Rank, number of deaths, percentage of deaths, and age-specific mortality rates for the leading causes of death, by age group and sex, 2000 to most recent year.

Content

This data contains provisional counts for drug overdose deaths based on a current flow of mortality data in the National Vital Statistics System. Counts for the most recent final annual data are provided for comparison. National provisional counts include deaths occurring within the 50 states and the District of Columbia as of the date specified and may not include all deaths that occurred during a given time period. Provisional counts are often incomplete and causes of death may be pending investigation (see Technical notes) resulting in an underestimate relative to final counts. To address this, methods were developed to adjust provisional counts for reporting delays by generating a set of predicted provisional counts (see Technical notes). Starting in June 2018, this monthly data release will include both reported and predicted provisional counts.

The provisional data include: (a) the reported and predicted provisional counts of deaths due to drug overdose occurring nationally and in each jurisdiction; (b) the percentage changes in provisional drug overdose deaths for the current 12 month-ending period compared with the 12-month period ending in the same month of the previous year, by jurisdiction; and (c) the reported and predicted provisional counts of drug overdose deaths involving specific drugs or drug classes occurring nationally and in selected jurisdictions. The reported and predicted provisional counts represent the numbers of deaths due to drug overdose occurring in the 12-month periods ending in the month indicated. These counts include all seasons of the year and are insensitive to variations by seasonality. Deaths are reported by the jurisdiction in which the death occurred.

Several data quality metrics, including the percent completeness in overall death reporting, percentage of deaths with cause of death pending further investigation, and the percentage of drug overdose deaths with specific drugs or drug classes reported are included to aid in interpretation of provisional data as these measures are related to the accuracy of provisional counts (see Technical notes). Reporting of the specific drugs and drug classes involved in drug overdose deaths varies by jurisdiction, and comparisons of death rates involving specific drugs across selected jurisdictions should not be made (see Technical notes). Provisional data will be updated on a monthly basis as additional records are received.

Technical notes

Nature and sources of data

Provisional drug overdose death counts are based on death records received and processed by the National Center for Health Statistics (NCHS) as of a specified cutoff date. The cutoff date is generally the first Sunday of each month. National provisional estimates include deaths occurring within the 50 states and the District of Columbia. NCHS receives the death records from state vital registration offices through the Vital Statistics Cooperative Program (VSCP).

The timeliness of provisional mortality surveillance data in the National Vital Statistics System (NVSS) database varies by cause of death. The lag time (i.e., the time between when the death occurred and when the data are available for analysis) is longer for drug overdose deaths compared with other causes of death (1). Thus, provisional estimates of drug overdose deaths are reported 6 months after the date of death.

Provisional death counts presented in this data visualization are for “12-month ending periods,” defined as the number of deaths occurring in the 12-month period ending in the month indicated. For example, the 12-month ending period in June 2017 would include deaths occurring from July 1, 2016, through June 30, 2017. The 12-month ending period counts include all seasons of the year and are insensitive to reporting variations by seasonality. Counts for the 12-month period ending in the same month of the previous year are shown for comparison. These provisional counts of drug overdose deaths and related data quality metrics are provided for public health surveillance and monitoring of emerging trends. Provisional drug overdose death data are often incomplete, and the degree of completeness varies by jurisdiction and 12-month ending period. Consequently, the numbers of drug overdose deaths are underestimated based on provisional data relative to final data and are subject to random variation. Methods to adjust provisional counts have been developed to provide predicted provisional counts of drug overdose deaths, accounting for delayed reporting (see Percentage of records pending investigation and Adjustments for delayed reporting).

Provisional data are based on available records that meet certain data quality criteria at the time of analysis and may not include all deaths that occurred during a given time period. Therefore, they should not be considered comparable with final data and are subject to change.

Cause-of-death classification and definition of drug deaths Mortality statistics are compiled in accordance with World Health Organization (WHO) regulations specifying that WHO member nations classify and code causes of death with the current revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). ICD provides the basic guidance used in virtually all countries to code and classify causes of death. It provides not only disease, injury, and poisoning categories but also the rules used to select the single underlying cause of death for tabulation from the several diagnoses that may be reported on a single death certificate, as well as definitions, tabulation lists, the format of the death certificate, and regulations on use of the classification. Causes of death for data presented in this report were coded according to ICD guidelines described in annual issues of Part 2a of the NCHS Instruction Manual (2).

