Vital Statistics Rapid Release

Report No. 006  August 2018

Methods to Adjust Provisional Counts of Drug Overdose

Deaths for Underreporting
Lauren M. Rossen, Ph.D., M.S., Farida B. Ahmad, M.P.H.,
Merianne R. Spencer, M.P.H., Margaret Warner, Ph.D., Paul Sutton, Ph.D.,
Division of Vital Statistics, National Center for Health Statistics

Abstract reported counts, and the differences

were larger for more recent months.
A recent report described the
timeliness of mortality data by cause of
Objectives—This report describes death, finding that lag times between
the completeness of provisional Conclusion—Provisional counts of when the death occurred and when the
drug overdose death data from the drug overdose deaths can be adjusted to data were available for analysis in the
National Center for Health Statistics’ account for delayed reporting of cause NVSS surveillance database were longer
mortality surveillance program and manner of death based on historical for deaths due to drug overdose than
and evaluates methods to adjust patterns, and these adjustments may for other causes of death, such as heart
provisional counts of drug overdose reduce the likelihood that recent trends disease (4). Drug overdose deaths often
deaths for delayed reporting. the provisional counts of drug overdose require lengthy investigations, including
deaths will be misinterpreted. Even with toxicological analysis, and death
Methods—Provisional data (captured reporting delays, provisional counts of certificates may be filed initially with a
weekly from February 28, 2016, through drug overdose deaths can provide more manner of death “pending investigation”
July 4, 2017) for drug overdose deaths timely information about the burden or with a preliminary or unknown
were compared with final counts to of drug overdose mortality across the cause of death. On average, provisional
determine the percentage of drug United States and where drug overdose counts of drug overdose deaths were
overdose death records available in the mortality is increasing rapidly. 83% complete after 6 months and
surveillance database (i.e., completeness) 95% complete within 9 months (4).
after a 6-month lag. Linear models were Keywords: drug overdose mortality •
used to predict completeness, based provisional mortality data • National In September 2017, NCHS began
on the month of death, the percentage Vital Statistics System • Vital Statistics releasing provisional 12-month ending
of death records with manner of death Rapid Release counts of drug overdose deaths for the
reported as “pending investigation,” purposes of public health surveillance
and accounting for clustering by
jurisdiction of occurrence. Results
Introduction (5). The “Provisional Drug Overdose
Death Counts” data visualization is
were used to develop adjustments to The National Center for Health updated monthly and includes: (a) the
provisional counts of drug overdose Statistics (NCHS) collects and provisional counts of deaths due to drug
deaths to account for delayed reporting. disseminates the country’s official birth overdose occurring nationally and in
and death statistics through the National each jurisdiction; (b) the provisional
Results—After a 6-month lag, counts of drug overdose deaths involving
Vital Statistics System (NVSS). Through
completeness of provisional counts of specific drugs or drug classes occurring
NVSS, 57 jurisdictions (including the
drug overdose deaths ranged from 92% nationally and in selected jurisdictions;
50 states, New York City, the District
to 98% for the United States by month, (c) a U.S. map of the percentage change
of Columbia, and 5 U.S. territories)
and from 77% to 100% by jurisdiction. in provisional drug overdose deaths
send birth and death data to NCHS.
The percentage of death records with for the current 12-month ending period
The NVSS surveillance program was
manner of death pending investigation compared with the 12-month period
initiated by NCHS to provide more
in provisional data for 2017 ranged from ending in the same month of the previous
timely access to vital statistics data for
0.18% to 0.33% for the United States, year, by jurisdiction. Provisional counts
the purposes of conducting public health
and was higher in more recent months. of drug overdose deaths are presented
surveillance of key indicators from
After adjustment for delayed reporting, with a 6-month lag (e.g., data for the
provisional birth and death data (1–3).
predicted provisional counts of drug 12-month period ending with September
overdose deaths were higher than 2017 were published in early April 2018).

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Even with this lag, provisional counts of February 28, 2016, enabling the analysis Adjustments for delayed
drug overdose deaths are underestimated of specific drugs and drug categories
relative to final counts. The degree in addition to overall drug overdose
reporting
of underestimation is determined mortality. Weekly provisional mortality Linear regression models were used to
primarily by the percentage of records data captured from February 28, 2016, predict the completeness of provisional
with the manner of death reported as through July 4, 2017 (approximately 6 data relative to final data (i.e., the
pending investigation and tends to months after the full 2016 data year) were percentage of drug overdose death
vary by reporting jurisdiction, year, used to calculate the number of drug records available in provisional data).
and month of death. Specifically, the overdose deaths occurring in 2015–2016 Models included the 12-month ending
number of drug overdose deaths will available for analysis in the NVSS period and the percentage of death
be underestimated to a larger extent in surveillance database. Final mortality records with manner of death reported as
jurisdictions with higher percentages data from 2015 and 2016 (6,7) were pending investigation as covariates.
of records reported as pending used to compare with provisional data. Since the completeness of provisional
investigation, and this percentage tends data and percentage pending are
to be higher in more recent months. Drug overdose deaths were identified
correlated across weekly provisional data
using underlying cause-of-death codes
sets within reporting jurisdictions,
Given the importance of monitoring from the International Statistical
models accounted for this correlation by
trends and geographic variation in Classification of Diseases and Related
jurisdiction using a generalized
drug overdose mortality across the Health Problems, 10th Revision
estimating equation approach with an
United States, a better understanding (ICD–10) (8): X40–X44 (unintentional
exchangeable correlation structure.
of the completeness of provisional drug overdose), X60–X64 (suicide
drug overdose mortality data is critical by drug overdose), X85 (homicide by Provisional Count it
for interpreting trends and patterns. drug poisoning), and Y10–Y14 (drug Y = • 100
it Final Count it
Additionally, the development of poisoning of undetermined intent). Drug
methods to adjust provisional counts may overdose deaths involving selected E (Yit ) = a + B1t ∗ Montht
reduce the likelihood that provisional drug categories were identified by + B2 • PercentPendingit
data will be misinterpreted, such as specific ICD–10 multiple cause-of-death
showing evidence of declining trends, (MCOD) codes. Drug categories include: Yit represents the completeness of
when observed decreases in provisional heroin (T40.1); natural opioid analgesics, provisional data relative to final data
numbers of deaths may be largely due to including morphine and codeine, and for jurisdiction i for the 12-month
delayed reporting or incomplete data. semisynthetic opioids, including drugs period ending in month t, modeled as
such as oxycodone, hydrocodone, a function of an overall intercept,a,
This report describes the hydromorphone, and oxymorphone a set of indicator variables for the
completeness of provisional counts (T40.2); methadone, a synthetic opioid ending month of the 12-month
of drug overdose deaths from NCHS’ (T40.3); synthetic opioid analgesics reporting period, and the percentage of
mortality surveillance program and other than methadone, including drugs records with manner of death pending
methods to adjust these provisional such as fentanyl and tramadol (T40.4); investigation for jurisdiction i in the
counts for delayed reporting. cocaine (T40.5); and psychostimulants 12-month period ending in month t.
with abuse potential, which includes
This model was estimated for the
Methods methamphetamine (T43.6). Opioid
overdose deaths were identified by the following eight drug overdose outcomes
In late 2014, as a component of the presence of any of the following MCOD of interest:
Vital Statistics Rapid Release mortality codes: opium (T40.0); heroin (T40.1);
1. Drug overdose deaths
surveillance program, NCHS began natural opioid analgesics (T40.2);
systematically taking snapshots of methadone (T40.3); synthetic opioid 2. Drug overdose deaths involving
its NVSS mortality data at the close analgesics other than methadone (T40.4); opioids
of each week. These provisional data or other and unspecified narcotics 3. Drug overdose deaths involving
sets include data on all of the death (T40.6). This latter category includes heroin
records available for analysis in the drug overdose deaths where ‘opioid’
4. Drug overdose deaths involving
NVSS surveillance database each week, was reported without more specific
natural and semisynthetic opioids
capturing the underlying causes of death, information to assign a more specific
dates of death, and select demographic ICD–10 code (T40.0–T40.4) (9,10). 5. Drug overdose deaths involving
information for all death records methadone
received from state vital records offices. 6. Drug overdose deaths involving
Multiple-cause-of-death codes were first synthetic opioids excluding
added to the surveillance database on methadone

