Decomposing Change in the Age-Standardized Drug Overdose Death Rate in the United States, 1999 to 2022

Antonino Polizzi , Max Planck Institute for Demographic Research
Monica Alexander, University of Toronto
Mathew Kiang, Stanford University

The United States is in the midst of a drug overdose crisis. Between 1999 and 2022, the national age-standardized drug overdose death rate increased five-fold from around 6 to around 33 deaths per 100,000 population. The rise in the age-standardized drug overdose death rate in the United States is the result of multiple overlapping sub-epidemics involving different drugs as well as increasing polysubstance use. Yet, previous research that describes U.S. drug overdose mortality patterns often focuses on overall drug deaths, narrowly focuses on single substances, or double counts deaths in the presence of polydrug use. Moreover, previous research exhibits a limited investigation of drug overdose mortality dynamics at the subnational level—such as by geography or race/ethnicity—and how these have contributed to the national trend in the age-standardized drug overdose death rate. Here, we systematically decompose the year-to-year change in the national age-standardized drug overdose death rate in the United States between 1999 and 2022 using Kitagawa decomposition. We identify additive contributions from (a) change in the population composition, as defined by the intersection of state, sex, and race/ethnicity; and (b) change in the state–sex–race/ethnicity–age–substance-specific death rates, using 18 mutually exclusive categories of substances and substance combinations. Our analysis uncovers important changes in the drivers of the national age-standardized drug overdose death rate over time and contributes to a more nuanced understanding of the complex mosaic of the U.S. drug overdose crisis.

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 Presented in Session 3. Flash Session Mortality Levels and Trends