Poisoned to Death. Christopher J. Ruhm. University of Virginia and NBER

Transcription

1 Poisoned to Death Christopher J. Ruhm University of Virginia and NBER

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4 # of Deaths Fig 1A: Poisoning and Motor Vehicle Deaths Poisoning Drug Poisoning Vehicle

5 Fig 1B: Poisoning and Motor Vehicle Death Rate Mortality Rate Per 100, Poisoning Drug Poisoning Vehicle

6 Fig 1C: Poisoning Death Rates by Reason Mortality Rate Per 100, Accidental Suicide Undetermined Assault/Homicide

7 Fig 1E: Drug Poisoning Share of All Poisoning Deaths Share of Deaths All Poisoning Accidental Poisoning

8 Fig 2A: Sex-Specific Poisoning Death Rate Mortality Rate Per 100, Poisoning: Males Poisoning: Females Drug Poisoning: Males Drug Poisoning: Females

9 Fig 2B: Drug Poisoning as Share of Poisoning Deaths Share of Poisoning Deaths Males Females

10 Fig 3A: Age-Specific Poisoning Death Rate Mortality Rate Per 100, year olds year olds year olds year olds year olds 65+ year olds <15 year olds

11 Fig 3B: Drug Poisoning as Share of Poisoning Deaths Share of Poisoning Deaths year olds year olds year olds year olds year olds 65+ year olds

12 Fig 4A: Race-Specific Poisoning Death Rate Mortality Rate Per 100, White Black Other Nonwhite

13 Fig 4B: Drug Poisoning as Share of Poisoning Deaths Share of Poisoning Deaths White Black Other Nonwhite

14 Fig 4C: Race-Ethnicity Specific Poisoning Death Rate Mortality Rate Per 100, Non-Hispanic White Non-Hispanic Black Non-Hispanic Other Hispanic

15 Fig 5A: Education-Specific Poisoning Death Rate Mortality Rate Per 100, < High School Graduate High School Graduate Some College College Graduate

16 Fig 5B: Drug Poisoning as Share of Poisoning Deaths Share of Poisoning Deaths < High School Graduate High School Graduate Some College College Graduate

17 Fig 6A: Specific Underlying Causes of Poisoning Deaths Mortality Rate Per 100, All Poisoning Drug Alcohol Gas/Vapors Other Poisoning

18 Fig 6B: Specific Underlying Causes of Drug Poisoning Deaths Mortality Rate Per 100, Narcotic Pain/Psych/Nerv Other Drug

19 Fig 7A: Drug Mention Rates in Drug Poisoning Deaths Mortality Rate Per 100, Narcotics Psychotropics Unspecified Sedatives Other Specified >1 Drug Type

20 Fig 7B: Narcotics Drug Mention Rates in Drug Poisoning Deaths Mortality Rate Per 100, Opioid Analgesics Heroin Cocaine Other Narcotics

21 Drug Involvement in Drug Poisoning Deaths

22 Drug Involvement in Drug Poisoning Deaths (cont.) Drug Mentions % # % # Narcotics 58.9% 9, % 23,222 Opioid Analgesics 23.9% 4, % 16,651 Methadone 4.7% % 4,577 Other Op. Analgesics 19.9% 3, % 13,123 Other Narcotics 42.4% 7, % 8,667 Heroin 11.6% 1, % 3,036 Cocaine 22.7% 3, % 4,183 Miscellaneous 17.4% 2, % 2,554 Sedatives 9.9% 1, % 7,673 Benzodiazepines 6.7% 1, % 6,497 Other Sedatives 3.9% % 1,963 Psychotropics 14.6% 2, % 6,420 Antidepressants 10.4% 1, % 3,889 Antipsychotics 1.9% % 1,351 Stimulants 3.2% % 1,854 Other Specified 6.9% 1, % 2,809 Unspecified 50.3% 8, % 21,346 >1 Major Drug Class 36.8% 6, % 16,579

23 Drug Involvement in Drug Poisoning Deaths By UCD, 2010 % [#] Underlying Cause of Death Drug Mentions All Drug Pain/Psych/ Other Poisonings Narcotics Nerv Drugs All [38,329] [14,132] [3,633] [20,502] Opioid Analgesics [16,651] [8,733] [61] [7,834] Other Narcotics [8,667] [6,529] [21] [2,104] Sedatives [7,673] [173] [1,024] [6,469] Psychotropics [6,420] [72] [2,371] [3,967] Other Specified [2,809] [26] [107] [2,669] Unspecified [21,346] [4,441] [1,498] [15,381] >1 Drug [16,579] [5,303] [1,487] [9,771]

24 Fig 1: Poisoning Mortality and Drug Specification Rate Mortality Rate Per 100, Poisoning Rate (left axis) Drug Poisoning Rate (left axis) Drug Specified (right axis) Share of Deaths with Specific Diagnosis

25 % Drug Poisoning Deaths, 1 Drug Specified

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27 Reported vs. Adjusted Prevalence Rates Probit Models Dependent Variables: Drug Mentions/UCD Controls: 1 Drug Specified on Death Certificate Sex Race (black, other nonwhite) Hispanic Married (currently married vs. other) Education (4 categories) Age (8 categories) Census region Day of Week Average predicted values (SPECIFY = 1)

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30 Actual and Estimated Underlying Cause of Death and Drug Mention Rates (Cont.) Exclusive Drug Mentions Reported Adjusted Reported Adjusted Opioid Analgesics 6.3% 6.7% [5.9%-7.6%] Other Narcotics 23.5% 35.3% [33.9%-36.8%] Sedatives 1.6% 1.8% [1.4%-2.3%] Psychotropics 4.1% 4.8% [4.0%-5.5%] Other Specified 3.5% 3.2% [2.7%-3.7%] Unspecified 21.9% 5.5% [4.9%-6.1%] 12.9% 18.4% [17.6%-19.3%] 10.4% 14.3% [13.6%-15.0%] 1.1% 1.4% [1.1%-1.6%] 3.3% 3.8% [3.4%-4.2%] 2.8% 2.9% [2.5%-3.2%] 25.0% 5.4% [5.0%-5.8%]

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32 Data Constraints Next Steps Your Help Needed Here! Death Certificates contain individual data on: age, sex, race, etc., as well as type of death, timing (restricted), location, autoposy etc. No information for those who don t die; limits analysis of microdata Can calculate group-specific mortality rates But then must do aggregate (state or county-level) analysis

33 Next Steps Your Help Needed Here! State/County Level Data I have collected % female, non-hispanic black, non-hispanic other nonwhite, Hispanic, specified age & education groups, foreign-born, female headed households Personal/household income, unemployment, poverty rate Population density, urbanicity, median home price, highspeed internet lines % with public, private, any health insurance Hospital beds, physicians, health care spending, prescription drug spending per capita Prescription drug laws (patient ID, physician exam, Rx limits, tamper-resistant prescription form, drug monitoring program)

34 Thank You!!