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7. Drug overdose deaths involving Figure 1. Provisional 12-month ending data period with a 6-month reporting lag
cocaine
Data
8. Drug overdose deaths involving published
psychostimulants with abuse
potential
6-month reporting lag
Coefficients from these models were
used to develop multiplication factors 12-month ending period
(11) based on the 12-month ending period Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr
and percentage of records pending 2016 2017 2018
investigation for each of the eight drug (final) (provisional) (provisional)
outcomes of interest. Multiplication
factors have been used in prior analyses SOURCE: NCHS, National Vital Statistics System.
and public health surveillance efforts
to adjust for underreporting of various
Because a small percentage of based on weekly provisional data as
infectious disease outcomes (11–16),
records remain in the final historical of July 2, 2017 (i.e., with a 6-month
and similar approaches have been
data with the manner of death pending lag). Updated estimates for this
used to adjust for reporting delays in
investigation, adjustments were also same 12-month ending period were
1 made to final data for the percentage of calculated based on provisional data as
MultiplicationFactorit = ,
records pending investigation to ensure of April 15, 2018, providing a nearly
Yˆit
where Yˆit is expressed as a proportion. consistency in the predicted counts over 15-month lag (Figure 2). The predicted
time. Failing to adjust final data could provisional counts with a 6-month lag
create abrupt changes in trend lines, were then compared with the observed
the surveillance of cancer incidence
particularly for some jurisdictions where provisional counts with a 15-month lag
(17–19). Predicted provisional counts
the percentage of death records pending to determine if the adjustment methods
of each of the drug overdose outcomes
investigation is higher than others. adequately accounted for reporting
were calculated by multiplying the
delays. Although data for 2017 have
reported provisional counts by the For final data periods (2015–2016), not yet been finalized, data should be
estimated multiplication factors. adjustments were based on a similar nearly complete after a 15-month lag,
set of models as described above, and so can be used to determine how
Predicted Countit = Provisional Countit
however, the models included only the well the predicted provisional counts
• Multiplication Factorit percent pending investigation variable will match updated or final estimates.
and did not include month-ending
Predicted provisional counts of indicator variables. This approach
drug overdose deaths
assumes that there is some degree Results
of underreporting of drug overdose
deaths in the final data, and that the
To illustrate the impact of adjusting Completeness of provisional
relationships between the percentage
provisional counts for delayed reporting,
of records pending investigation and drug overdose death counts
reported and predicted provisional
counts of drug overdose deaths were the degree of underreporting of drug Relative to final data, 12-month ending
calculated for 12-month ending overdose deaths in the final data is provisional counts of drug overdose
periods from January 2015 through the the same as in the provisional data. deaths were 93% to 98% complete
most recent time period (September This assumption was necessary since after a 6-month lag, depending upon
2017). Similar to the “Provisional it is unknown how many of the death the month in which the 12-month
Drug Overdose Death Counts” data records pending investigation in the final period ended (Figure 3). The degree of
visualization (5), estimates for 2015 historical data are drug overdose deaths. underestimation was largest for 12-month
and 2016 are based on final data, periods ending in July or August, where
while estimates for 2017 are based Evaluation of the adjustment provisional counts were approximately
on provisional data available as of 93% to 94% of final counts, on average.
April 15, 2018. Figure 1 illustrates To determine how well the predicted
how the 12-month ending provisional estimates account for potential reporting The degree of underestimation also
counts include both final data and delays, observed and predicted varied by reporting jurisdiction (Table 1).
provisional data, and are generated provisional counts of drug overdose For the 12-month ending periods ending
after a 6-month lag following the deaths for the 12-month period ending in July (when completeness is generally
end of the 12-month period. with January 2017 were calculated lowest), completeness of provisional
counts relative to final counts ranged

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Figure 2. Provisional 12-month ending data period with a 6-month and 15-month lag

Second
analysis

15-month lag

Initial analysis
6-month lag

12-month ending period

Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May
2016 2017 2018
(final) (provisional) (provisional)

