Drug-overdose deaths in Pennsylvania increased 14-fold in the last 35 years, with rates climbing especially fast in relatively young white women, according to the University of Pittsburgh Graduate School of Public Health.
The analysis is the first to examine in detail accidental overdose deaths over time in Pennsylvania and suggests potential targets for public health intervention and law enforcement efforts. It is published in the journal PLOS ONE.
"Pitt Public Health has the most comprehensive mortality database in the nation, which can be easily cross-referenced with U.S. Census data to shed light on myriad public health issues," said co-author Donald. S. Burke, M.D., Pitt Public Health dean and UPMC-Jonas Salk Chair of Global Health. "Our latest analysis reveals that drug overdoses are the biggest problem facing our nation in terms of years of life lost - more than car crashes, or cancer, or HIV - and we as a society need to work together to solve it."
Pennsylvania ranks in the top 20 states for overdose mortality, which is the leading cause of accidental death in the U.S.
Using the Mortality and Population Data System, a repository and retrieval system for detailed death data from the National Center for Health Statistics housed at Pitt Public Health, the research team broke down overdose deaths in Pennsylvania from 1979 to 2014 by sex, age and race. The team started with 1979 because changes in reporting cause of death make it impossible to make comparisons with previous years. 2014 is the most recent year for which data are available.
Overdose deaths concentrated around the counties of southwestern Pennsylvania, those surrounding Philadelphia and those in northeast Pennsylvania near Scranton. Philadelphia County is in the lead, but Allegheny County is close behind with rates rapidly increasing since the mid-1990s.
The 35- to 44-year-old age group had the greatest increase in rate of overdose deaths, growing almost 22-fold since 1979, but 25- to-34-year-olds seem to be overtaking them, with the highest overdose death rate in 2014.
The overdose death rate for white men peaks between ages 25 and 44; for black men, it peaks between ages 45 and 65, indicating different racial patterns in drug use. A national survey showed higher prevalence of cocaine and nonmedical painkiller use among white adults, compared with a higher prevalence of crack cocaine use among black adults. Also, a study of heroin use among patients entering substance abuse treatment centers indicates a shift to predominantly white users in the last 50 years.
Accidental overdose rates are higher in men than in women; however, women saw a more dramatic increase, particularly from 2010 to 2014. High overdose death rates for women also spanned a longer age range of 25 to 54 for white women and 35 to 64 for black women, compared to the U.S. average peak between ages 45 to 54.
"This seems to indicate a more prolonged period of concern for overdoses in Pennsylvania women," said lead author Lauren C. Balmert, a graduate student researcher in Pitt Public Health's Department of Biostatistics. "Previous research has shown that women are more prone to having accelerated progression from their first drug use to substance abuse and often enter into treatment programs with more severe dependence than men."
Compounding matters, most women who enter substance abuse treatment programs also are responsible for children and tend to be more reliant on public insurance, factors that the researchers say could affect a woman's decision to enter or remain in a drug rehabilitation program.
"While our analysis examined accidental poisoning deaths in Pennsylvania, many of these findings are applicable to other states as well," said co-author Jeanine M. Buchanich, Ph.D., deputy director of Pitt Public Health's Center for Occupational Biostatistics and Epidemiology. "Our county-level findings provide possible avenues for targeting interventions to areas and people with the highest drug overdose mortality. It also points to issues on the horizon that public health officials could prepare for - such as overdoses in younger age groups and rapid overdose increases in areas centered on smaller cities with fewer resources."
Additional researchers on this study are senior author Gary M. Marsh, Ph.D., of Pitt Public Health; and co-authors Janice L. Pringle, Ph.D., of Pitt's School of Pharmacy, and Karl E. Williams, M.D., M.P.H., of the Allegheny County Office of the Medical Examiner.
This research was supported through internal University of Pittsburgh funding.