Co-involvement of Opioids in Drug Overdose Deaths Involving Cocaine and Psychostimulants, 2011-2021.

Drug overdose deaths involving cocaine and psychostimulants with abuse potential (that is, drugs such as methamphetamine, amphetamine, and methylphenidate) have risen in the past several years (1-4). A recent report highlighted that drug overdose deaths involving cocaine rose 22% and drug overdose deaths involving psychostimulants rose 33% from 2020 through 2021 (1). By the end of 2021, the report counted 24,486 drug overdose deaths involving cocaine and 32,537 drug overdose deaths involving psychostimulants (1,5). This report presents trends from 2011 through 2021 in death rates involving cocaine and psychostimulants, with and without opioid co-involvement, and by U.S. Census region in 2021.

Urban-Rural Differences in Drug Overdose Death Rates, 2020.

Drug overdose death rates, which have been rising over the past decade, differ by urban and rural counties across the United States (1-4). A previous report demonstrated higher drug overdose death rates in urban counties by various demographic and geographic characteristics (4). This report uses the most recent final mortality data from the National Vital Statistics System (NVSS) to describe urban and rural differences in drug overdose death rates in 2020 by sex, race and Hispanic origin, and selected types of opioids and stimulants.

Drug Overdose Deaths in the United States, 2001-2021.

Drug overdose deaths have been rising over the past 2 decades in the United States (1-4). This report uses the most recent data from the National Vital Statistics System (NVSS) to update statistics on deaths from drug overdose in the United States, showing rates by demographic groups and by the types of drugs involved (specifically, opioids and stimulants), with a focus on changes from 2020 through 2021.

Co-involvement of Opioids in Drug Overdose Deaths Involving Cocaine and Psychostimulants.

Deaths from drug overdose continue to contribute to the public health burden in the United States (1). The increase in the rate of drug overdose deaths involving cocaine and psychostimulants has been well-documented in recent years (1-4). This NCHS Data Brief provides additional information on drug overdose deaths involving cocaine and other psychostimulants (drugs such as methamphetamine, amphetamine, and methylphenidate) by examining the concurrent involvement of opioids. Trends from 2009 through 2019 and differences by census region in 2019 are presented.

Drug Overdose Deaths in the United States, 1999-2020.

Deaths from drug overdose continue to contribute to overall mortality and the lowering of life expectancy in the United States (1-4). This report uses the most recent data from the National Vital Statistics System (NVSS) to update statistics on deaths from drug overdose in the United States, showing rates by demographic group and by specific types of drugs involved (such as opioids or stimulants), with a focus on changes from 2019 to 2020.

Drug Overdose Deaths in the United States, 1999-2018.

Deaths from drug overdose continue to contribute to mortality in the United States (1-5). This report uses the most recent data from the National Vital Statistics System (NVSS) to update trends in drug overdose deaths for all drugs and for specific drugs and drug types, and to identify changes in rates by state from 2017 to 2018.

Evaluation of the Pregnancy Status Checkbox on the Identification of Maternal Deaths.

Objectives-This report quantifies the impact of the inclusion of a pregnancy status checkbox item on the U.S. Standard Certificate of Death on the number of deaths classified as maternal. Maternal mortality rates calculated with and without using the checkbox information for deaths in 2015 and 2016 are presented. Methods-This report is based on cause-of-death information from 2015 and 2016 death certificates collected through the National Vital Statistics System. Records originally assigned to a specified range of ICD-10 codes (i.e., A34, O00-O99) when using information from the checkbox item were recoded without using the checkbox item. Ratios of deaths assigned as maternal deaths using checkbox item information to deaths assigned without checkbox item information were calculated to quantify the impact of the pregnancy status checkbox item on the classification of maternal deaths for 47 states and the District of Columbia. Maternal mortality rates for all jurisdictions calculated using cause-of-death information entered on the certificate with and without the checkbox were compared overall and by characteristics of the decedent. Results-Use of information from the checkbox, along with information from the cause-of-death section of the certificate, identified 1,527 deaths as maternal compared with 498 without the checkbox in 2015 and 2016 (ratio = 3.07), with the impact varying by characteristics of the decedent such as age at death. The ratio for women under age 25 was 2.15 (204 compared with 95 deaths) but was 14.14 (523 compared with 37 deaths) for women aged 40-54. Without the adoption of the checkbox item, maternal mortality rates in both 2015 and 2016 would have been reported as 8.7 deaths per 100,000 live births compared with 8.9 in 2002. With the checkbox, the maternal mortality rate would be reported as 20.9 and 21.8 deaths per 100,000 live births in 2015 and 2016.