SOURCE: NCHS, National Vital Statistics System.

from lows of 77% (New York, drug outcomes. For overall drug (β = –19.0, robust SE = 0.5), and
excluding New York City), 78% (New overdose deaths, the coefficient for psychostimulants with abuse potential
Mexico), and 80% (Mississippi), to percent pending was –16.8 (robust (β = –19.2, robust SE = 0.5). For deaths
more than 99% for Oklahoma, Virginia, standard error [SE] = 0.3), meaning involving cocaine, the percentage of
Minnesota, Maine, and Alaska. that for every 1 percentage point records pending investigation was not
increase in the percentage of death associated with underreporting to the
records with manner of death pending same extent as the other drugs or drug
Model results investigation, provisional drug overdose classes (β = –2.9, robust SE = 0.6).
In general, the model results deaths were underreported by 16.8%.
Associations were similar for deaths Coefficients from these models
were fairly consistent across the were used to generate multiplication
different drug outcomes of interest, involving heroin (β = –17.1, robust SE
= 0.4), and somewhat larger for deaths factors for the provisional counts of
with some exceptions (Tables 2 each of the drug outcomes, to adjust
and 3). The percentage of records involving any opioid (β = –18.0, robust
SE = 0.3), natural and semisynthetic for underreporting due to temporal
with the manner of death pending factors (i.e., month ending) and the
investigation was consistently related to opioids (β = –20.4, robust SE = 0.5),
methadone (β = –21.2, robust SE = 0.5), percentage of records that are reported
underreporting, though the magnitude pending investigation. The percentage
of these associations varied across synthetic opioids excluding methadone,
of records pending investigation is
highest in the most recent months
Figure 3. Average completeness of provisional counts of drug overdose deaths relative to final
(Figure 4) and ranged from 0.00% to
counts after a 6-month lag, by 12-month ending period: United States, 2015–2016 1.57% across reporting jurisdictions
for the 12-month period ending in
100
September 2017 (data not shown).

90
Reported and predicted
provisional counts of drug
overdose deaths
Percent complete

80
Figure 5 shows the reported
provisional counts of drug overdose
70
deaths from January 2015 through
September 2017, along with the
60 predicted estimates (dashed line).
Figures 6–12 show the reported and
predicted provisional counts of deaths
0 involving each of the specific drugs
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec or drug classes over the same time
Month ending period. The differences between the
reported and predicted counts are
NOTE: Completeness of weekly provisional data is shown with a 6-month lag following the 12-month period ending in the month
indicated. largest for the most recent time periods,
SOURCE: NCHS, National Vital Statistics System, February 28, 2016, through July 4, 2017.

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Figure 4. Percentage of death records with manner of death reported as “pending investigation,” estimates were more than 5% lower
by 12-month ending period: United States, 2015–2017 than the updated observed counts of
drug overdose deaths, suggesting that
0.35
the adjustment did not fully account for
delayed reporting in those jurisdictions.
0.30
For six jurisdictions (Arizona, Hawaii,
Percentage of death records

0.25
Massachusetts, New Jersey, New York
pending investigation

[excluding New York City], and Utah),

0.20
the predicted provisional counts were
more than 5% higher than the updated
0.15
observed counts; however, these
jurisdictions reported a high percentage
0.10
of records pending investigation in the
provisional data even after a 15-month
0.05 lag, suggesting that drug overdose deaths
were likely underreported in those
0 jurisdictions even with the 15-month lag.
Jan Mar May July Sept Nov Jan Mar May July Sept Nov Jan Mar May July Sept
2015 2016 2017
12-month ending period Discussion
NOTE: Counts are for the 12-month periods ending in the month indicated. Twelve-month ending counts of
SOURCE: NCHS, National Vital Statistics System, April 15, 2018.
provisional drug overdose deaths with
a 6-month lag are incomplete relative to
Figure 5. Predicted and reported provisional counts of drug overdose deaths, by 12-month final data. The degree of completeness
ending period: United States, 2015–2017
for the total United States varies by
80,000 month of the year (93% to 98%), with
provisional counts for the 12-month
ending periods ending in July or August
less complete than during other periods
Number of drug overdose deaths

70,000
Predicted provisional count
of the year. Additionally, completeness
varied by jurisdiction of occurrence.
60,000 For example, for the 12-month ending
Reported provisional count
periods ending in July, completeness
of provisional counts was lowest
50,000
in New York (excluding New York
City), New Mexico, and Mississippi
(77%, 78%, and 80%, respectively).
40,000
In contrast, provisional counts were
within 1% of final counts (more than
0
99% complete) for Oklahoma, Virginia,
Jan Mar May July Sept Nov Jan Mar May July Sept Nov Jan Mar May July Sept Minnesota, Maine, and Alaska.
2015 2016 2017
12-month ending period Of most importance for the
interpretation of recent trends,
NOTE: Counts are for the 12-month periods ending in the month indicated.
SOURCE: NCHS, National Vital Statistics System, April 15, 2018.
results of this analysis suggest that
for every 1 percentage point increase
in the percentage of death records
consistent with the larger percentage of to the observed counts after a 15-month with manner of death specified as
records with manner of death pending lag, when data should be nearly complete pending investigation, the provisional
investigation in more recent months. (Table 4). For the United States and 29 numbers of drug overdose deaths after
jurisdictions, the predicted provisional a 6-month lag are nearly 17% lower
The evaluation of the adjustment counts of drug overdose deaths with than the final numbers. For specific
methods suggested that the predicted a 6-month lag were within 2% of the drugs or drug classes, the degree of
provisional counts for the 12-month updated values after a 15-month lag. underreporting varied from 17% to 21%,
period ending with January 2017 after a For two jurisdictions (Connecticut and with the exception of cocaine (3%).
6-month lag were generally very close the District of Columbia), the predicted On average, the percentage of death

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Figure 6. Predicted and reported provisional counts of drug overdose deaths involving any opioid, to updated provisional counts (within
by 12-month ending period: United States, 2015–2017 2%) after a 15-month lag, when data
should be nearly complete. For most
50,000
jurisdictions (29 and the United States),
predicted estimates after a 6-month lag
were within 2% of updated provisional
Number of drug overdose deaths

