TABLE 1. Opioid-involved overdose death rates and synthetic opioid–involved overdose death rates* among adults aged ≥18 years, by urbanization level,† race/ethnicity,§ and age group — National Vital Statistics System, United States, 2015–2017.
| Urbanization, Race/Ethnicity, Age Group (yrs) | Opioid-involved overdose deaths |
Opioid-involved overdose deaths involving synthetic opioids |
||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 2015 no. (rate) | 2016 no. (rate) | 2017 no. (rate) | Absolute rate change¶ | % Rate change¶ | 2015 no. (rate) | 2016 no. (rate) | 2017 no. (rate) | Absolute rate change¶ | % Rate change¶ | |
|
Large central metro
| ||||||||||
|
Black, overall
|
1,518 (11.8)
|
2,503 (19.3)
|
3,161 (24.0)
|
12.2**
|
103**
|
464 (3.6)
|
1,430 (11.0)
|
2,186 (16.6)
|
13.0**
|
361**
|
| 18–24 |
68 (3.6) |
112 (6.0) |
113 (6.2) |
2.6** |
72** |
23 (1.2) |
54 (2.9) |
80 (4.4) |
3.2** |
267** |
| 25–34 |
225 (8.6) |
368 (13.6) |
462 (16.5) |
7.9** |
92** |
79 (3.0) |
221 (8.1) |
325 (11.6) |
8.6** |
287** |
| 35–44 |
255 (11.5) |
417 (18.9) |
532 (23.9) |
12.4** |
108** |
71 (3.2) |
231 (10.5) |
354 (15.9) |
12.7** |
397** |
| 45–54 |
437 (19.3) |
730 (32.5) |
934 (41.9) |
22.6** |
117** |
130 (5.7) |
451 (20.1) |
654 (29.4) |
23.7** |
416** |
| 55–64 |
437 (21.8) |
706 (34.6) |
885 (42.7) |
20.9** |
96** |
139 (6.9) |
388 (19.0) |
619 (29.8) |
22.9** |
332** |
| ≥65 |
96 (5.2) |
170 (8.8) |
235 (11.6) |
6.4** |
123** |
22 (1.2) |
85 (4.4) |
154 (7.6) |
6.4** |
533** |
|
White, overall
|
6,636 (18.2)
|
8,251 (22.6)
|
8,989 (24.6)
|
6.4**
|
35**
|
1,743 (4.7)
|
3,633 (9.9)
|
5,038 (13.7)
|
9.0**
|
192**
|
| 18–24 |
591 (16.6) |
721 (20.7) |
703 (20.5) |
3.9** |
24** |
176 (4.9) |
324 (9.3) |
421 (12.3) |
7.4** |
149** |
| 25–34 |
1,736 (24.8) |
2,271 (32.2) |
2,484 (35.2) |
10.4** |
42** |
531 (7.6) |
1,160 (16.4) |
1,560 (22.1) |
14.5** |
191** |
| 35–44 |
1,360 (24.2) |
1,812 (32.4) |
2,039 (36.3) |
12.1** |
50** |
378 (6.7) |
902 (16.1) |
1,253 (22.3) |
15.6** |
232** |
| 45–54 |
1,503 (24.1) |
1,768 (29.0) |
1,908 (32.1) |
8.0** |
33** |
362 (5.8) |
726 (11.9) |
1,034 (17.4) |
11.6** |
199** |
| 55–64 |
1,156 (18.2) |
1,369 (21.5) |
1,462 (23.0) |
4.8** |
26** |
239 (3.8) |
447 (7.0) |
657 (10.3) |
6.5** |
174** |
| ≥65 |
290 (3.8) |
310 (3.9) |
393 (4.8) |
1.0** |
26** |
57 (0.7) |
74 (0.9) |
113 (1.4) |
0.7** |
100** |
|
Hispanic, overall††
|
1,176 (6.2)
|
1,674 (8.8)
|
1,901 (9.7)
|
3.5**
|
57**
|
238 (1.3)
|
766 (4.0)
|
1,058 (5.4)
|
4.2**
|
350**
|
| 18–24 |
152 (4.9) |
202 (6.5) |
234 (7.6) |
2.7** |
55** |
26 (0.8) |
82 (2.7) |
132 (4.3) |
3.5** |
438** |
| 25–34 |
297 (6.8) |
440 (9.9) |
512 (11.2) |
4.4** |
65** |
68 (1.5) |
203 (4.6) |
289 (6.3) |
4.8** |
