Drug Overdose Deaths among Kentucky Residents, 2000-2016 · Drug Overdose Deaths among Kentucky...

Kentucky Injury Prevention and Research Center

Drug Overdose Deaths

among Kentucky

Residents, 2000-2016 January, 2018

Prepared by

David Akers MA, MS

Peter Rock, MPH

Svetla Slavova, PhD

Terry L. Bunn, PhD

Released by

Kentucky Injury Prevention and Research Center (KIPRC),

bona fide agent of the Kentucky Department for Public Health

333 Waller Avenue, Suite 242

Lexington, Kentucky 40504

For more information contact

David Akers

E-mail: [email protected]

1

Executive Summary

1. The age adjusted drug overdose death rate among Kentucky residents was 33.5 deaths per

100,000 residents in 2016 (Figure 2), ranking 5th behind West Virginia, Ohio, New Hampshire,

and Pennsylvania.

2. There were 1,419 deaths among Kentucky residents in 2016 (Figure 3). This is an increase of

11.5% from the 1,273 deaths in 2015, and marks the third straight year of increase in drug

overdose deaths among Kentucky residents.

3. The age adjusted drug overdose death rate among Kentucky residents of 33.5 deaths per

100,000 residents in 2016 was 69% higher than the national age adjusted drug overdose death

rate of 19.8 (Figure 4).

4. The 25-34, 35-44, and 45-54 age groups were also the age groups in Kentucky that deviated the

most from the national rates from 2014-2016 (Figure 5). The rate of drug overdose deaths

among the 25-34 age group was 48.7 per 100,000 Kentucky residents versus 34.6/100,000

nationally. The rate of drug overdose deaths among the 35-44 age group was 62.6/100,000

versus 35.0/100,000 nationally. The rate of drug overdose deaths among the 45-54 age group

was 53.9/100,000 versus 34.5/100,000 nationally.

5. The age group with the highest drug overdose death rate among Kentucky residents in 2016 was

the 35-44 age group with a rate of 77.6 deaths per 100,000 residents, followed by the 45-54 age

group (57.3/100,000), and the 25-44 age group (53.5/100,000) (Figure 6).

6. The age adjusted drug overdose death rate among male Kentucky residents was 41.9 per

100,000 residents in 2016, higher than the female rate of 25.1/100,000 (Figure 7); both rates

were greater than their national counterparts of 26.2/100,000 male residents and 13.4/100,000

female residents.

7. The age adjusted heroin overdose death rate of deaths among Kentucky residents was 7.6 per

100,000 residents in 2016, higher than the national rate of 4.9/100,000 (Figure 10). This rate

increased from 0.9/100,000 in 2010 to 7.6/ 100,000 residents in 2016 among Kentucky

residents, while the national rate increased from 1.0/100,000 to 4.9/100,000 over the same

time period.

8. The age adjusted synthetic opioid (other than methadone) death rate was 11.5 per 100,000

Kentucky residents in 2016, higher than the national rate of 6.2/100,000 (Figure 12). The rate of

11.5 per 100,000 Kentucky residents in 2016 marked a third straight year of increase from the

rate of 1.7/100,000 observed in 2013.

9. The age adjusted cocaine overdose death rate among Kentucky residents was 3.5 per 100,000

residents in 2016, similar to the national rate of 3.2/100,000 in 2016 (Figure 13). This is more

than double the rate of 1.7/100,000 observed in 2014.

10. The age adjusted drug overdose death rate of deaths among Kentucky Appalachian residents

was 29.8 per 100,000 residents in 2016, and 34.7 per 100,000 resident in 2016 among Non-

Appalachian Kentucky residents (Figure 14).

2

Figure 2: States with the Highest Age Adjusted Drug Overdose Death Rates, 2016

State Total Drug Overdose Deaths

Population Crude Rate per 100,000

Age Adjusted Rate per 100,000

1. West Virginia 884 1,831,102 48.3 52.0

2. Ohio 4,329 11,614,373 37.3 39.1

3. New Hampshire 481 1,334,795 36.0 39.0

4. Pennsylvania 4,627 12,784,227 36.2 37.9

5. Kentucky 1,419 4,436,974 32.0 33.5

6. Maryland 2,044 6,016,447 34.0 33.2

7. Massachusetts 2,227 6,811,779 32.7 33.0

8. Rhode Island 326 1,056,426 30.9 30.8

9. Delaware 282 952,065 29.6 30.8

10. Maine 353 1,331,479 26.5 28.7

11. Connecticut 971 3,576,452 27.1 27.4

12. New Mexico 500 2,081,015 24.0 25.2

13. Tennessee 1,630 6,651,194 24.5 24.5

14. Michigan 2,347 9,928,300 23.6 24.4

15. Indiana 1,526 6,633,053 23.0 24.0 Produced by the Kentucky Injury Prevention and Research Center (KIPRC), as bona fide agent for the Kentucky Department for Public Health, January 2017. Data sources: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2016 on CDC WONDER Online Database, released December, 2017. Data are from the Multiple Cause of Death Files, 1999-2016, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10.html on Jan 8, 2018. Data are provisional and subject to change.