Predicted provisional count counts after a 15-month lag. For 25

40,000 jurisdictions and the United States,
the predicted provisional counts were
slightly higher than the updated observed
Reported provisional count provisional counts after a 15-month lag,
though the magnitudes of the differences
30,000 were generally small (less than 5% in
most cases). For 28 jurisdictions, the
predicted provisional estimates were
slightly lower than the updated observed
0
provisional counts, suggesting that the
Jan Mar May July Sept Nov Jan Mar May July Sept Nov Jan Mar May July Sept adjustment methods did not fully account
2015 2016 2017 for delayed reporting. Analyses presented
12-month ending period here will need to be updated once final
historical 2017 data are available, to
NOTE: Counts are for the 12-month periods ending in the month indicated.
SOURCE: NCHS, National Vital Statistics System, April 15, 2018.
determine if these differences between
predicted and reported counts are
Figure 7. Predicted and reported provisional counts of drug overdose deaths involving heroin, consistent throughout the year.
by 12-month ending period: United States, 2015–2017
Delayed reporting of provisional
18,000 drug overdose death data can lead to
downward bias in the slope of recent
trends. Specifically, the degree of
16,000
Number of drug overdose deaths

underreporting is largest in the most

Predicted provisional count recent time periods, and trends may
14,000 Reported provisional count therefore appear to be plateauing,
or even declining, after periods of
12,000 historic increases. While data quality
metrics related to underreporting,
10,000 such as the percent completeness and
percent pending, are provided in the
“Provisional Drug Overdose Death
8,000
Counts” data visualization (5), the
impact of these factors on the magnitude
0 of underreporting and the direction of
Jan Mar May July Sept Nov Jan Mar May July Sept Nov Jan Mar May July Sept
recent trends is unclear. The provision
2015 2016 2017
of predicted provisional counts, adjusted
12-month ending period
for underreporting, provides a more
accurate visual representation of recent
NOTE: Counts are for the 12-month periods ending in the month indicated.
SOURCE: NCHS, National Vital Statistics System, April 15, 2018. trends in drug overdose mortality, and
generally suggests that the 12-month
records with manner of death pending of declining trends when decreasing ending number of drug overdose
investigation in provisional data for numbers of deaths may be due to deaths occurring in the United States
2017 ranged from 0.18% to 0.33% for delayed reporting or incomplete data. continues to increase in recent months.
the United States, and was higher for Given the importance of monitoring
the most recent months. As a result, the Methods to adjust provisional data trends and geographic variation in
provisional numbers of drug overdose for underreporting led to improvements drug overdose mortality across the
deaths will tend to be underestimated in the accuracy of the provisional data. United States, methods to account for
to a larger extent in more recent Predicted provisional counts after a underreporting of provisional drug
months, potentially showing evidence 6-month lag were generally very close

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Figure 8. Predicted and reported provisional counts of drug overdose deaths involving natural records remain pending investigation
and semisynthetic opioids, by 12-month ending period: United States, 2015–2017
in the final data, the degree of
underreporting in provisional data may
18,000
be underestimated relative to the true
number of drug overdose deaths. While
16,000 there is variation across jurisdictions
Number of drug overdose deaths

in reporting and the percentage of

Predicted provisional count
14,000 records pending investigation, the
Reported provisional count
adjustment factors were not jurisdiction
12,000 specific, beyond accounting for a given
jurisdiction’s percentage of records
pending investigation. Fixed effects for
10,000
jurisdiction were not included in the
models, as underreporting for a given
8,000 jurisdiction may be inconsistent over
time and unpredictable. Periodic delays
0 in reporting may be due to one-time
Jan Mar May July Sept Nov Jan Mar May July Sept Nov Jan Mar May July Sept factors (i.e., IT system issues), making
2015 2016 2017 jurisdiction-specific adjustment factors
12-month ending period unreliable. Some jurisdictions may
have a relatively low percentage of
NOTE: Counts are for the 12-month periods ending in the month indicated.
SOURCE: NCHS, National Vital Statistics System, April 15, 2018.
records pending investigation but still
underreport drug overdose deaths. For
Figure 9. Predicted and reported provisional counts of drug overdose deaths involving methadone, these jurisdictions, other factors like
by 12-month ending period: United States, 2015–2017 overall data completeness, the percentage
of records with unknown cause of death
4,000 (R99), or the percentage of drug overdose
deaths with a specific drug identified on
the death certificate (i.e., drug specificity)
Predicted provisional count
Number of drug overdose deaths

3,500 could be related to underreporting.

For example, some jurisdictions do not
submit death certificate information until
Reported provisional count
the cause and manner of death have been
3,000
determined, and thus these jurisdictions
have low percentages of records where
the manner of death is indicated as
2,500 pending investigation. In other cases,
the manner of death checkbox may be
blank, but terms such as “undetermined”
0
or “pending” might appear in the literal
Jan Mar May July Sept Nov Jan Mar May July Sept Nov Jan Mar May July Sept text fields on the death certificate.
2015 2016 2017 The methods used in this report do
12-month ending period not account for these scenarios, which
may also contribute to underreporting.
NOTE: Counts are for the 12-month periods ending in the month indicated. Finally, other analytic methods or
SOURCE: NCHS, National Vital Statistics System, April 15, 2018.
approaches are available to address
underreporting, such as forecasting
overdose mortality data can improve changes. Rapid improvements or or imputation. More sophisticated
surveillance of these outcomes. declines in reporting could contribute algorithms or approaches (17–19) may
to greater differences between the result in predicted estimates that more
There are some limitations to the predicted provisional counts and the closely match final data, but they would
approach described in this report. The counts based on final data. Final data likely be more difficult to implement
models from which the multiplication were used to determine the magnitude in the current NVSS environment for
factors are derived will have to be of underreporting or delayed reporting the production of monthly provisional
updated each year as timeliness of in provisional data after a 6-month lag; data releases. Additional work is
reporting of drug overdose mortality however, since a certain percentage of needed to determine whether the

