Poisoned to Death
Christopher J. Ruhm
University of Virginia
and NBER
# of Deaths
20000
30000
40000
50000
Fig 1A: Poisoning and Motor Vehicle Deaths
10000
Poisoning
Drug Poisoning
Vehicle
1983
1986
1989
1992
1995 1998
Year
2001
2004
2007
2010
Mortality Rate Per 100,000
8
12
16
20
Fig 1B: Poisoning and Motor Vehicle Death Rate
4
Poisoning
Drug Poisoning
Vehicle
1983
1986
1989
1992
1995 1998
Year
2001
2004
2007
2010
Mortality Rate Per 100,000
3
6
9
12
Fig 1C: Poisoning Death Rates by Reason
0
Accidental
Suicide
Undetermined
Assault/Homicide
1983
1986
1989
1992
1995 1998
Year
2001
2004
2007
2010
.65
Share of Deaths
.75
.85
.95
Fig 1E: Drug Poisoning Share of All Poisoning Deaths
.55
All Poisoning
Accidental Poisoning
1983
1986
1989
1992
1995 1998
Year
2001
2004
2007
2010
18
Fig 2A: Sex-Specific Poisoning Death Rate
2
Mortality Rate Per 100,000
6
10
14
Poisoning: Males
Poisoning: Females
Drug Poisoning: Males
Drug Poisoning: Females
1983
1986
1989
1992
1995 1998
Year
2001
2004
2007
2010
Share of Poisoning Deaths
.55
.65
.75
.85
.95
Fig 2B: Drug Poisoning as Share of Poisoning Deaths
.45
Males
Females
1983
1986
1989
1992
1995 1998
Year
2001
2004
2007
2010
30
Fig 3A: Age-Specific Poisoning Death Rate
0
Mortality Rate Per 100,000
10
20
15-24 year olds
25-34 year olds
35-44 year olds
45-54 year olds
55-64 year olds
65+ year olds
<15 year olds
1983
1986
1989
1992
1995 1998
Year
2001
2004
2007
2010
Share of Poisoning Deaths
.55
.65
.75
.85
.95
Fig 3B: Drug Poisoning as Share of Poisoning Deaths
.45
15-24 year olds
25-34 year olds
35-44 year olds
45-54 year olds
55-64 year olds
65+ year olds
1983
1986
1989
1992
1995 1998
Year
2001
2004
2007
2010
Fig 4A: Race-Specific Poisoning Death Rate
0
Mortality Rate Per 100,000
3
6
9
12
15
White
Black
Other Nonwhite
1983
1986
1989
1992
1995 1998
Year
2001
2004
2007
2010
Share of Poisoning Deaths
.65
.75
.85
.95
Fig 4B: Drug Poisoning as Share of Poisoning Deaths
.55
White
Black
Other Nonwhite
1983
1986
1989
1992
1995 1998
Year
2001
2004
2007
2010
Non-Hispanic White
Non-Hispanic Black
Non-Hispanic Other
Hispanic
0
Mortality Rate Per 100,000
4
8
12
16
Fig 4C: Race-Ethnicity Specific Poisoning Death Rate
1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010
Year
10
Fig 5A: Education-Specific Poisoning Death Rate
0
Mortality Rate Per 100,000
2
4
6
8
< High School Graduate
High School Graduate
Some College
College Graduate
1994
1996
1998
2000
2002
2004
Year
2006
2008
2010
Share of Poisoning Deaths
.7
.75
.8
.85
.9
.95
Fig 5B: Drug Poisoning as Share of Poisoning Deaths
.65
< High School Graduate
High School Graduate
Some College
College Graduate
1994
1996
1998
2000
2002
2004
Year
2006
2008
2010
All Poisoning
Drug
Alcohol
Gas/Vapors
Other Poisoning
0
Mortality Rate Per 100,000
3
6
9
12
15
Fig 6A: Specific Underlying Causes of Poisoning Deaths
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Narcotic
Pain/Psych/Nerv
Other Drug
0
Mortality Rate Per 100,000
2
4
6
Fig 6B: Specific Underlying Causes of Drug Poisoning Deaths
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Narcotics
Psychotropics
Unspecified
Sedatives
Other Specified
>1 Drug Type
0
Mortality Rate Per 100,000
2
4
6
8
10
Fig 7A: Drug Mention Rates in Drug Poisoning Deaths
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Opioid Analgesics
Heroin
Cocaine
Other Narcotics
0
Mortality Rate Per 100,000
2
4
6
Fig 7B: Narcotics Drug Mention Rates in Drug Poisoning Deaths
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Drug Involvement in Drug Poisoning Deaths
Drug Involvement in Drug Poisoning Deaths (cont.)
