An Update on Deaths of Despair From Newly Released 2018 Vital Statistics

by Anne Case and Angus Deaton

Mortality rates from drug overdose in midlife (ages 25 to 64) fell between 2017 and 2018, largely the result of a decline in mortality from prescription opioids. Mortality rates from synthetic opioids (primary fentanyl) continued to rise. In addition, mortality rates from suicide and alcoholic liver disease continued to climb. This short note presents preliminary statistics on mortality by cause of death, race, education and age.

White non-Hispanics ages 25-64 (age-adjusted)

All cause mortality rate fell from 2017 to 2018 for whites (-3.9 per 100,000).

This can be accounted for by declines in drug overdose (-2.4 per 100,000) and cancer (-1.7 per 100,000). Countering these declines were increases in mortality rates from suicide (+0.1 per 100,000), alcoholic liver disease (+0.4 per 100,000), and heart disease (+0.1 per 100,000).

Change in mortality rates, white non-Hispanics, age adjusted 25-64, graph


Black non-Hispanics ages 25-64 (age-adjusted)

All cause mortality rate rose from 2017 to 2018 for blacks (+1.4 per 100,000).

A substantial decline in cancer (-3.4 per 100,000) was not enough to offset increases in mortality from heart disease (+2.0 per 100,000), drug overdose (+0.6 per 100,000), suicide (+0.6 per 100,000) and alcoholic liver disease (+0.4 per 100,000).

Change in mortality rates, black non-Hispanics, age adjusted 25-64, graph


Mortality by age, race and education

Drug overdose

Mortality rates from drug overdose in midlife (ages 25 to 64) fell between 2017 and 2018. This may signal a reduction in opioid use disorder.  However, we don’t know the extent to which access to naloxone (a medication that can reverse opioid overdose) contributed to the decline. The FDA reported 5 million units of naloxone were sold in 2017. [https://www.fda.gov/media/121182/download] It would be great if the reduction in deaths was a sign of a reduction in opioid use disorder, but we can’t tell that from the mortality statistics.

Drug overdose mortality fell between 2017 and 2018 for whites, with and without a bachelor’s degree, in almost every five-year age group. However, for blacks, drug overdose mortality continued to rise (albeit more slowly) in half of all five-year age groups, in both education groups (BA and no-BA).

Differences in trends between black and white drug mortality have been the rule and not the exception since the early 1990s. Black drug mortality had been stable from the early 1990s until the arrival of street fentanyl in the early 20-teens, while white drug mortality began rising in the early 1990s (before the arrival of OxyContin). Between 2017 and 2018, deaths involving heroin fell for both blacks and whites, and deaths involving fentanyl rose for both groups. The prescription opioid crisis was more severe for whites than for blacks and, between 2017 and 2018, white mortality from “other opioids” fell by 1.6 per 100,000 (from 10.5 to 8.9 per 100,000), suggesting progress is being made in controlling the supply of prescription opioids. Blacks were less likely to die from prescription opioids, and while black mortality from “other opioids” fell between 2017 and 2018, the fall was smaller than it was for whites – falling from 5.0 to 4.6 per 100,000 – and was not enough to compensate for the increase in deaths involving fentanyl.

drug overdose graphs


Suicide

Suicide rates rose between 2017 and 2018 for both blacks and whites in both educational groups (BA and no BA), although rates are markedly lower for those with a four-year degree, especially among whites.

suicide rates graphs


Alcoholic liver disease

For both black and white non-Hispanics without a four-year college degree, mortality rates from alcoholic liver disease rose between 2017 and 2018, in almost every five-year age group. For whites, this is a continuation of a trend that began in the 1990s. For blacks, after two decades of progress against alcoholic liver disease, progress stalled around 2010, and rates for less-educated blacks began to rise. Particularly disturbing for both groups are increases in alcoholic liver disease mortality among those in their thirties, which suggests heavier drinking at earlier ages.  

alcoholic liver disease graphs

 

Deaths of Despair strike women too

An Update on Deaths of Despair From Newly Released 2018 Vital Statistics

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