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Figure 10. Predicted and reported provisional counts of drug overdose deaths involving synthetic mortality. Predicted provisional
opioids (excluding methadone), by 12-month ending period: United States, 2015–2017 counts, adjusted for the percentage of
30,000
death records with manner of death
reported as pending investigation, may
represent a more accurate picture of
25,000
recent trends. Nonetheless, predicted
Number of drug overdose deaths

provisional counts may not fully

20,000 account for reporting delays. As such,
predicted provisional counts may still
15,000 Predicted provisional count underestimate the number of drug
Reported provisional count overdose deaths occurring in recent
months in some jurisdictions, and they
10,000
cannot be interpreted as an upper bound
estimate. It is important to note that flat
5,000 or declining numbers of drug overdose
deaths (either reported or predicted)
0 could be due to incomplete data, true
Jan Mar May July Sept Nov Jan Mar May July Sept Nov Jan Mar May July Sept decreases in the number of deaths, or a
2015 2016 2017 combination of the two. True declines or
12-month ending period plateaus in the numbers of drug overdose
deaths across the United States cannot
NOTE: Counts are for the 12-month periods ending in the month indicated.
SOURCE: NCHS, National Vital Statistics System, April 15, 2018.
be determined until final data become
available approximately 11 months after
Figure 11. Predicted and reported provisional counts of drug overdose deaths involving cocaine, the data year. Improving the timeliness
by 12-month ending period: United States, 2015–2017 of full reporting of cause of death would
allow for the monitoring of more recent
14,000 trends with a much shorter lag time.
Given the importance of monitoring
12,000 trends and geographic variation in drug
Number of drug overdose deaths

overdose mortality across the United

10,000
States, provisional drug overdose
death data can highlight where drug
Predicted provisional count overdose mortality is increasing more
8,000
Reported provisional count
rapidly and inform public health efforts
to reduce drug overdose deaths.
6,000

4,000 References
1. Rossen LM, Osterman M, Hamilton
0 B, Martin J. Quarterly provisional
Jan Mar May July Sept Nov Jan Mar May July Sept Nov Jan Mar May July Sept
2015 2016 2017 estimates for selected birth
12-month ending period
indicators, 2016–Quarter 1, 2018.
National Center for Health Statistics.
NOTE: Counts are for the 12-month periods ending in the month indicated.
National Vital Statistics System,
SOURCE: NCHS, National Vital Statistics System, April 15, 2018. Vital Statistics Rapid Release
Program, 2018.
methods described here to account for mortality across the United States 2. Ahmad F, Bastian B. Quarterly
underreporting in provisional mortality and where drug overdose mortality provisional estimates for selected
data could be improved in the future. is increasing more rapidly. However, indicators of mortality, 2016–Quarter
provisional counts may understate recent 4, 2017. National Center for Health
trends, primarily due to delays in the
Conclusions reporting of the cause and manner of
Statistics. National Vital Statistics
System, Vital Statistics Rapid
death in provisional data. As such, the Release Program. 2018.
Provisional drug overdose mortality
reported provisional counts represent
data can provide timely information
lower bound estimates of drug overdose
about the burden of drug overdose

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics • National Vital Statistics System
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Vital Statistics Surveillance Report

Figure 12. Predicted and reported provisional counts of drug overdose deaths involving OJ, et al. The global burden of
psychostimulants with abuse potential, by 12-month ending period: United States, 2015–2017
dengue: An analysis from the Global
12,000
Burden of Disease Study 2013.
Lancet Infect Dis 16(6):712–23. 2016.
14. Sethi D, Wheeler J, Rodrigues LC,
Number of drug overdose deaths

10,000
Fox S, Roderick P. Investigation
of under-ascertainment in
8,000
epidemiological studies based in
Predicted provisional count
general practice. Int J Epidemiol
28(1):106–12. 1999.
6,000 Reported provisional count 15. van Lier A, McDonald SA,
Bouwknegt M, EPI group,
4,000 Kretzschmar ME, Havelaar AH, et
al. Disease burden of 32 infectious
diseases in the Netherlands, 2007–
0 2011. PLoS One 11(4):e0153106.
Jan Mar May July Sept Nov Jan Mar May July Sept Nov Jan Mar May July Sept 2016.
2015 2016 2017
12-month ending period 16. Undurraga EA, Halasa YA, Shepard
DS. Use of expansion factors to
NOTE: Counts are for the 12-month periods ending in the month indicated. estimate the burden of Dengue
SOURCE: NCHS, National Vital Statistics System, April 15, 2018. in Southeast Asia: A systematic
analysis. PLoS Negl Trop Dis
3. Rossen LM. Quarterly provisional 8. World Health Organization. 7(2):e2056. 2013.
estimates for infant mortality, 2015– International statistical classification
17. Noone AM, Howlader N, Krapcho
Quarter 3, 2017. National Center of diseases and related health
M, Miller D, Brest A, Yu M, et
for Health Statistics, National Vital problems, 10th revision (ICD–10).
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Statistics System, Vital Statistics 2008 ed. Geneva, Switzerland. 2009.
review, 1975– 2015. 2018. Available
Rapid Release Program. 2018.
9. Slavova S, O’Brien DB, Creppage from: https://seer.cancer.gov/
4. Spencer M, Ahmad F. Timeliness of K, Dao D, Fondario A, Haile E, csr/1975_2015/.
death certificate data for mortality et al. Drug overdose deaths: Let’s
18. Midthune DN, Fay MP, Clegg LX,
surveillance and provisional get specific. Public Health Rep
Feuer EJ. Modeling reporting delays
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and reporting corrections in cancer
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10. Rudd RA, Seth P, David F, Scholl registry data. J Am Stat Assoc
National Center for Health Statistics.
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involved overdose deaths—United
19. Clegg LX, Feuer EJ, Midthune DN,
5. Ahmad FB, Rossen LM, Spencer States, 2010–2015. MMWR Morb
Fay MP, Hankey BF. Impact of
MR, Warner M, Sutton P. Provisional Mortal Wkly Rep 65(5051):1445–52.
reporting delay and reporting error
drug overdose death counts. National 2016.
on cancer incidence rates and trends.
Center for Health Statistics. 2018.
11. Gibbons CL, Mangen MJ, Plass D, J Natl Cancer Inst 94(20):1537–45.
Available from: https://www.cdc.
Havelaar AH, Brooke RJ, Kramarz P, 2002.
gov/nchs/nvss/vsrr/drug-overdose-
et al. Measuring underreporting and
data.htm. 20. National Center for Health Statistics.
under-ascertainment in infectious
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6. Murphy SL, Xu JQ, Kochanek disease datasets: A comparison
Instruction manuals. Available from:
KD, Curtin SC, Arias E. Deaths: of methods. BMC Public Health
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Final data for 2015. National Vital 14:147. 2014.
instruction_manuals.htm.
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12. Kristensen M, van Lier A, Eilers R,
Hyattsville, MD: National Center for
McDonald SA, Opstelten W, van
Health Statistics. 2017.
der Maas N, et al. Burden of four
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Arias E. Mortality in the United adults. Vaccine 34(7):942–9. 2016.
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Center for Health Statistics. 2017.

