Drug overdose deaths and Premature mortality
Where Drug overdose deaths is higher, Premature mortality tends to be higher. The link is moderate: +0.44 across 1,765 counties, on a scale from −1 (opposite) to +1 (in step). That figure compares places with the same population density, income and education, so those differences can't explain it. It holds inside states too. Measured separately within each of 30 states, the middle value of the link is +0.54.
Holds after adjusting
Every place, plotted
One dot for each place reporting both measures. Hover over or tap a dot to see its name and values. The thin line is the straight line that best fits the dots. The bold line, shown for counties, is the link after adjusting for density, income and education. A dot far from the lines is a place that does not follow the pattern.
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What each measure is
Drug overdose deaths
Deaths from drug overdose per 100,000 people, from any drug.
County Health Rankings · County Health Rankings v138
Premature mortality
Deaths before age 75 per 100,000 people. It is adjusted so places with older or younger populations can be compared fairly.
County Health Rankings · County Health Rankings v127
Highest and lowest
Where each measure is highest and lowest among the places reporting both (2023), with the other measure beside it. This is shown for every size of place where both are published. Metro-area values are added up from their counties. A measure that cannot be added up across counties, such as a middle value (median), has no metro figure. Counts are shown per 1,000 residents, since raw totals would only list the largest places. Cities and towns and ZIP codes are shown where the Census survey or the CDC publishes them; most other sources stop at the county. They are shown for places of 5,000 residents or more, and only where the survey’s margin of error is small enough for the figure to be usable. The CDC publishes its health estimates for cities in a version adjusted for age, so places with older or younger people can be compared fairly, but not for ZIP codes.
Counties
By drug overdose deaths
| Drug overdose deaths | Premature mortality | |
|---|---|---|
| Highest | ||
| McDowell County, WV | 181 | 1,106 |
| Logan County, WV | 164 | 1,004 |
| Baltimore city, MD | 144 | 735 |
| Raleigh County, WV | 138 | 760 |
| Cabell County, WV | 132 | 782 |
| Lowest | ||
| Hidalgo County, TX | 5.37 | 431 |
| Cameron County, TX | 6.05 | 473 |
| Limestone County, AL | 6.55 | 446 |
| Gallatin County, MT | 7.14 | 207 |
| Lincoln County, SD | 7.43 | 227 |
By premature mortality
| Drug overdose deaths | Premature mortality | |
|---|---|---|
| Highest | ||
| McDowell County, WV | 181 | 1,106 |
| Petersburg city, VA | 112 | 1,097 |
| McKinley County, NM | 30.6 | 1,079 |
| Apache County, AZ | 39.4 | 1,064 |
| Menominee County, WI | 123 | 1,047 |
| Lowest | ||
| Summit County, CO | 18.5 | 156 |
| Loudoun County, VA | 8.81 | 181 |
| Fairfax County, VA | 10.5 | 182 |
| Summit County, UT | 10.9 | 192 |
| Arlington County, VA | 12.3 | 195 |
States
By drug overdose deaths
| Drug overdose deaths | Premature mortality | |
|---|---|---|
| Highest | ||
| West Virginia | 78 | 625 |
| District of Columbia | 64.5 | 486 |
| Tennessee | 51 | 553 |
| Delaware | 50.1 | 413 |
| Kentucky | 49.9 | 565 |
| Lowest | ||
| South Dakota | 10.5 | 401 |
| Nebraska | 11.1 | 355 |
| Iowa | 14.4 | 373 |
| Texas | 16.5 | 419 |
| North Dakota | 16.6 | 381 |
By premature mortality
| Drug overdose deaths | Premature mortality | |
|---|---|---|
| Highest | ||
| Mississippi | 24.1 | 629 |
| West Virginia | 78 | 625 |
| Alabama | 26.1 | 569 |
| Kentucky | 49.9 | 565 |
| Louisiana | 48.6 | 563 |
| Lowest | ||
| Massachusetts | 36.1 | 303 |
| Hawaii | 19.3 | 310 |
| Minnesota | 22.2 | 315 |
| Utah | 19.2 | 317 |
| Connecticut | 40.8 | 323 |
Metro areas
By drug overdose deaths
| Drug overdose deaths | Premature mortality | |
|---|---|---|
| Highest | ||
| Portsmouth, OH | 126 | 780 |
| Beckley, WV | 125 | 763 |
| Española, NM | 111 | 806 |
| Charleston, WV | 104 | 702 |
| Bluefield, WV-VA | 97 | 770 |
| Lowest | ||
| McAllen-Edinburg-Mission, TX | 5.37 | 431 |
| Brownsville-Harlingen, TX | 6.05 | 473 |
| Bozeman, MT | 7.14 | 207 |
| Ames, IA | 7.73 | 279 |
| Grand Island, NE | 8.1 | 382 |
By premature mortality
| Drug overdose deaths | Premature mortality | |
|---|---|---|
| Highest | ||
| Gallup, NM | 30.6 | 1,079 |
| Middlesborough, KY | 53.5 | 929 |
| Cleveland, MS | 15.6 | 927 |
| Blytheville, AR | 28.7 | 869 |
| Selma, AL | 23.5 | 865 |
| Lowest | ||
| Breckenridge, CO | 18.5 | 189 |
| Heber, UT | 10.9 | 202 |
| Bozeman, MT | 7.14 | 207 |
| Vineyard Haven, MA | 33.7 | 212 |
| San Jose-Sunnyvale-Santa Clara, CA | 17.5 | 214 |
Counties furthest from the pattern
Compared with the straight line that best fits all 1,765 counties: the five with far more premature mortality than their drug overdose deaths would suggest, and the five with far less.