320** |
| 35–44 |
287 (7.2) |
419 (10.5) |
458 (11.3) |
4.1** |
57** |
58 (1.5) |
212 (5.3) |
271 (6.7) |
5.2** |
347** |
| 45–54 |
256 (7.8) |
360 (10.8) |
420 (12.3) |
4.5** |
58** |
54 (1.7) |
173 (5.2) |
235 (6.9) |
5.2** |
306** |
| 55–64 |
151 (7.0) |
219 (9.8) |
223 (9.5) |
2.5** |
36** |
26 (1.2) |
90 (4.0) |
106 (4.5) |
3.3** |
275** |
| ≥65 |
33 (1.7) |
34 (1.7) |
54 (2.5) |
0.8 |
47 |
—§§ |
— |
25 (1.2) |
— |
— |
|
Large fringe metro
| ||||||||||
|
Black, overall
|
519 (7.2)
|
906 (12.3)
|
1,086 (14.4)
|
7.2**
|
100**
|
179 (2.5)
|
499 (6.8)
|
812 (10.8)
|
8.3**
|
332**
|
| 18–24 |
48 (4.4) |
87 (8.1) |
88 (8.1) |
3.7** |
84** |
20 (1.8) |
56 (5.2) |
62 (5.7) |
3.9** |
217** |
| 25–34 |
102 (7.3) |
220 (15.3) |
273 (18.2) |
10.9** |
149** |
44 (3.2) |
130 (9.0) |
205 (13.7) |
10.5** |
328** |
| 35–44 |
132 (9.9) |
193 (14.4) |
249 (18.2) |
8.3** |
84** |
47 (3.5) |
108 (8.0) |
197 (14.4) |
10.9** |
311** |
| 45–54 |
127 (9.3) |
232 (16.8) |
258 (18.4) |
9.1** |
98** |
36 (2.6) |
118 (8.5) |
184 (13.1) |
10.5** |
404** |
| 55–64 |
99 (9.2) |
140 (12.5) |
184 (15.8) |
6.6** |
72** |
30 (2.8) |
71 (6.3) |
137 (11.7) |
8.9** |
318** |
| ≥65 |
11 (—) |
34 (3.4) |
34 (3.3) |
— |
— |
— |
16 (—) |
27 (2.6) |
— |
— |
|
White, overall
|
7,561 (17.8)
|
10,179 (23.8)
|
11,442 (26.7)
|
8.9**
|
50**
|
2,594 (6.1)
|
5,292 (12.4)
|
7,486 (17.5)
|
11.4**
|
187**
|
| 18–24 |
801 (18.5) |
1,106 (25.8) |
1,097 (25.9) |
7.4** |
40** |
303 (7.0) |
620 (14.5) |
778 (18.4) |
11.4** |
163** |
| 25–34 |
2,283 (36.9) |
3,177 (50.9) |
3,658 (58.3) |
21.4** |
58** |
901 (14.6) |
1,887 (30.3) |
2,666 (42.5) |
27.9** |
191** |
| 35–44 |
1,738 (26.9) |
2,392 (37.5) |
2,699 (42.4) |
15.5** |
58** |
628 (9.7) |
1,318 (20.7) |
1,874 (29.4) |
19.7** |
203** |
| 45–54 |
1,644 (20.2) |
2,009 (25.1) |
2,274 (29.2) |
9.0** |
45** |
501 (6.1) |
925 (11.6) |
1,363 (17.5) |
11.4** |
187** |
| 55–64 |
911 (11.4) |
1,260 (15.6) |
1,433 (17.6) |
6.2** |
54** |
223 (2.8) |
475 (5.9) |
701 (8.6) |
5.8** |
207** |
| ≥65 |
184 (1.9) |
235 (2.4) |
281 (2.8) |
0.9** |
47** |
38 (0.4) |
67 (0.7) |
104 (1.0) |
0.6** |
150** |
|
Hispanic, overall††
|
423 (5.7)
|
674 (8.9)
|
790 (10.0)
|
4.3**
|
75**
|
123 (1.7)
|
362 (4.8)
|
531 (6.7)
|
5.0**
|
294**
|
| 18–24 |
65 (5.2) |
94 (7.5) |
95 (7.4) |
2.2** |
42** |
21 (1.7) |
48 (3.8) |
61 (4.7) |
3.0** |
177** |
| 25–34 |
128 (7.5) |
214 (12.4) |
243 (13.6) |
6.1** |
81** |
44 (2.6) |
131 (7.6) |
165 (9.2) |
6.6** |
254** |
| 35–44 |
119 (7.0) |
194 (11.2) |
210 (11.7) |
4.7** |
67** |
33 (1.9) |
106 (6.1) |
149 (8.3) |
6.4** |
337** |
| 45–54 |
71 (5.4) |
129 (9.5) |
157 (11.1) |
5.7** |
106** |
20 (1.5) |
58 (4.3) |
114 (8.0) |
6.5** |
433** |
| 55–64 |
33 (4.1) |
37 (4.4) |
73 (8.1) |