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Vital Statistics Surveillance Report

List of Detailed Tables

Report tables
1. Completeness of 12-month ending
provisional counts of drug overdose
deaths relative to final counts, by
reporting jurisdiction and ending
month ...................................................... 11
2. Model results of the completeness
of provisional data for drug overdose
deaths and drug overdose deaths
involving any opioid, by month
ending and percentage pending .............. 13
3. Model results of the completeness of
provisional data for deaths involving
specific drugs and drug classes,
by month ending and percentage
pending.................................................... 14
4. Reported and predicted provisional
counts of drug overdose deaths
for the 12-month period ending
with January 2017, by reporting
jurisdiction............................................... 15

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics • National Vital Statistics System
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 Table 1. Completeness of 12-month ending provisional counts of drug overdose deaths relative to final counts, by reporting jurisdiction and ending month

Vital Statistics Surveillance Report

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics • National Vital Statistics System

Reporting jurisdiction January February March April May June July August September October November December

United States 97.7 96.8 96.0 96.1 95.5 94.4 93.3 93.9 94.6 95.6 97.0 97.6
Alabama 98.0 97.4 96.9 95.9 95.0 93.8 96.7 96.1 97.4 98.0 98.8 98.5
Alaska 99.4 99.2 99.2 99.8 100.0 100.0 100.0 99.7 100.0 99.8 100.0 100.0
Arizona 98.6 97.8 96.7 95.6 94.6 94.4 95.5 97.6 98.4 98.9 99.1 99.0
Arkansas 93.2 89.6 84.8 79.3 90.2 91.2 87.1 84.3 87.9 95.3 99.8 100.0
California 93.3 89.3 83.8 91.4 90.7 88.7 86.7 87.9 90.0 89.9 91.2 96.9
Colorado 97.5 97.1 94.4 98.3 99.8 97.5 97.8 99.8 99.8 99.1 99.8 99.9
Connecticut 97.1 95.2 94.4 95.0 89.9 87.0 83.7 84.5 87.9 89.5 94.7 98.4
Delaware 99.0 99.3 99.3 99.5 98.8 98.9 96.5 98.1 99.5 100.0 100.0 100.0
District of Columbia 96.0 94.3 94.9 97.4 92.9 88.0 85.9 89.8 92.1 94.3 95.3 98.1
Florida 98.8 97.7 96.7 97.3 97.7 98.3 98.9 99.0 98.6 98.7 99.3 99.8
Georgia
99.1 98.4 97.4 97.4 95.8 93.4 91.7 94.0 95.7 97.3 98.9 99.9
Hawaii 100.0 99.4 99.5 98.5 98.4 98.4 98.0 95.4 98.2 98.8 99.2 99.9
Idaho 99.4 98.1 98.3 99.0 98.7 98.4 97.9 98.5 99.2 98.4 99.6 99.9
Illinois 99.6 99.0 98.6 98.5 97.9 97.4 98.9 99.3 99.7 99.9 99.9 100.0
Indiana 98.2 97.6 98.1 98.3 98.3 97.7 97.1 96.3 96.3 96.7 97.7 99.1
Iowa 99.5 99.0 99.0 99.1 99.4 98.7 98.2 98.7 98.2 96.3 98.4 99.7
Kansas 98.8 97.6 96.6 96.2 95.1 92.9 91.7 94.7 96.1 99.5 100.0 99.9
Kentucky 100.0 99.8 99.7 99.3 98.8 98.0 97.3 98.0 98.9 99.0 99.7 100.0
Louisiana 98.9 98.7 98.9 99.2 99.0 98.3 98.8 99.5 99.6 99.6 99.6 99.3
Maine 99.7 99.6 99.9 100.0 100.0 100.0 99.6 99.7 99.3 98.3 98.1 100.0
Maryland
99.3 99.3 99.5 99.5 99.0 97.2 96.5 97.2 98.7 96.4 98.5 100.0
Massachusetts 98.3 98.8 97.9 98.1 97.2 95.2 96.5 91.1 78.7 83.2 84.7 76.8
11