10.4

10.1

11.2

11.7

25.220.3

21.76.4

8.4

16.6

11.9

17.6

14

11.1

22.4

12.515.2

18

10.6

21.5

23.6

14.5

24

13.3

18.9

19.3

23.7

16.2

19.7

12.1

21.8

37.9

52

24.5

24.4

39.1

33.516.7

28.7

18.1

3933

33.2

22.2

23.2

27.4

30.8

Figure 1: Age Adjusted Drug Overdose Mortality Rates by State, 2016

Age Adjusted Rate

6.4 - 12.5

12.6 - 17.6

17.7 - 22.2

22.3 - 28.7

28.8 - 52.0

Produced by the Kentucky Injury Prevention and Research Center (KIPRC), a bona fide agent for the Kentucky Department for Public Health,

January 2017. Data sources: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2016on CDC WONDER Online Database, released December, 2017. Data are from the Multiple Cause of Death Files, 1999-2016, as compiled from

data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-

icd10.htmlon Jan 8, 2018. Data are provisional and subject to change.

16.8

12.8

0 500 1,000250 Miles

0 600 1,200300 Miles

0 300 600150 Miles

Figure 1:

Produced by the Kentucky Injury Prevention and Research Center (KIPRC), as bona fide agent for the Kentucky Department for Public Health, January 2017. Data sources: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2016 on CDC WONDER Online Database, released December, 2017. Data are from the Multiple Cause of Death Files, 1999-2016, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10.html on Jan 8, 2018. Data are provisional and subject to change.

http://wonder.cdc.gov/mcd-icd10.html

http://wonder.cdc.gov/mcd-icd10.html

3

197 241 345

426

560 526

638 728 708

764 769

1,007 1,058 1,078

1,019 1,077

1,273

1,419

-

200

400

600

800

1,000

1,200

1,400

1,600

Nu

mb

er o

f D

eath

s

Year

Figure 3: Number of Drug Overdose Deaths among Kentucky Residents, 1999-2016

Produced by the Kentucky Injury Prevention and Research Center (KIPRC), as bona fide agent for the Kentucky Department for Public Health, January 2017. Data sources: Centers for Disease Control and Prevention, National Center for Health Statistics.Multiple Cause of Death 1999-2016 on CDC WONDER Online Database, released December, 2017. Data are from the Multiple Cause of Death Files, 1999-2016, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10.htmlon Jan 8, 2018. Data are provisional and subject to change.

4.9 5.9

8.410.5

13.6 12.815.3

17.4 16.717.9 18

23.625 25

23.7 24.7

29.9

33.5

6.1 6.2

6.88.2 8.9 9.4 10.1

11.5 11.9 11.9 11.9 12.3 13.2 13.1 13.8 14.716.3

19.8

0

5

10

15

20

25

30

35

40

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Age

Ad

just

ed R

ate

per

10

0,0

00

Res

iden

ts

Year

Figure 4: Age Adjusted Drug Overdose Mortality Rates for Kentucky vs. US Residents, 1999-2016

Kentucky

US


4

3.7

8.2

25.6

34.5

35

34.6

12.4

4.3

7.1

31.5

53.9

62.6

48.7

12.8

0 10 20 30 40 50 60 70

75+ years

65-74 years

55-64 years

45-54 years

35-44 years

25-34 years

15-24 years

Rate per 100,000 residents

Age

Gro

up

Figure 5: Drug Overdose Death Rates for Kentucky vs. US Residents by Age Group, 2014-2016

Kentucky

US

Produced by the Kentucky Injury Prevention and Research Center (KIPRC), as bona fide agent for the Kentucky Department for Public Health, January 2017. Data sources: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2016 on CDC WONDER Online Database, released December, 2017. Data are from the Multiple Cause of Death Files, 1999-2016, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10.htmlon Jan 8, 2018. Data are provisional and subject to change.