| Drug overdose deaths | Premature mortality | |
|---|---|---|
| Above the line | ||
| McKinley County, NM | 30.6 | 1,079 |
| Apache County, AZ | 39.4 | 1,064 |
| Neshoba County, MS | 16.2 | 937 |
| Rolette County, ND | 39.3 | 1,019 |
| Bolivar County, MS | 15.6 | 927 |
| Below the line | ||
| San Francisco County, CA | 63.3 | 280 |
| Dukes County, MA | 33.7 | 212 |
| Summit County, CO | 18.5 | 156 |
| Marin County, CA | 23.7 | 195 |
| Rappahannock County, VA | 67.7 | 383 |
Two series, one county
Both measures over time for a county you pick. The two charts are stacked, so they share only the years along the bottom. You can pick from the thirty largest counties reporting both. This panel covers 2010–2024, and a measure published only once shows as a single dot.
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Every version of the link
Each row measures the same link, from −1 to +1, in a different way. If the rows mostly agree, the link does not depend on one choice of method.
| Before adjusting for anything | +0.510 | 1,765 counties reporting both |
| After adjusting for density, income and education | +0.443 | the part of the link that is not just how urban, rich and educated a place is |
| Also adjusting for population size | +0.427 | size taken out as well as density |
| Also comparing only within each state | +0.510 | each county is compared only with others in its own state, so this is no longer a comparison between states |
| Giving bigger counties more weight | +0.539 | the adjusted link for the average resident rather than the average county. With this weighting, the data counts for about 256 equally weighted counties |
| Middle value inside single states | +0.544 | the link worked out inside each of 30 states with at least 20 counties reporting |
| Using ranks, after adjusting | +0.360 | uses each county’s rank, not its value, so a few extreme counties cannot create the link |
How much to believe it
Could it be chance?
The p-value is the chance of seeing a link this strong if there were really none. A value of 0.05 or less means the link is unlikely to be chance. Very small values are written in short form: 3.1e-16 means 0.00000000000000031, and the bigger the number after “e-”, the smaller the value. Treating every county as a separate case gives p = 1.3e-85. But counties in the same state tend to resemble each other, so the better figure allows for that: p = 2.7e-9. The site tested 20,910 pairs, and testing so many turns up some flukes. The q-value allows for that too. For this pair it is 1.0e-84.
Do nearby places look alike?
Moran’s I measures how much nearby places look alike: 0 means no map pattern, and higher means neighbours are more similar. For the part of each county that the adjustment leaves unexplained, it is +0.47 (p = 0.001). That unexplained part still clusters on the map. So some regional factor shared by both measures is not accounted for.
Did they change together?
The figures above compare counties at one moment. This asks a different question: where drug overdose deaths rose most, did premature mortalitymove too? Each county’s change is compared with the average change in its own state. That takes out ups and downs that hit a whole region at once. Each change is the gap between two estimates that both contain some error. That error pulls these links towards zero, so a weak one is weak partly for that reason. The q column shows whether a link could be a fluke, allowing for the many pairs tested: 0.05 or less means it is unlikely to be chance.
| Period | Counties | Change together | Within states | q |
|---|---|---|---|---|
| 2014–2019 the main test: each Census survey figure averages five years, and these two do not overlap; before the pandemic | 1,232 | +0.37 | +0.35 | 3.9e-6 |
| 2019–2023 a repeat check: its two five-year survey figures both include 2019, and it covers the COVID years | 1,431 | +0.52 | +0.47 | 1.4e-13 |
Measured over the nearest years published: Premature mortality: 2013–2019 for the 2014–2019 row; Drug overdose deaths: 2019–2022 for the 2019–2023 row; Premature mortality: 2019–2022 for the 2019–2023 row.
In counties where one changed more, the other tended to move the same way, compared with other counties in the same state (r = +0.35). The same holds in the second period. How change is measured.
Related pairs
- Premature mortality and Safety score — -0.67
- Premature mortality and Homicide rate, annual — +0.67
- Share American Indian or Alaska Native, not Hispanic and Premature mortality — +0.63
- Independent-living disability and Premature mortality — +0.60
- Threat of utility shut-off and Premature mortality — +0.58
- Premature mortality and Returns claiming the earned income credit — +0.58
- Premature mortality and Disability-free score — -0.57
- Stroke and Premature mortality — +0.57
Association only. Nothing here shows that either measure changes the other. This describes counties, not the people in them. Two measures going together across places does not mean the same people have both. How the US county data works · Explore Drug overdose deaths and Premature mortality