Maternal Mortality in the United States: Changes in Coding, Publication, and Data Release, 2018.

This report describes changes in how the National Center for Health Statistics (NCHS) will code, publish, and release maternal mortality data and presents official 2018 maternal mortality estimates using a new coding method. Due to the incremental implementation of the pregnancy status checkbox item on the 2003 revised U.S. Standard Certificate of Death, NCHS last published an official estimate of the U.S. maternal mortality rate in 2007. As of 2018, implementation of the revised certificate, including its pregnancy checkbox, is complete for all 50 states (noting that California implemented a different checkbox than that on the U.S. Standard Certificate of Death), allowing NCHS to resume the routine publication of maternal mortality statistics. However, an evaluation of data quality indicated some errors with the reporting of maternal deaths (deaths within 42 days of pregnancy) following adoption of the checkbox, including overreporting of maternal deaths among older women. Therefore, NCHS has adopted a new method (to be called the 2018 method) for coding maternal deaths to mitigate these probable errors. The 2018 method involves further restricting application of the pregnancy checkbox to decedents aged 10-44 years from the previous age group of 10-54. In addition, the 2018 method restricts assignment of maternal codes to the underlying cause alone when the checkbox is the only indication of pregnancy on the death certificate, and such coding would be applied only to decedents aged 10-44 based solely on the checkbox when no other pregnancy information is provided in the cause-of-death statement. Based on the new method, a total of 658 deaths were identified in 2018 as maternal deaths. The maternal mortality rate for 2018 was 17.4 deaths per 100,000 live births, and the rate for non-Hispanic black women (37.1) was 2.5 to 3.1 times the rates for non-Hispanic white (14.7) and Hispanic (11.8) women. Rates also increased with age. Maternal mortality rates calculated without using information obtained from the checkbox are also presented for 2002, 2015, 2016, 2017, and 2018 to provide comparisons over time using a comparable coding approach across all states.

Drug Overdose Deaths in the United States, 1999-2019.

Deaths from drug overdose continue to be a public health burden in the United States (1-5). This report uses the most recent data from the National Vital Statistics System (NVSS) to update statistics on deaths from drug overdose in the United States, including information on trends from 1999 through 2019 by sex and age group, and by specific types of drugs involved (i.e., opioids and stimulants).

Deaths Associated With Hepatitis C Virus Infection Among Residents in 50 States and the District of Columbia, 2016-2017.