0

10

20

30

40

50

60

70

80

90

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Rat

e p

er 1

00

,00

0 R

esid

ents

Year

Figure 6: Drug Overdose Death Rates by Age Group among Kentucky Residents, 2007-2016

15-24 years

25-34 years

35-44 years

45-54 years

55-64 years

65+ years

Produced by the Kentucky Injury Prevention and Research Center (KIPRC), as bona fide agent for the Kentucky Department for Public Health, January 2017. Data sources: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2016 on CDC WONDER Online Database, released December, 2017. Data are from the Multiple Cause of Death Files, 1999-2016, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10.htmlonJan 8, 2018. Data are provisional and subject to change.

5

25.1

41.9

13.4

26.2

0

5

10

15

20

25

30

35

40

45

Female Male

Age

Ad

just

ed R

ate

per

10

0,0

00

Res

iden

ts

Gender

Figure 7: Drug Overdose Age Adjusted Death Rates by Gender for Kentucky vs. US Residents, 2016

Kentucky

US


21.7 21.8 22.5

29.230.7 30.6 29.9 30.8

36.6

41.9

11.614.1 13.4

17.919.4 19.2

17.5 18.6

23.325.1

0

5

10

15

20

25

30

35

40

45

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016Age

Ad

just

ed R

ate

per

10

0,0

00

Res

iden

ts

Year

Figure 8: Drug Overdose Age Adjusted Death Rates by Gender among Kentucky Residents, 2007-2016

Male

Female


6

0

2

4

6

8

10

12

14

2010 2011 2012 2013 2014 2015 2016

Age

Ad

just

ed R

ate

per

10

0,0

00

Res

iden

ts

Year

Figure 9: Kentucky Resident Drug Overdose Death Rates by Involved Drug(s), 2010-2016

Heroin (T40.1) Natural and Semi-synthetic Opioids (T40.2)

Methadone (T40.3) Synthetic Opioids other than Methadone (T40.4)

Cocaine (T40.5) Benzodiazepines (T42.2)

Deaths were counted under each relevant category. Produced by the Kentucky Injury Prevention and Research Center (KIPRC), as bona fide agent for the Kentucky Department for Public Health, January 2017. Data sources: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2016 on CDC WONDER Online Database, released December, 2017. Data are from the Multiple Cause of Death Files, 1999-2016, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10.htmlon Jan 8, 2018. Data are provisional and subject to change.

0.91.3

3.4

5.15.5

7.4 7.6

11.4

1.9

2.7

3.4

4.1

4.9

0

1

2

3

4

5

6

7

8

2010 2011 2012 2013 2014 2015 2016

Age

Ad

just

ed R

ate

per

10

0,0

00

Res

iden

ts

Year

Figure 10: Age Adjusted Heroin Overdose Fatality Rates (T40.1) for Kentucky vs. US Residents, 2007-2016

Kentucky

US


7

10.311.1

9

8 7.7

8.99.3

3.5 3.7 3.5 3.5 3.8 3.94.4

0

2

4

6

8

10

12

2010 2011 2012 2013 2014 2015 2016

Age

Ad

just

ed R

ate

per

10

0,0

00

Res

iden

ts

Year

Figure 11: Age Adjusted Rates for Deaths Involving Natural and Semi-synthetic Opioids (T40.2) for Kentucky vs. US Residents,

2007-2016

Kentucky

US


1.3 1.7 1.6 1.7

4.3

7.9

11.5

1.0 0.8 0.8 1.01.8

3.1

6.2

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

2010 2011 2012 2013 2014 2015 2016

Age

Ad

just

ed R

ate

Per

10

0,0

00

Res

iden

ts

Year

Figure 12: Age Adjusted Rates for Deaths Involving Synthetic Opioids Other than Methadone (T40.4) for Kentucky vs. US

Residents, 2007-2016

Kentucky

US


8

1.8

1.4

0.9 0.9 0.8

1.3

1.8

1.7

2.4

3.5

2.2

1.7

1.4 1.31.5 1.4

1.6

1.72.1

3.2

0

0.5

1

1.5

2

2.5

3

3.5

4

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Age

Ad

just

ed R

ate

per

10

0,0

00

Res

iden

ts

Year

Figure 13: Age Adjusted Cocaine Fatality Rates (T40.5) for Kentucky vs. US Residents, 2007-2016

Kentucky

US


25.1

28.7 28.6

39.8 42.3

34.1

28.229.7

35.1

29.8

13.8 13.7 13.9

17.418.8

21.8 22.1 22.8

27.8

34.7

0

5

10

15

20

25

30

35

40

45

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016Age

Ad

just

ed R

ate

per

10

0,0

00

Res

iden

ts

Year

Appalachia

Non-Appalachia


Figure 14: Age Adjusted Drug Overdose Fatality Rates for Kentucky Appalachian vs. Non-Appalachian Residents, 2007-2016

9

Appendix

This report presents drug overdose mortality data for Kentucky residents. The data

source for the report is the U.S. Multiple Cause of Death files, 1999-2016, accessible through

the CDC WONDER online query system http://wonder.cdc.gov/mcd-icd10.html. The Multiple

Cause of Death database contains mortality and population counts for all U.S. counties. Data

are based on death certificates for U.S. residents.