4.0** |
98** |
— |
19 (—) |
37 (4.1) |
— |
— |
| ≥65 |
— |
— |
12 (—) |
— |
— |
— |
— |
— |
— |
— |
|
Medium and small metro
| ||||||||||
|
Black, overall
|
553 (7.3)
|
776 (10.1)
|
1,036 (13.3)
|
6.0**
|
82**
|
199 (2.6)
|
387 (5.0)
|
698 (8.9)
|
6.3**
|
242**
|
| 18–24 |
36 (2.6) |
57 (4.2) |
83 (6.2) |
3.6** |
139** |
21 (1.5) |
27 (2.0) |
54 (4.0) |
2.5** |
167** |
| 25–34 |
111 (7.2) |
183 (11.6) |
231 (14.2) |
7.0** |
97** |
39 (2.5) |
99 (6.3) |
176 (10.8) |
8.3** |
332** |
| 35–44 |
146 (11.4) |
193 (15.0) |
267 (20.5) |
9.1** |
80** |
55 (4.3) |
100 (7.8) |
186 (14.3) |
10.0** |
233** |
| 45–54 |
139 (11.0) |
154 (12.2) |
219 (17.5) |
6.5** |
59** |
48 (3.8) |
78 (6.2) |
149 (11.9) |
8.1** |
213** |
| 55–64 |
99 (8.7) |
153 (13.2) |
187 (15.8) |
7.1** |
82** |
30 (2.6) |
72 (6.2) |
110 (9.3) |
6.7** |
258** |
| ≥65 |
22 (2.2) |
36 (3.4) |
49 (4.4) |
2.2** |
100** |
— |
11 (—) |
23 (2.1) |
— |
— |
|
White, overall
|
8,794 (16.4)
|
10,530 (19.6)
|
11,767 (21.9)
|
5.5**
|
34**
|
2,547 (4.8)
|
4,449 (8.3)
|
6,803 (12.6)
|
7.8**
|
163**
|
| 18–24 |
757 (11.7) |
943 (14.9) |
960 (15.4) |
3.7** |
32** |
260 (4.0) |
433 (6.8) |
634 (10.2) |
6.2** |
155** |
| 25–34 |
2,270 (27.7) |
2,963 (35.9) |
3,324 (40.2) |
12.5** |
45** |
772 (9.4) |
1,454 (17.6) |
2,203 (26.6) |
17.2** |
183** |
| 35–44 |
2,042 (26.9) |
2,552 (33.9) |
2,892 (38.3) |
11.4** |
42** |
634 (8.4) |
1,188 (15.8) |
1,816 (24.1) |
15.7** |
187** |
| 45–54 |
2,032 (22.6) |
2,228 (25.2) |
2,475 (28.7) |
6.1** |
27** |
530 (5.9) |
867 (9.8) |
1,326 (15.4) |
9.5** |
161** |
| 55–64 |
1,349 (14.0) |
1,450 (14.9) |
1,706 (17.5) |
3.5** |
25** |
292 (3.0) |
415 (4.3) |
733 (7.5) |
4.5** |
150** |
| ≥65 |
344 (2.7) |
394 (3.0) |
410 (3.1) |
0.4 |
15 |
59 (0.5) |
92 (0.7) |
91 (0.7) |
0.2** |
40** |
|
Hispanic, overall††
|
709 (7.3)
|
870 (8.8)
|
1,012 (9.9)
|
2.6**
|
36**
|
127 (1.3)
|
321 (3.2)
|
485 (4.7)
|
3.4**
|
262**
|
| 18–24 |
78 (4.2) |
110 (5.9) |
111 (5.8) |
1.6** |
38** |
20 (1.1) |
40 (2.1) |
59 (3.1) |
2.0** |
182** |
| 25–34 |
196 (8.6) |
250 (10.8) |
298 (12.5) |
3.9** |
45** |
33 (1.4) |
88 (3.8) |
159 (6.7) |
5.3** |
379** |
| 35–44 |
184 (9.2) |
231 (11.4) |
270 (12.9) |
3.7** |
40** |
37 (1.9) |
103 (5.1) |
138 (6.6) |
4.7** |
247** |
| 45–54 |
159 (10.2) |
166 (10.4) |
199 (12.1) |
1.9 |
19 |
29 (1.9) |
57 (3.6) |
87 (5.3) |
3.4** |
179** |
| 55–64 |
77 (7.3) |
93 (8.4) |
117 (10.1) |
2.8** |
39** |
— |
29 (2.6) |
38 (3.3) |
— |
— |
| ≥65 | 15 (—) | 20 (2.0) | 17 (—) | — | — | — | — | — | — | — |