BACKGROUND: Mortality associated with hepatitis C virus (HCV) has been well-documented nationally, but an examination across regions and jurisdictions may inform health-care planning. METHODS: To document HCV-associated deaths sub-nationally, we calculated age-adjusted, HCV-associated death rates and compared death rate ratios (DRRs) for 10 US regions, 50 states, and Washington, D.C., using the national rate and described rate changes between 2016 and 2017 to determine variability. We examined the mean age at HCV-associated death, and rates and proportions by sex, race/ethnicity, and birth year. RESULTS: In 2017, there were 17 253 HCV-associated deaths, representing 4.13 (95% confidence interval [CI], 4.07-4.20) deaths/100 000 standard population, in a significant, 6.56% rate decline from 4.42 in 2016. Age-adjusted death rates significantly surpassed the US rate for the following jurisdictions: Oklahoma; Washington, D.C.; Oregon; New Mexico; Louisiana; Texas; Colorado; California; Kentucky; Tennessee; Arizona; and Washington (DRRs, 2.87, 2.77, 2.24, 1.62, 1.57, 1.46, 1.36, 1.35, 1.35, 1.35, 1.32, and 1.32, respectively; P < .05). Death rates ranged from a low of 1.60 (95% CI, 1.07-2.29) in Maine to a high of 11.84 (95% CI, 10.82-12.85) in Oklahoma. Death rates were highest among non-Hispanic (non-H) American Indians/Alaska Natives and non-H Blacks, both nationally and regionally. The mean age at death was 61.4 years (range, 56.6 years in West Virginia to 64.1 years in Washington, D.C.), and 78.6% of those who died were born during 1945-1965. CONCLUSIONS: In 2016-2017, the national HCV-associated mortality declined but rates remained high in the Western and Southern regions and Washington, D.C., and among non-H American Indians/Alaska Natives, non-H Blacks, and Baby Boomers. These data can inform local prevention and control programs to reduce the HCV mortality burden.

Urban-rural Differences in Drug Overdose Death Rates, by Sex, Age, and Type of Drugs Involved, 2017.

Drug overdose deaths remain a significant public health concern in the United States (1-3). This report uses the most recent data from the National Vital Statistics System (NVSS) to examine urban-rural differences in drug overdose death rates by sex, age group, and the type of drugs involved.

Drug Overdose Deaths in the United States, 1999-2017.

Deaths from drug overdose continue to be a public health burden in the United States (1-5). This report uses the most recent final mortality data from the National Vital Statistics System (NVSS) to update trends in drug overdose deaths, describe demographic and geographic patterns, and identify shifts in the types of drugs involved.

Recent Increases in Injury Mortality Among Children and Adolescents Aged 10-19 Years in the United States: 1999-2016.

This report presents numbers of injury deaths and death rates for children and adolescents aged 10-19 years in the United States for 1999-2016. Numbers and rates are presented by sex for 1999-2016, by injury intent (e.g., unintentional, suicide, and homicide) and method (e.g., motor vehicle traffic, firearms, and suffocation). Numbers and rates of death according to leading injury intents and methods are shown by sex for ages 10-14 years and 15-19 years for 2016. Mortality statistics in this report are based on information from death certificates filed in all 50 states and the District of Columbia. Injury deaths are classified by the International Classification of Diseases, Tenth Revision; underlying cause-of-death codes *U01-*U03, V01-Y36, Y85-Y87, and Y89. Death rates are calculated per 100,000 population. Ranking of the three leading intents of injury deaths and methods are based on numbers of deaths. The total death rate for persons aged 10-19 years declined 33% between 1999 (44.4 per 100,000 population) and 2013 (29.6) and then increased 12% between 2013 and 2016 (33.1). This recent rise is attributable to an increase in injury deaths for persons aged 10-19 years during 2013-2016. Increases occurred among all three leading injury intents (unintentional, suicide, and homicide) during 2013-2016. Unintentional injury, the leading injury intent for children and adolescents aged 10-19 years in 2016, declined 49% between 1999 (20.6) and 2013 (10.6), and then increased 13% between 2013 and 2016 (12.0). The death rate for suicide, the second leading injury intent among ages 10-19 years in 2016, declined 15% between 1999 and 2007 (from 4.6 to 3.9), and then increased 56% between 2007 and 2016 (6.1). The death rate for homicide, the third leading intent of injury death in 2016, fluctuated and then declined 35% between 2007 (5.7) and 2014 (3.7) before increasing 27%, to 4.7 in 2016.

Drug Overdose Deaths in the United States, 1999-2015.