Drug Mentions
Narcotics
Opioid Analgesics
Methadone
Other Op. Analgesics
Other Narcotics
1999
2010
%
58.9%
#
9,922
%
60.6%
#
23,222
23.9%
4,030
43.4%
16,651
4.7%
784
11.9%
4,577
19.9%
3,360
34.2%
13,123
42.4%
7,137
22.6%
8,667
Heroin
11.6%
1,960
7.9%
3,036
Cocaine
22.7%
3,822
10.9%
4,183
Miscellaneous
17.4%
2,931
6.7%
2,554
Sedatives
9.9%
1,662
20.0%
7,673
Benzodiazepines
6.7%
1,135
17.0%
6,497
Other Sedatives
3.9%
663
5.1%
1,963
Psychotropics
Antidepressants
14.6%
2,466
16.7%
6,420
10.4%
1,749
10.1%
3,889
Antipsychotics
1.9%
321
3.5%
1,351
Stimulants
3.2%
547
4.8%
1,854
Other Specified
6.9%
1,171
7.3%
2,809
Unspecified
50.3%
8,477
55.7%
21,346
>1 Major Drug Class
36.8%
6,202
43.3%
16,579
Drug Involvement in Drug Poisoning Deaths By UCD, 2010
Drug Mentions
All Drug
Poisonings
% [#]
Underlying Cause of Death
Pain/Psych/
Other
Narcotics
Nerv
Drugs
100.0
100.0
100.0
[14,132]
[3,633]
[20,502]
All
100.0
[38,329]
Opioid Analgesics
43.4
[16,651]
61.8
[8,733]
1.7
[61]
38.2
[7,834]
Other Narcotics
22.6
[8,667]
46.2
[6,529]
0.6
[21]
10.3
[2,104]
Sedatives
20.0
[7,673]
1.2
[173]
28.2
[1,024]
31.6
[6,469]
Psychotropics
16.7
[6,420]
0.5
[72]
65.3
[2,371]
19.3
[3,967]
Other Specified
7.3
[2,809]
0.2
[26]
2.9
[107]
13.0
[2,669]
Unspecified
55.7
[21,346]
31.4
[4,441]
41.2
[1,498]
75.0
[15,381]
43.3
[16,579]
37.5
[5,303]
40.9
[1,487]
47.7
[9,771]
>1 Drug
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Year
.75
.76
.77
.78
Share of Deaths with Specific Diagnosis
Poisoning Rate (left axis)
Drug Poisoning Rate (left axis)
Drug Specified (right axis)
.74
0
Mortality Rate Per 100,000
5
10
15
Fig 1: Poisoning Mortality and Drug Specification Rate
% Drug Poisoning Deaths, ≥1 Drug Specified
Reported vs. Adjusted Prevalence Rates
•  Probit Models
•  Dependent Variables: Drug Mentions/UCD
•  Controls:
≥ 1 Drug Specified on Death Certificate
Sex
Race (black, other nonwhite)
Hispanic
Married (currently married vs. other)
Education (4 categories)
Age (8 categories)
Census region
Day of Week
•  Average predicted values (SPECIFY = 1)
Actual and Estimated Underlying Cause of Death and Drug Mention Rates (Cont.)
1999
2010
Exclusive Drug Mentions
Reported
Adjusted
Reported
Adjusted
Opioid Analgesics
6.3%
6.7%
12.9%
[5.9%-7.6%]
Other Narcotics
23.5%
35.3%
[17.6%-19.3%]
10.4%
[33.9%-36.8%]
Sedatives
1.6%
1.8%
4.1%
4.8%
1.1%
3.5%
3.2%
3.3%
21.9%
5.5%
[4.9%-6.1%]
3.8%
[3.4%-4.2%]
2.8%
[2.7%-3.7%]
Unspecified
1.4%
[1.1%-1.6%]
[4.0%-5.5%]
Other Specified
14.3%
[13.6%-15.0%]
[1.4%-2.3%]
Psychotropics
18.4%
2.9%
[2.5%-3.2%]
25.0%
5.4%
[5.0%-5.8%]
Next Steps
Your Help Needed Here!
•  Data Constraints
–  Death Certificates contain individual data on: age, sex, race,
etc., as well as type of death, timing (restricted), location,
autoposy etc.
–  No information for those who don’t die; limits analysis of
microdata
–  Can calculate group-specific mortality rates
–  But then must do aggregate (state or county-level) analysis
Next Steps
Your Help Needed Here!
•  State/County Level Data I have collected
–  % female, non-Hispanic black, non-Hispanic other nonwhite,
Hispanic, specified age & education groups, foreign-born,
female headed households
–  Personal/household income, unemployment, poverty rate
–  Population density, urbanicity, median home price, highspeed internet lines
–  % with public, private, any health insurance
–  Hospital beds, physicians, health care spending,
prescription drug spending per capita
–  Prescription drug laws (patient ID, physician exam, Rx
limits, tamper-resistant prescription form, drug monitoring
program)
Thank You!!