Institute for Health
Metrics and Evaluation
More than 2,000 US
counties witnessed increases of 200% or more in deaths related to substance
abuse and mental disorders since 1980, including clusters of counties in
Kentucky, West Virginia, and Ohio with alarming surges over 1,000%, according
to a new scientific study.
The study examines
deaths in 21 cause groups, ranging from chronic illnesses like diabetes and
other endocrine diseases, to infectious diseases, such as HIV/AIDS and
tuberculosis, to accidents, including traffic fatalities. It explores mortality
rates and how they have changed in every US county between 1980 and 2014,
creating the most comprehensive view to date of how Americans die.
The study was
conducted by the Institute for Health Metrics and Evaluation (IHME) at the
University of Washington in Seattle, and was published in JAMA.
Cardiovascular disease
was the leading cause of death overall in the United States in 2014, but
cancers were responsible for more years of life lost to early death than any
other cause.
Still, the rate at which Americans die from cancer and other diseases or injuries differs significantly among communities, highlighting stark health disparities across the nation. For instance, the counties with the highest and the lowest mortality rates from cirrhosis and other liver diseases were both in South Dakota, with 193 deaths per 100,000 people in Oglala Lakota County, to seven deaths per 100,000 people in Lincoln County.
Still, the rate at which Americans die from cancer and other diseases or injuries differs significantly among communities, highlighting stark health disparities across the nation. For instance, the counties with the highest and the lowest mortality rates from cirrhosis and other liver diseases were both in South Dakota, with 193 deaths per 100,000 people in Oglala Lakota County, to seven deaths per 100,000 people in Lincoln County.
"While the
leading causes of death are similar across counties, we found massive
disparities in the rates at which people are dying among causes and
communities," explained lead author Laura Dwyer-Lindgren. "For causes
of death with effective treatments, inequalities in mortality rates spotlight
areas where access to essential health services and quality of care needs to be
improved."
Other causes vary by
changes in mortality rates since 1980. For example, about half of US counties
saw increases in suicide and violence, while the other half of counties
experienced decreases.
Kusilvak Census Area in Alaska topped the list with a
131% mortality rate increase, while the rate in New York County, New York,
dropped by 72% -- the most dramatic decrease in the country.
Mortality rates from
substance abuse -- including alcohol and drug use -- and mental health
disorders are highly variable as well, showing the greatest increases in
Clermont County, Ohio (2,206%), and Boone County, West Virginia (2,030%), and
the largest drops in Aleutians East Borough, Aleutians West Census Area,
Alaska, and Miami-Dade County, Florida, declining by 51% and 45%, respectively.
"The mortality
trends in mental and substance use disorders, as well as with other causes of
death covered in the study, point to the need for a well-considered response
from local and state governments, as well as care providers, to help reduce the
disparities we are seeing across the country," said Dr. Christopher
Murray, Director of IHME.
Other county-level
trends in the study include:
Chronic respiratory
diseases, a group that includes COPD and asthma, saw the most dramatic
increases in a band of counties spanning northern Texas to the Carolinas.
Concurrently, a small number of counties along the Mexico border, in
northwestern New Mexico, and in central Colorado, experienced decreases.
The national mortality
rate from traffic accidents decreased by 45% between 1980 and 2014. Generally,
lower death rates were found in urban areas, and higher rates were seen in
rural counties.
While select counties
in Montana, Florida, and North and South Dakota have the highest mortality
rates from cirrhosis and liver disease, sharp increases were seen in
southwestern Oregon and northwestern Texas since 1980.
Deaths from
neurological disorders, such as Alzheimer's disease and other forms of
dementia, increased in the majority of counties over the 35-year span of the
study, with especially large increases in counties stretching from eastern
Texas and Oklahoma to Alabama.
"We know that
unequal medical access and quality of care create health disparities in the US
for many causes of death, while other causes are linked to risk factors or
policies," said Dr. Ali Mokdad, Professor of Global Health at IHME and
study co-author. "Indeed, this study will inform the debate on how to
improve the health of our nation."
While nearly all
deaths in the United States are reported in death certificates, the causes of
death recorded may be vague or even implausible. For example, a physician may
report that someone died of heart disease, when the underlying cause was, in
fact, hypertensive heart disease. To correct for this, the study authors
reassigned deaths with nonspecific causes to their likely underlying causes,
improving the accuracy of the estimates.
Below are the 10
counties with the largest increases in mortality rates from cancer, 1980-2014:
1. Owsley County,
Kentucky (+46%)
2. Lee County,
Kentucky (+40%)
3. Estill County,
Kentucky (+38%)
4. Breathitt County,
Kentucky (+38%)
5. Madison County,
Mississippi (+36%)
6. Anderson County,
Texas (+35%)
7. Union County,
Florida (+33%)
8. Marlboro County,
South Carolina (+32%)
9. Powell County,
Kentucky (+30%)
10. Johnson County,
Kentucky (+29%)
Below are the 10
counties with the largest decreases in mortality rates from cancer, 1980-2014:
1. Aleutians East
Borough, Aleutians West Census Area, Alaska (-58%)
2. Alexandria City,
Virginia (-46%)
3. Loudoun County,
Virginia (-46%)
4. Summit County,
Colorado (-46%)
5. Howard County,
Maryland (-46%)
6. Eagle County,
Colorado (-45%)
7. Pitkin County,
Colorado (-44%)
8. Presidio County,
Texas (-44%)
9. Rockland County,
New York (-43%)
10. Falls Church City,
Virginia (-43%)