KEY FINDINGS: Key findings Data from the National Vital Statistics System, Mortality ● The age-adjusted rate of drug overdose deaths in the United States in 2015 (16.3 per 100,000) was more than 2.5 times the rate in 1999 (6.1). ● Drug overdose death rates increased for all age groups, with the greatest percentage increase among adults aged 55-64 (from 4.2 per 100,000 in 1999 to 21.8 in 2015). In 2015, adults aged 45-54 had the highest rate (30.0). ● In 2015, the age-adjusted rate of drug overdose deaths among non-Hispanic white persons (21.1 per 100,000) was nearly 3.5 times the rate in 1999 (6.2). ● The four states with the highest age-adjusted drug overdose death rates in 2015 were West Virginia (41.5), New Hampshire (34.3), Kentucky (29.9), and Ohio (29.9). ● In 2015, the percentage of drug overdose deaths involving heroin (25%) was triple the percentage in 2010 (8%). Deaths from drug overdose have been identified as a significant public health burden in the United States in recent years (1-4). This report uses data from the National Vital Statistics System (NVSS) to highlight recent trends in drug overdose deaths, describing demographic and geographic patterns as well as the types of drugs involved.

Drug Overdose Deaths in the United States, 1999-2016.

Deaths from drug overdose are an increasing public health burden in the United States (1­4). This report uses the most recent data from the National Vital Statistics System (NVSS) to update trends in drug overdose deaths, describe demographic and geographic patterns, and identify shifts in the types of drugs involved.

Using Literal Text From the Death Certificate to Enhance Mortality Statistics: Characterizing Drug Involvement in Deaths.

Objectives-This report describes the development and use of a method for analyzing the literal text from death certificates to enhance national mortality statistics on drug-involved deaths. Drug-involved deaths include drug overdose deaths as well as other deaths where, according to death certificate literal text, drugs were associated with or contributed to the death. Methods-The method uses final National Vital Statistics System-Mortality files linked to electronic files containing literal text information from death certificates. Software programs were designed to search the literal text from three fields of the death certificate (the cause of death from Part I, significant conditions contributing to the death from Part II, and a description of how the injury occurred from Box 43) to identify drug mentions as well as contextual information. The list of drug search terms was developed from existing drug classification systems as well as from manual review of the literal text. Literal text surrounding the identified drug search terms was analyzed to ascertain the context. Drugs mentioned in the death certificate literal text were assumed to be involved in the death unless contextual information suggested otherwise (e.g., "METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS INFECTION"). The literal text analysis method was assessed by comparing the results from application of the method with results based on ICD-10 codes, and by conducting a manual review of a sample of records.

Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2010-2014.