Michigan 89.1 92.5 90.5 97.2 95.8 94.1 91.1 88.0 88.1 94.9 95.6 92.3
Minnesota 99.4 99.0 99.6 99.7 99.8 99.8 99.6 99.8 99.7 99.2 99.5 100.0
Mississippi 95.1 90.8 86.3 84.1 80.7 82.7 79.7 81.1 87.1 90.1 92.2 94.9
Missouri 99.7 99.0 98.8 99.1 98.7 97.3 96.1 96.7 97.8 98.7 99.6 100.0
Montana 97.0 97.5 94.6 92.3 92.0 91.2 87.7 89.7 91.5 94.3 96.9 97.5
Nebraska 100.0 99.0 98.9 98.4 98.4 98.3 96.4 99.3 99.5 99.2 99.6 99.9
Nevada 100.0 99.9 98.6 99.2 98.1 97.9 97.3 97.6 99.3 99.5 99.8 100.0
New Hampshire 99.6 98.4 97.7 96.7 93.5 92.8 90.0 96.1 97.9 99.1 99.5 99.9
New Jersey
94.6 92.5 91.2 88.8 89.0 89.4 89.3 89.8 86.7 88.3 91.9 93.2
New Mexico 97.0 93.0 90.7 91.2 87.5 81.6 78.3 88.2 91.8 93.3 95.4 99.3
New York1 92.0 86.0 82.3 86.5 85.9 83.3 77.0 76.6 72.4 73.1 75.3 70.3
New York City 98.1 96.6 97.0 96.7 97.5 97.2 98.2 98.1 96.8 99.0 99.7 99.7
North Carolina 95.1 93.7 92.4 92.0 89.2 87.8 86.6 86.1 84.8 85.7 89.5 94.4
North Dakota 100.0 100.0 100.0 94.2 100.0 100.0 98.5 91.2 93.1 99.3 100.0 100.0
Ohio 99.5 99.1 98.5 98.8 98.5 98.2 98.9 99.0 99.2 99.5 99.7 99.9
Oklahoma 97.3 97.5 98.3 99.8 99.6 99.7 99.5 97.7 97.7 97.8 98.6 97.9
Oregon 99.1 98.5 97.9 97.3 94.9 91.8 88.8 91.2 95.1 97.1 99.5 100.0
Pennsylvania 93.1 94.3 95.1 94.1 91.7 87.6 84.6 82.3 82.5 81.3 82.7 83.3

See footnotes at end of table.

 Table 1. Completeness of 12-month ending provisional counts of drug overdose deaths relative to final counts, by reporting jurisdiction and ending month—Con.

Vital Statistics Surveillance Report

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics • National Vital Statistics System

Reporting jurisdiction January February March April May June July August September October November December

Rhode Island 96.8 98.1 96.1 96.5 95.0 91.7 90.2 94.4 96.7 97.5 99.3 100.0
South Carolina 98.1 97.4 98.8 99.8 98.7 94.6 93.2 92.3 94.3 94.4 96.9 99.8
South Dakota 98.4 98.5 98.5 98.6 98.6 98.5 94.9 90.8 97.0 99.0 99.3 99.8
Tennessee 89.7 87.0 83.5 79.2 79.3 84.4 81.1 79.2 83.3 83.9 87.4 92.3
Texas 98.7 97.9 98.5 98.8 98.7 98.1 98.8 99.4 99.3 99.2 99.3 99.4
Utah 97.8 96.6 95.0 93.7 92.1 88.4 86.8 88.4 89.0 92.6 96.1 98.9
Vermont 100.0 99.5 99.2 99.4 99.0 97.2 98.5 96.2 91.7 91.6 98.4 100.0
Virginia 98.1 95.3 96.7 97.5 97.5 97.3 99.6 99.5 99.1 99.1 99.3 99.3
Washington 99.5 99.2 98.9 98.6 98.2 97.8 98.8 99.4 99.7 99.7 99.8 99.9
West Virginia 99.4 98.9 98.9 98.9 97.3 93.9 91.3 95.5 97.6 97.7 99.5 99.9
Wisconsin 97.9 96.7 97.0 96.9 95.7 94.1 96.1 98.4 98.4 99.2 99.4 99.9
Wyoming 100.0 100.0 100.0 100.0 100.0 97.4 96.0 99.4 100.0 100.0 100.0 100.0

1
Excludes New York City.
NOTE: Completeness of weekly provisional data is shown with a 6-month lag following the 12-month period ending in the month indicated.
SOURCE: NCHS, National Vital Statistics System, February 28, 2016, through July 4, 2017.
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Vital Statistics Surveillance Report

Table 2. Model results of the completeness of provisional data for drug overdose deaths and
drug overdose deaths involving any opioid, by month ending and percentage pending

Outcome

Drug overdose deaths

Model parameter Drug overdose death involving any opioid

Intercept 100.5 (0.1) 100.5 (0.1)

February –0.4 (0.1) –0.3 (0.1)
March –0.4 (0.2) –0.4 (0.2)
April –0.5 (0.2) –0.4 (0.2)
May –0.5 (0.2) –0.4 (0.2)
June –0.8 (0.2) –0.7 (0.2)
July –1.0 (0.2) –1.2 (0.2)
August –1.5 (0.2) –1.5 (0.2)
September –1.4 (0.2) –1.5 (0.2)
October –1.2 (0.1) –1.2 (0.2)
November –0.9 (0.1) –1.0 (0.2)
December –0.2 (0.1) –0.2 (0.2)
Percentage pending –16.8 (0.3) –18.0 (0.3)

NOTES: Values are estimated coefficients (robust standard errors). Drug overdose deaths were identified using underlying cause-
of-death codes from the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD–10):
X40–X44 (unintentional drug overdose), X60–X64 (suicide by drug overdose), X85 (homicide by drug poisoning), and Y10–Y14 (drug
poisoning of undetermined intent). Any opioid is defined using ICD–10 multiple-cause-of-death codes T40.0–T40.4 or T40.6.
SOURCE: NCHS, National Vital Statistics System, February 28, 2016, through July 4, 2017.

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics • National Vital Statistics System
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Vital Statistics Surveillance Report

Table 3. Model results of the completeness of provisional data for deaths involving specific drugs and drug classes, by month ending and
percentage pending

Outcome

Natural and Synthetic opioids,

semisynthetic excluding Psychostimulants
Model parameter Heroin opioids Methadone methadone Cocaine with abuse potential

