Source/Disclosures
Disclosures: One study author reports receiving grants from Health Research Board Ireland during the conduct of the study. The other study authors report no relevant financial disclosures.
September 15, 2020
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‘Deaths of despair’ have increased along demographic, geographic lines

Source/Disclosures
Disclosures: One study author reports receiving grants from Health Research Board Ireland during the conduct of the study. The other study authors report no relevant financial disclosures.
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Increasing death rates related to drug poisonings, suicide and alcohol varied significantly based on demographics and geography, according to results of a serial cross-sectional study published in JAMA Network Open.

“By 2017, death rates due to drug poisonings had increased 3.6-fold and those due to suicide had increased 1.3-fold since 1999, while alcohol-induced deaths increased 1.4-fold during 1999 to 2017,” Meredith S. Shiels, PhD, of the division of cancer epidemiology and genetics at the National Cancer Institute, and colleagues wrote. “Collectively, these [three] causes of death have been termed deaths of despair and have been largely discussed in relation to rising death rates among white men and women without a college degree. It is important to note that increases in death rates due to these causes have not been restricted to middle-aged white individuals in nonurban America.”

man with depression sitting on bench
Source: Adobe Stock

Death rates linked to these causes increased from 2015 to 2016 across all racial/ethnic groups, according to the researchers. Further, they noted that gaining insight into the demographic and geographic characteristics would allow for targeted interventions to groups at high risk.

Shiels and colleagues analyzed national vital statistics data of U.S. residents aged 20 to 64 years from January 2000 to December 2017. Exposures included age, county level percentage of unemployment, geography, race/ethnicity and sex. The investigators categorized deaths as due to drug poisoning, suicide or alcohol-induced causes based on underlying cause of death and estimated age-standardized incidence rates and annual percentage changes in rates. They also identified clusters of high-rate counties with hot spot analysis and estimated excess deaths during the study period for each cause as the difference between observed number of deaths and expected deaths if rates had remained stable beginning in 2000.

Results showed 1,446,177 deaths due to these three causes in the U.S. for the study period. Of these, 563,765 were due to drug poisoning, 517,679 to suicide and 364,733 to alcohol, for a total of 451,596 more deaths than expected according to rates in 2000. The researchers observed a significant cluster of drug poisoning deaths among the Northeast through Appalachia; however, rates of alcohol-induced and suicide deaths appeared higher in the West. For rural areas, only suicide death rates were highest. Death rates for drug poisoning were highest among people aged 35 to 49 years, and deaths rates suicide and alcohol use were highest among people aged 50 to 64 years.

Although trajectories and inflection years vary, Shiels and colleagues noted increases over time across racial/ethnic groups. They observed recently accelerated increases in drug poisoning and alcohol-induced death rates but an increase at a constant trajectory for suicide death rates.

“This cross-sectional study found alarming recent increases in drug poisoning, suicide and alcohol-induced death rates that differed substantially by demographic and geographic factors in the U.S.,” Shiels and colleagues wrote. “Each of these causes of death represents increasing and complex causal factors requiring targeted efforts at multiple levels to reverse alarming trends, reach national and international public health goals and catch up with the steady progress in life expectancy occurring in other high-income countries.”