Objectives-This report identifies the specific drugs most frequently involved in drug overdose deaths in the United States from 2010 through 2014. Methods-The 2010-2014 National Vital Statistics System mortality files were linked to electronic files containing literal text information from death certificates. Drug overdose was defined using the International Classification of Diseases, Tenth Revision underlying cause-of-death codes X40-X44 (unintentional), X60-X64 (suicide), X85 (homicide), and Y10-Y14 (undetermined intent). Among deaths with an underlying cause of death of drug overdose, the literal text in three fields of the death certificate (i.e., the cause of death from Part I, significant conditions contributing to death from Part II, and a description of how the injury occurred from Box 43) were searched to identify drug mentions. Search term lists were developed using existing drug classification systems as well as from manual review of the literal text. The search term list was then used to identify the specific drugs involved in overdose deaths. Descriptive statistics were reported for drug overdose deaths involving the 10 most frequently mentioned drugs on death certificates. Tables and figures presenting information on the specific drugs involved in deaths are based on deaths with mention of at least one specific drug on the death certificate. Results-From 2010 through 2014, the number of drug overdose deaths per year increased 23%, from 38,329 in 2010 to 47,055 in 2014. During this time period, the percentage of drug overdose deaths involving at least one specific drug increased, from 67% in 2010 to 78% in 2014. Among drug overdose deaths with at least one drug specified on the death certificate, the 10 drugs most frequently involved in overdose deaths included the following opioids: heroin, oxycodone, methadone, morphine, hydrocodone, and fentanyl; the following benzodiazepines: alprazolam and diazepam; and the following stimulants: cocaine and methamphetamine. During this 5-year period, the age-adjusted rate of drug overdose deaths involving heroin more than tripled, and the rate of drug overdose deaths involving methamphetamine more than doubled. The rate of drug overdose deaths involving fentanyl more than doubled in a single year (from 2013 to 2014). In 2014, of the 36,667 drug overdose deaths involving at least one specific drug, 52% of these deaths specified one drug, 38% specified two or three drugs, and 11% specified four or more drugs. Conclusions-Analysis of the literal text from death certificates can be used to identify patterns in the specific drugs most frequently involved in drug overdose deaths. From 2010 through 2014, the top 10 drugs involved were the same, but the relative ranking and age-adjusted rates for deaths involving these drugs changed. Literal text analysis also revealed that many drug overdose deaths involved multiple drugs. Findings should be interpreted in light of the improvement in the quality of the data that resulted from better reporting of specific drugs on death certificates from 2010 through 2014. Relative increases in the death rates involving specific drugs and the rankings of these drugs may be affected by improvements in reporting, real increases in the numbers of death, or both.

Declines in Cancer Death Rates Among Children and Adolescents in the United States, 1999-2014.

KEY FINDINGS: Data from the National Vital Statistics System •During 1999-2014, the cancer death rate for children and adolescents aged 1-19 years in the United States declined 20%, from 2.85 to 2.28 per 100,000 population. •The cancer death rate for males aged 1-19 years in 2014 was 30% higher than for females. •Declines in cancer death rates during 1999-2014 were experienced among both white and black persons aged 1-19 years and for all 5-year age groups. •During 1999-2014, brain cancer replaced leukemia as the most common cancer causing death among children and adolescents aged 1-19 years, accounting for 3 out of 10 cancer deaths in 2014. Since the mid-1970s, cancer death rates among children and adolescents in the United States showed marked declines despite a slow increase in incidence for some of the major types (1-3). These trends have previously been shown through 2012. This data brief extends previous research by showing trends in cancer death rates through 2014 among children and adolescents aged 1-19 years in the United States. Cancer death rates for 1999-2014 are presented and trends are compared for both females and males, by 5-year age group, and for white and black children and adolescents. Percent distributions of cancer deaths among children and adolescents aged 1-19 years are shown by anatomical site for 1999 and 2014.

Death in the United States, 2011.

In 2011, the age-adjusted death rate for the United States was 740.6 per 100,000 population (1). This rate represents a 0.9% drop from the rate in 2010 (747.0), and is a record low. The highest mortality was observed for the non-Hispanic black population (903.9), followed by the non-Hispanic white population (753.9). Death rates for all race groups of the U.S. population generally have been decreasing since 1935 (2), and the rates for the Hispanic population have been declining since the late 1990s (3). Data for 2011 maintain that trend. The figures presented in this report are based on preliminary mortality data for 2011 and final data for 2000-2010.

Death in the United States, 2010.

Data from the National Vital Statistics System (Mortality) Life expectancy at birth is 78.7 years. Hispanic females have the longest life expectancy (83.8 years) followed by non-Hispanic white females (81.1 years). The largest decrease in mortality between the years 2000 and 2010 occurred in the age group under age 25 years (15.8 percent), followed by those aged 65 years and over (13.3 percent). States in the southeast region generally have higher death rates than those in other regions of the country. In 2010, the five leading causes of death were: heart disease, cancer, chronic lower respiratory diseases, stroke, and accidents. The ranking of conditions varies according to demographics such as age, sex, and race. The infant mortality rate reached a record-low level of 6.14 infant deaths per 1,000 live births in 2010.