Drug overdose deaths are identified using underlying cause-of-death codes from the Tenth Revision of ICD (ICD–10): X40–X44 (unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined). Drug overdose deaths involving selected drug categories are identified by specific multiple cause-of-death codes. Drug categories presented include: heroin (T40.1); natural opioid analgesics, including morphine and codeine, and semisynthetic opioids, including drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone (T40.2); methadone, a synthetic opioid (T40.3); synthetic opioid analgesics other than methadone, including drugs such as fentanyl and tramadol (T40.4); cocaine (T40.5); and psychostimulants with abuse potential, which includes methamphetamine (T43.6). Opioid overdose deaths are identified by the presence of any of the following MCOD codes: opium (T40.0); heroin (T40.1); natural opioid analgesics (T40.2); methadone (T40.3); synthetic opioid analgesics other than methadone (T40.4); or other and unspecified narcotics (T40.6). This latter category includes drug overdose deaths where ‘opioid’ is reported without more specific information to assign a more specific ICD–10 code (T40.0–T40.4) (3,4). Among deaths with an underlying cause of drug overdose, the percentage with at least one drug or drug class specified is defined as that with at least one ICD–10 multiple cause-of-death code in the range T36–T50.8.

Drug overdose deaths may involve multiple drugs; therefore, a single death might be included in more than one category when describing the number of drug overdose deaths involving specific drugs. For example, a death that involved both heroin and fentanyl would be included in both the number of drug overdose deaths involving heroin and the number of drug overdose deaths involving synthetic opioids other than methadone.

Selection of specific states and other jurisdictions to report Provisional counts are presented by the jurisdiction in which the death occurred (i.e., the reporting jurisdiction). Data quality and timeliness for drug overdose deaths vary by reporting jurisdiction. Provisional counts are presented for reporting jurisdictions based on measures of data quality: the percentage of records where the manner of death is listed as “pending investigation,” the overall completeness of the data, and the percentage of drug overdose death records with specific drugs or drug classes recorded. These criteria are defined below.

Percentage of records pending investigation

Drug overdose deaths often require lengthy investigations, and death certificates may be initially filed with a manner of death “pending investigation” and/or with a preliminary or unknown cause of death. When the percentage of records reported as “pending investigation” is high for a given jurisdiction, the number of drug overdose deaths is likely to be underestimated. For jurisdictions reporting fewer than 1% of records as “pending investigation”, the provisional number of drug overdose deaths occurring in the fourth quarter of 2015 was approximately 5% lower than the final count of drug overdose deaths occurring in that same time period. For jurisdictions reporting greater than 1% of records as “pending investigation” the provisional counts of drug overdose deaths may underestimate the final count of drug overdose deaths by as much as 30%. Thus, jurisdictions are included in Table 2 if 1% or fewer of their records in NVSS are reported as “pending investigation,” following a 6-month lag for the 12-month ending periods included in the dashboard. Values for records pending investigation are updated with each monthly release and reflect the most current data available.

Percent completeness

NCHS receives monthly counts of the estimated number of deaths from each jurisdictional vital registration offices (referred to as “control counts”). This number represents the best estimate of how many deaths occurred in a given jurisdiction in each month. Death records in the NVSS database must have