Typically, when a drug overdose death occurs, the coroner completes a death certificate

and lists the causes of death and information on how the death occurred. This information/text

is then transferred in an electronic record that is sent to the National Center for Health

Statistics (NCHS) at the Centers for Disease Control and Prevention (CDC ) to be coded

according to the guidelines of the Tenth Revision of the International Classification of Diseases

(ICD-10) [www.who.int/classifications/icd10/] to allow standardized classification of the causes

of death. Each death certificate is assigned a single underlying cause of death and up to twenty

additional multiple causes of death. The underlying cause of death is defined as the reason that

initiated the chain of events leading directly to death.

For example, the death described below is coded with an underlying cause of death

being unintentional drug overdose (X42 Accidental poisoning and exposure to narcotics and

psychodysleptics). The following additional multiple causes of death were assigned based on

the information listed on the death certificate: T40.3 Methadone, G93.1 Anoxic brain damage,

T50.9 Other and unspecified drugs.

http://www.who.int/classifications/icd10/

10

When the information on the death certificate is not specific enough and there is no

mention of a particular drug contributing to the death, the death cannot be associated with a

drug/drug class. For example, about one third of the death certificates for drug overdose cases

in Kentucky list only “drug overdose”, “drug toxicity”, “acute drug intoxication”, or

“polypharmacy intoxication”, with no mention of particular drugs involved. Therefore, the

involvement of pharmaceutical opioids or heroin in Kentucky resident overdose deaths could

be underestimated as about one third of the overdose deaths are not associated with specific

drugs. When an overdose death involves multiple drugs from different classes (for example

heroin and methadone), each drug will receive appropriate ICD-10-coded cause of death (T40.1

for heroin, T40. 3 for methadone) and the death will be counted under both categories of drugs

(heroin-associated deaths and pharmaceutical opioid-associated deaths). If an overdose death

involves multiple drugs from the same drug class, only one multiple cause of death ICD-10 code

will be assigned. For example, if oxycodone and hydrocodone are both listed on a death

certificate, their involvement will be coded with one ICD-10 code (T40.2) that represents the

involvement of natural or semi-synthetic opioids.

Definition: Drug overdose deaths were identified as deaths with an underlying cause of death

in the following ICD-10 code range: X40-X44(accidental/unintentional drug poisoning), X60-

X64(suicide by drug poisoning), X85(homicide by drug poisoning), and Y10-Y14 (drug poisoning

with undetermined intent).

X40 (Accidental poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics)

X41 (Accidental poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere

classified)

X42 (Accidental poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified)

X43 (Accidental poisoning by and exposure to other drugs acting on the autonomic nervous system)

X44 (Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances)

X60 (Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics)

X61 (Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not

elsewhere classified)

X62 (Intentional self-poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified)

X63 (Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system)

X64 (Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substances)

X85 (Assault by drugs, medicaments and biological substances)

Y10 (Poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics, undetermined intent)

Y11 (Poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified,

undetermined intent)

Y12 (Poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified, undetermined intent)

Y13 (Poisoning by and exposure to other drugs acting on the autonomic nervous system, undetermined intent)

Y14 (Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, undetermined intent)

The types of drugs contributing to drug overdose deaths can be identified using ICD-10

codes T36-T50.9 listed in any of the multiple causes of death fields. In this report we included

statistics on drug overdose deaths involving heroin (T40.1), pharmaceutical opioids (T40.2,

T40.3, or T40.4), cocaine ( T40.5), or benzodiazepines (T42.4).

11

Age-adjusted morbidity and mortality rates were based on 2000 U.S. standard

population data.

Previous reports (http://www.mc.uky.edu/kiprc/projects/kdodhedv/index.html) on

Kentucky resident drug overdose deaths were based on data from the state Office of Vital

Statistics and therefore the numbers do not necessarily match with the numbers presented in

this report.

Drug Overdose Deaths among Kentucky Residents, 2000-2016 · Drug Overdose Deaths among Kentucky...

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