonder_ucd_alcohol_state_2018_2024.parquet | 16,162 | 94c821fe0bce60f99f2a300acf8e929b857a8b0f780f5634cadce0698fd665a4 | 94c821fe0bce60f99f2a300acf8e929b857a8b0f780f5634cadce0698fd665a4 |
| data/staged/mortality/wonder_ucd_drug_county_2018_2024.parquet | 308,988 | b0e5cb6dfb44fc1ce53a192faf74cb84277bb5d601a3fc32b65078a7ec03bbf1 | b0e5cb6dfb44fc1ce53a192faf74cb84277bb5d601a3fc32b65078a7ec03bbf1 |
| data/staged/mortality/wonder_ucd_drug_state_2018_2024.parquet | 17,336 | 72a7ecbb0c49a8ba9b90b22f6fad1a6d19c025c256c72799a7acf2369ebabe44 | 72a7ecbb0c49a8ba9b90b22f6fad1a6d19c025c256c72799a7acf2369ebabe44 |
| data/staged/mortality/wonder_ucd_suicide_county_2018_2024.parquet | 290,192 | 448558540a3f42296acf7f66a945f7c6794fd6f4dc9c7032a18a3d105d0541f1 | 448558540a3f42296acf7f66a945f7c6794fd6f4dc9c7032a18a3d105d0541f1 |
| data/staged/mortality/wonder_ucd_suicide_state_2018_2024.parquet | 15,948 | 7588fe51ddda48e57e88852172442b4d2bf64689882e600ebf342668ff79ea1a | 7588fe51ddda48e57e88852172442b4d2bf64689882e600ebf342668ff79ea1a |

Outputs:

| File | SHA-256 |
| --- | --- |
| facts.json | 2e4793e07040c1c46d5b7699ee19be04371b9757c5df30872eb87ef5b0dc8f39 |
| figures/bias_curve.json | a058216f6e2b6b5bc15da34d50d7e44b29bda0ec28b8456fed309097a4738dea |
| figures/naive_vs_panel.json | d368724bd9fbb6b522cf8544f47a314d998cb08c8d09a2b71bbf0c5b3e56c3dc |
| figures/panel_rate_by_status.json | e1d62c22a520b95c1489df6a62a10eb98c2ef49e9bafe7e71e77afa6d166a991 |
| figures/sources_compared.json | ea933eb62096a0d8e18de37c54c6d166e9ba9dd5d43ec120a7de4af0963e4c4b |
| figures/who_lives_in_withheld.json | ef6a8d0f6dcb1a8aa9a9b2d5ba52925bd1a2abc70a569cd15080c520e13a3fac |
| figures/withheld_by_size.json | 14ce2750e0ae465a7193793dfcf22424888e120fca45b4e11c571e182267350f |
| figures/withheld_by_year.json | 30a7742899dbc27a521636508b42c93ae47a85401970c0ba963e29aeefc63609 |
| figures/years_withheld_map.json | 4346f780624c01c337080414444743d98d39e52470293c6675b5c0b909de58b2 |
| meta.json | ccad6a25ac8b151d1ac0a4b407ecfe5996be8b9d9ec7bfd03113484d8b028f59 |
| public/data/suppressed-counties-in-death-data/years_withheld_alc.json | a66b8f4800b86bbfc8fe318c0b7fe686b96b2df67f955abe816b8446b7679c0b |
| public/data/suppressed-counties-in-death-data/years_withheld_od.json | b125033cac1d13d5a54c95df96056d7fdf7bbfe27dfd36f202d1506c336840b6 |
| public/data/suppressed-counties-in-death-data/years_withheld_su.json | 23fa30ccf142b86ff89da916a984d43dcea603b34984863f953cbbdb34f43d39 |
| refs.json | a574352100fa16cf945a0afa913026618387e09606acaa91381fe0a3feed8a00 |

## Machine formats

- Report (HTML): https://vishalsingh.org/zipcode/suppressed-counties-in-death-data/report
- Report (Markdown): https://vishalsingh.org/zipcode/suppressed-counties-in-death-data/report.md
- Every estimate (JSON): https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/facts.json
- Table 1, figure "withheld_by_year" (JSON): https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/figures/withheld_by_year.json
- Table 2, figure "withheld_by_size" (JSON): https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/figures/withheld_by_size.json
- Table 3, figure "years_withheld_map" (JSON): https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/figures/years_withheld_map.json
- Table 4, figure "who_lives_in_withheld" (JSON): https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/figures/who_lives_in_withheld.json
- Table 5, figure "panel_rate_by_status" (JSON): https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/figures/panel_rate_by_status.json
- Table 6, figure "bias_curve" (JSON): https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/figures/bias_curve.json
- Table 7, figure "naive_vs_panel" (JSON): https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/figures/naive_vs_panel.json
- Table 8, figure "sources_compared" (JSON): https://vishalsingh.org/zipcode/report/suppressed-counties-in-death-data/figures/sources_compared.json
- Payload of "years_withheld_map" (JSON): https://vishalsingh.org/zipcode/data/suppressed-counties-in-death-data/years_withheld_od.json
- Index of every report: https://vishalsingh.org/zipcode/llms.txt; all reports in one file: https://vishalsingh.org/zipcode/llms-full.txt