Social vulnerability is defined as the disproportionate susceptibility of some social groups to the impacts of hazards, including death, injury, loss, or disruption of livelihood. In this dataset from Climate Ready Boston, groups identified as being more vulnerable are older adults, children, people of color, people with limited English proficiency, people with low or no incomes, people with disabilities, and people with medical illnesses. Source:The analysis and definitions used in Climate Ready Boston (2016) are based on "A framework to understand the relationship between social factors that reduce resilience in cities: Application to the City of Boston." Published 2015 in the International Journal of Disaster Risk Reduction by Atyia Martin, Northeastern University.Population Definitions:Older Adults:Older adults (those over age 65) have physical vulnerabilities in a climate event; they suffer from higher rates of medical illness than the rest of the population and can have some functional limitations in an evacuation scenario, as well as when preparing for and recovering from a disaster. Furthermore, older adults are physically more vulnerable to the impacts of extreme heat. Beyond the physical risk, older adults are more likely to be socially isolated. Without an appropriate support network, an initially small risk could be exacerbated if an older adult is not able to get help.Data source: 2008-2012 American Community Survey 5-year Estimates (ACS) data by census tract for population over 65 years of age.Attribute label: OlderAdultChildren: Families with children require additional resources in a climate event. When school is cancelled, parents need alternative childcare options, which can mean missing work. Children are especially vulnerable to extreme heat and stress following a natural disaster.Data source: 2010 American Community Survey 5-year Estimates (ACS) data by census tract for population under 5 years of age.Attribute label: TotChildPeople of Color: People of color make up a majority (53 percent) of Boston’s population. People of color are more likely to fall into multiple vulnerable groups aswell. People of color statistically have lower levels of income and higher levels of poverty than the population at large. People of color, many of whom also have limited English proficiency, may not have ready access in their primary language to information about the dangers of extreme heat or about cooling center resources. This risk to extreme heat can be compounded by the fact that people of color often live in more densely populated urban areas that are at higher risk for heat exposure due to the urban heat island effect.Data source: 2008-2012 American Community Survey 5-year Estimates (ACS) data by census tract: Black, Native American, Asian, Island, Other, Multi, Non-white Hispanics.Attribute label: POC2Limited English Proficiency: Without adequate English skills, residents can miss crucial information on how to preparefor hazards. Cultural practices for information sharing, for example, may focus on word-of-mouth communication. In a flood event, residents can also face challenges communicating with emergency response personnel. If residents are more sociallyisolated, they may be less likely to hear about upcoming events. Finally, immigrants, especially ones who are undocumented, may be reluctant to use government services out of fear of deportation or general distrust of the government or emergency personnel.Data Source: 2008-2012 American Community Survey 5-year Estimates (ACS) data by census tract, defined as speaks English only or speaks English “very well”.Attribute label: LEPLow to no Income: A lack of financial resources impacts a household’s ability to prepare for a disaster event and to support friends and neighborhoods. For example, residents without televisions, computers, or data-driven mobile phones may face challenges getting news about hazards or recovery resources. Renters may have trouble finding and paying deposits for replacement housing if their residence is impacted by flooding. Homeowners may be less able to afford insurance that will cover flood damage. Having low or no income can create difficulty evacuating in a disaster event because of a higher reliance on public transportation. If unable to evacuate, residents may be more at risk without supplies to stay in their homes for an extended period of time. Low- and no-income residents can also be more vulnerable to hot weather if running air conditioning or fans puts utility costs out of reach.Data source: 2008-2012 American Community Survey 5-year Estimates (ACS) data by census tract for low-to- no income populations. The data represents a calculated field that combines people who were 100% below the poverty level and those who were 100–149% of the poverty level.Attribute label: Low_to_NoPeople with Disabilities: People with disabilities are among the most vulnerable in an emergency; they sustain disproportionate rates of illness, injury, and death in disaster events.46 People with disabilities can find it difficult to adequately prepare for a disaster event, including moving to a safer place. They are more likely to be left behind or abandoned during evacuations. Rescue and relief resources—like emergency transportation or shelters, for example— may not be universally accessible. Research has revealed a historic pattern of discrimination against people with disabilities in times of resource scarcity, like after a major storm and flood.Data source: 2008-2012 American Community Survey 5-year Estimates (ACS) data by census tract for total civilian non-institutionalized population, including: hearing difficulty, vision difficulty, cognitive difficulty, ambulatory difficulty, self-care difficulty, and independent living difficulty. Attribute label: TotDisMedical Illness: Symptoms of existing medical illnesses are often exacerbated by hot temperatures. For example, heat can trigger asthma attacks or increase already high blood pressure due to the stress of high temperatures put on the body. Climate events can interrupt access to normal sources of healthcare and even life-sustaining medication. Special planning is required for people experiencing medical illness. For example, people dependent on dialysis will have different evacuation and care needs than other Boston residents in a climate event.Data source: Medical illness is a proxy measure which is based on EASI data accessed through Simply Map. Health data at the local level in Massachusetts is not available beyond zip codes. EASI modeled the health statistics for the U.S. population based upon age, sex, and race probabilities using U.S. Census Bureau data. The probabilities are modeled against the census and current year and five year forecasts. Medical illness is the sum of asthma in children, asthma in adults, heart disease, emphysema, bronchitis, cancer, diabetes, kidney disease, and liver disease. A limitation is that these numbers may be over-counted as the result of people potentially having more than one medical illness. Therefore, the analysis may have greater numbers of people with medical illness within census tracts than actually present. Overall, the analysis was based on the relationship between social factors.Attribute label: MedIllnesOther attribute definitions:GEOID10: Geographic identifier: State Code (25), Country Code (025), 2010 Census TractAREA_SQFT: Tract area (in square feet)AREA_ACRES: Tract area (in acres)POP100_RE: Tract population countHU100_RE: Tract housing unit countName: Boston Neighborhood