Do you want to avoid the hassle of traveling with your printed poster? IAPHS2026 is pleased to make poster printing available to you through our supplier PosterSessionOnline. Your poster will be professionally reviewed, printed and shipped directly to Portland and you will be able to pick it up from the Poster desk. Click here to learn more.
Primary Submission Category: Mortality
Inequitable improvements in the US drug overdose crisis
Authors: Mathew Kiang, Antonino Polizzi, Monica Alexander, Corinne Riddell,
Presenting Author: Mathew Kiang*
From 1999 to 2023, the US drug-related mortality rate increased from 6 deaths per 100,000 (95% Uncertainty Interval [UI]: 5.8, 6.2) to 31 deaths per 100,000 (95% UI: 30.0, 31.6). Over this 24-year period, there were only two instances of significant year-over-year declines in mortality: first in 2018, when there was a decrease of 1.0 deaths per 100,000 (95% UI: -1.9, -0.2), and again in 2023, when there was a decrease of 1.3 deaths per 100,000 (95% UI: -2.4, -0.1). Understanding why (ie, which substances), where, and who benefitted from these improvements is essential for informing public health interventions.
We use a demographic decomposition on the CDC restricted-use multiple cause of death data to examine these declines in drug-related mortality in 2018 and 2023. Using a Kitagawa decomposition, we quantify the contribution of mutually-exclusive drug categories to the decrease in the national age-standardized drug-related mortality rate by both geography and sociodemographic subgroups.
We found stark geographic, pharmacologic, and sociodemographic differences between the 2018 decline and the 2023 decline. Geographically, the 2018 decline was highly concentrated: 3 states accounted for 80% of the national decline, and all states that had a decline were located in the Eastern US, except for Alaska. In contrast, the 2023 decline was geographically diffuse with 6 states accounting for 75% of the decline. Pharmacologically, the entirety of the 2018 decline was driven by a reduction in non-fentanyl drug deaths. Conversely, the 2023 decline was driven entirely by a drop in fentanyl-involved deaths. Sociodemographically, the decline was driven exclusively by lower mortality in the non-Hispanic white population in both 2018 (-1.9; 95% UI: -2.9, -0.8) and 2023 (-2.6; 95% UI: -3.8, -1.4).
These preliminary results show that demographic decomposition methods provide insight into targeted, equitable interventions and policies to reduce drug-related mortality in the US.