A Spatial Exploration of Changes in Drug Overdose Mortality in the United States, 2000–2016

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Map A depicts total drug mortality rates by US county. Spatial Empirical Bayes smoothing provides stability to the rates based on small numbers. The Midwest and areas of Texas had the lowest mortality rates. Counties in the Southwest, especially New Mexico, Utah, Florida, Appalachia, the Rust Belt, and the Northeast had the highest mortality rates. Mortality rates indicate strong clustering.

Map B contains 2 maps that show spatial clustering of drug overdose mortality rates in 2000 and 2016. The first map (2000) shows strong spatial clustering in California, Florida, and the Northeast. Large scattered areas of significant clustering of low mortality rates were observed in the Midwest, Texas, and counties in Mississippi and Alabama. An inset map shows the Northeast cluster of high mortality rates. The second map (2016) shows a decrease in the spatial clustering of high mortality rates in California, and clusters are only observed in the southern region of the state. Florida’s high mortality rate clusters in 2000 remain high in 2016. In 2016, there was growth of clusters in the Northeast and expansion into Appalachia and the Rust Belt. The scattered areas of significant clustering of low mortality rates in 2000 are now condensed in the Midwest, Texas, and counties in Mississippi and Alabama. An inset map shows the Northeast cluster of high mortality rates and the growth of high-mortality counties.

Map A displays all drug overdose mortality in contiguous US counties for 2000–2016. Overall, observed mortality rates were higher in Appalachia and the Southwest. Map B displays clustering in US county-level drug overdose mortality in 2000 adjacent to drug overdose mortality in 2016 to visually compare the geographic change in drug overdose mortality. The magnified images suggest that counties with low mortality rates that are adjacent to those with high mortality rates may be at risk for increased deaths from drug overdose. The results highlight areas that are identified as significant clusters of drug related overdose mortality.

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