Assessment of Drug Overdose Mortality in Ohio, 2009-2018

Introduction:
An epidemic of drug overdoses continues in the United States despite sustained efforts to reduce overdose mortality. Ohio is second among states in rate of fatal overdose and therefore remains an important bellwether of this evolving national crisis. A recent article revealed that over 500,000 years of life were lost (YLL) to opioid overdose in Ohio from 2010-to-2016, and showed that opioid overdose had a measurable impact on lifespan in the state. However, more work is needed to contextualize these opioid deaths within the broader drug overdose epidemic and in relation to other leading causes of mortality. The present study builds upon our previous report of overdose mortality burden in Ohio to provide such context.

Methods:
Data included death records obtained from the Ohio Department of Health. A serial cross-sectional analysis was performed for all unintentional drug overdoses (N = 26,350) between January 1, 2009 and December 31, 2018. The burden of drug overdose was calculated in YLL. YLL were computed by subtracting the age at death from the standard life expectancy for each decedent. Life expectancy was determined from the Social Security Administration Period Life Table. This procedure was repeated for all causes of death. Finally, the negative effect of overdose on average lifespan was calculated.

Results:
Overdose decedents numbered 26,350. Opioids were involved in 78.9% of cases. YLL were highest among whites (89.2%), males (64.6%) and those aged 30 to 39, (31.9%) or 20 to 29 (25.2%). Drug overdose was associated with 1,026,821 YLL and was the third leading cause of excess mortality (YLL) following malignant neoplasms and heart disease in Ohio between 2009 and 2018.
All-cause mortality increased with total annual YLL rising from 1,607,512 in 2009 to 1,836,220 in 2018. Thirty-eight percent (38.2%) of this increase was due to drug overdose. The next leading clinical entity, heart disease, accounted for just 12.7% of the increase.
The peak year for overdose deaths was 2017, during which Ohio experienced 187,006 overdose-related YLL. By 2017, drug overdose accounted for 9.9% of all-cause excess mortality (YLL) in Ohio and had the effect of lowering the average lifespan by 1.27 years.

Discussion:
Over the course of a decade, Ohio lost over one-million years of human life to drug overdose. Drug overdose contributed more to an observed rise in all-cause mortality than any other cause and had a measurable effect lowering average lifespan in 2017. Drug overdose was the third leading cause of excess mortality (YLL) in Ohio; a fact previously obfuscated by reports which included these deaths in the category of accidents and presented incidence alone without accompanying YLL. Our analysis was limited by the use of death certificate data with possible incomplete cause-of-death reporting.
We recommend that YLL be monitored in states experiencing elevated drug overdose burden and that drug overdose YLL be compared with other clinical entities to better contextualize this epidemic. Finally, drug overdoses should be reported separately from other accidents in epidemiological research as this obscures drug overdose as a leading cause of preventable mortality.

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5. United States Social Security Administration. Period Life Table, 2014. https://www.ssa.gov/oact/STATS/table4c6.html 2013.