@article{ref1,
title="Trends and geographic patterns in drug-poisoning death rates in the U.S., 1999-2009",
journal="American journal of preventive medicine",
year="2013",
author="Rossen, Lauren M. and Khan, Diba and Warner, Margaret A.",
volume="45",
number="6",
pages="e19-25",
abstract="BACKGROUND: Drug poisoning mortality has increased substantially in the U.S. over the past 3 decades. Previous studies have described state-level variation and urban-rural differences in drug-poisoning deaths, but variation at the county level has largely not been explored in part because crude county-level death rates are often highly unstable. PURPOSE: The goal of the study was to use small-area estimation techniques to produce stable county-level estimates of age-adjusted death rates (AADR) associated with drug poisoning for the U.S., 1999-2009, in order to examine geographic and temporal variation. METHODS: Population-based observational study using data on 304,087 drug-poisoning deaths in the U.S. from the 1999-2009 National Vital Statistics Multiple Cause of Death Files (analyzed in 2012). Because of the zero-inflated and right-skewed distribution of drug-poisoning death rates, a two-stage modeling procedure was used in which the first stage modeled the probability of observing a death for a given county and year, and the second stage modeled the log-transformed drug-poisoning death rate given that a death occurred. Empirical Bayes estimates of county-level drug-poisoning death rates were mapped to explore temporal and geographic variation. RESULTS: Only 3% of counties had drug-poisoning AADRs greater than ten per 100,000 per year in 1999-2000, compared to 54% in 2008-2009. Drug-poisoning AADRs grew by 394% in rural areas compared to 279% for large central metropolitan counties, but the highest drug-poisoning AADRs were observed in central metropolitan areas from 1999 to 2009. CONCLUSIONS: There was substantial geographic variation in drug-poisoning mortality across the U.S.<p /> <p>Language: en</p>",
language="en",
issn="0749-3797",
doi="10.1016/j.amepre.2013.07.012",
url="http://dx.doi.org/10.1016/j.amepre.2013.07.012"
}