* Deaths were classified using the International Classification of Diseases, Tenth Revision (ICD-10). Opioid-involved overdose deaths were identified using underlying cause-of-death codes X40–44, X60–64, X85, and Y10–14. Among deaths with overdose as the underlying cause, the type of drug involved in the overdose death was indicated by the following ICD-10 multiple cause-of-death codes: any opioid (T40.0, T40.1, T40.2, T40.3, T40.4, or T40.6) and synthetic opioids other than methadone (T40.4). Totals for deaths by category might involve more than one drug other than synthetic opioids. Rates displayed are age-specific crude rates per 100,000 persons.
† Based on the 2013 urbanization classification (https://www.cdc.gov/nchs/data_access/urban_rural.htm). Large central metro: counties in metropolitan statistical areas (MSAs) of ≥1 million population that 1) contain the entire population of the largest principal city of the MSA, or 2) have their entire population contained in the largest principal city of the MSA, or 3) contain at least 250,000 inhabitants of any principal city of the MSA. Large fringe metro: counties in the MSAs of ≥1 million population that did not qualify as large central metro counties. Medium metro: counties in MSAs of populations of 250,000–999,999. Small metro: counties in MSAs of populations <250,000. Because of low numbers of deaths and rate suppression for key populations, micropolitan areas (nonmetropolitan counties) and noncore areas (counties that did not qualify as micropolitan) were not included in this analysis.
§ Blacks and whites are non-Hispanic; Hispanic persons can be of any race.
¶ Absolute rate change is the difference between the 2015 and 2017 rates. Percent change in rate is calculated as the absolute rate change divided by the 2015 rate, multiplied by 100. Statistical significance was determined using nonoverlapping 95% confidence intervals (CIs) based on the gamma method if the number of deaths was <100 in 2015 and 2017, and z-tests were used if the number of deaths was ≥100 in 2015 and 2017. Percent changes were rounded to the nearest whole number. The method of comparing CIs is a conservative method for statistical significance, and caution should be used when interpreting a nonsignificant difference when the lower and upper bounds being compared only slightly overlap.
** p<0.05 using z-tests when deaths were ≥100 or when deaths were <100; nonoverlapping 95% CIs based on a gamma distribution.
†† Data for Hispanic origin should be interpreted with caution; studies comparing Hispanic origin on death certificates and on census surveys have indicated that reporting on Hispanic ethnicity is inconsistent. https://www.cdc.gov/nchs/data/series/sr_02/sr02_172.pdf.
§§ Dashes indicate that result is suppressed because <10 deaths, and rates based on <20 deaths are considered unreliable. Absolute and percent changes in rates cannot be calculated for these values.