Intercept 100.7 (0.2) 100.2 (0.2) 100.6 (0.2) 100.5 (0.2) 97.4 (0.3) 99.5 (0.4)
February –0.4 (0.1) –0.3 (0.2) –0.1 (0.2) –0.4 (0.2) –0.3 (0.2) 0.3 (0.2)
March –0.2 (0.2) –0.4 (0.2) –0.3 (0.3) –0.6 (0.3) –0.3 (0.4) 0.2 (0.3)
April 0.0 (0.2) –0.5 (0.2) –0.3 (0.3) –1.0 (0.3) –0.9 (0.5) 0.3 (0.4)
May 0.2 (0.2) –0.2 (0.3) –0.6 (0.3) –1.3 (0.3) –0.9 (0.5) 0.5 (0.4)
June 0.0 (0.3) –0.5 (0.3) –0.1 (0.3) –2.0 (0.3) –1.1 (0.5) 0.2 (0.4)
July –1.1 (0.3) –1.1 (0.3) –0.7 (0.3) –2.3 (0.3) –0.6 (0.4) –0.9 (0.5)
August –1.3 (0.2) –1.5 (0.2) –1.1 (0.3) –2.0 (0.3) –0.4 (0.4) –1.4 (0.4)
September –1.4 (0.2) –1.4 (0.2) –1.1 (0.3) –1.9 (0.2) –0.7 (0.3) –1.5 (0.4)
October –1.2 (0.2) –1.1 (0.2) –0.7 (0.2) –1.5 (0.2) –0.9 (0.3) –0.8 (0.4)
November –1.0 (0.2) –0.8 (0.2) –0.6 (0.2) –1.1 (0.2) –1.1 (0.2) –0.1 (0.4)
December –0.4 (0.2) 0.1 (0.2) 0.2 (0.2) –0.3 (0.2) –0.7 (0.1) 0.7 (0.5)
Percentage pending –17.1 (0.4) –20.4 (0.5) –21.2 (0.5) –19.0 (0.5) –2.9 (0.6) –19.2 (0.5)

NOTES: Values are estimated coefficients (robust standard errors). Specific drugs or drug classes are defined using the following International Statistical Classification of Diseases and Related Health
Problems, 10th Revision multiple-cause-of-death codes: heroin, T40.1; natural and semisynthetic opioids, T40.2; methadone, T40.3; synthetic opioids, excluding methadone, T40.4; cocaine, T40.5; and
psychostimulants with abuse potential, T43.6.
SOURCE: NCHS, National Vital Statistics System, February 28, 2016, through July 4, 2017.

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics • National Vital Statistics System
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Vital Statistics Surveillance Report

Table 4. Reported and predicted provisional counts of drug overdose deaths for the 12-month period ending with January 2017, by reporting
jurisdiction

6-month lag 15-month lag Percent difference

between predicted Percent of
Reported Predicted Reported (6-month lag) records pending
provisional provisional provisional and reported investigation
Reporting jurisdiction count count count (15-month lag) count (6-month lag)

United States 63,295 66,158 65,392 –1.2 0.2

Alabama 740 780 762 –2.4 0.3
Alaska 126 128 126 –1.6 0.1
Arizona 1,399 1,587 1,417 –12.0 0.6
Arkansas 373 377 384 1.8 0.1
California 4,571 4,972 4,767 –4.3 0.4
Colorado 973 977 976 –0.1 0.0
Connecticut 908 935 985 5.1 0.0
Delaware 306 306 310 1.3 0.0
District of Columbia 300 303 325 6.8 0.0
Florida 5,150 5,193 5,180 –0.3 0.0
Georgia 1,330 1,352 1,399 3.4 0.1
Hawaii 199 216 203 –6.4 0.3
Idaho 223 226 226 0.0 0.1
Illinois 2,518 2,520 2,524 0.2 0.0
Indiana 1,548 1,550 1,576 1.6 0.0
Iowa 322 321 325 1.2 0.0
Kansas 318 324 326 0.6 0.1
Kentucky 1,460 1,457 1,480 1.6 0.0
Louisiana 1,013 1,011 1,016 0.5 0.0
Maine 355 360 368 2.2 0.0
Maryland 2,151 2,183 2,174 –0.4 0.0
Massachusetts 2,203 2,426 2,223 –9.1 0.5
Michigan 2,291 2,419 2,310 –4.7 0.3
Minnesota 647 644 655 1.7 0.0
Mississippi 307 313 326 4.0 0.1
Missouri 1,362 1,361 1,393 2.3 0.0
Montana 117 121 119 –1.7 0.1
Nebraska 110 111 114 2.6 0.0
Nevada 699 696 705 1.3 0.0
New Hampshire 451 461 458 –0.7 0.1
New Jersey 1,997 2,197 2,080 –5.6 0.4
New Mexico 471 494 502 1.6 0.1
New York1 2,111 2,447 2,283 –7.2 0.6
New York City 1,476 1,488 1,479 –0.6 0.1
North Carolina 1,779 1,959 1,968 0.5 0.3
North Dakota 80 84 81 –3.7 0.3
Ohio 4,072 4,656 4,501 –3.4 0.0
Oklahoma 802 803 830 3.3 0.0
Oregon 478 491 504 2.6 0.1
Pennsylvania 4,602 4,929 4,855 –1.5 0.3
Rhode Island 334 349 350 0.3 0.1
South Carolina 881 898 903 0.6 0.0
South Dakota 73 73 75 2.7 0.0
Tennessee 1,562 1,656 1,644 –0.7 0.2
Texas 2,804 2,883 2,809 –2.6 0.2
Utah 615 764 640 –19.4 0.9
Vermont 135 135 137 1.5 0.0
Virginia 1,391 1,390 1,392 0.1 0.0
Washington 1,100 1,105 1,104 –0.1 0.0
West Virginia 881 922 911 –1.2 0.2
Wisconsin 1,092 1,116 1,101 –1.4 0.1
Wyoming 89 89 91 2.2 0.0

1
Excludes New York City.
SOURCE: NCHS, National Vital Statistics System, July 2, 2017, and April 15, 2018.

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics • National Vital Statistics System
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Vital Statistics Surveillance Report

Technical Notes Multiple-cause-of-death codes were first

added to the surveillance database on
specific causes if further, more specific
cause-of-death information is provided.
February 28, 2016, enabling the analysis
Definitions of specific drugs and drug categories
12-month ending period refers to in addition to overall drug overdose Acknowledgments
the 12-month periods ending with mortality. Weekly provisional mortality
The Data Acquisition and Evaluation
the month specified, and are the time data captured from February 28, 2016,
Branch staff of the National Center
periods used for reporting provisional through July 4, 2017 (approximately 6
for Health Statistics Division of Vital
drug overdose deaths. For example, months after the full 2016 data year)
Statistics evaluated the quality of and
data for the 12-month period ending were used to calculate the number of
acceptance procedures for the data
with September 2017 include deaths drug overdose death records available
files on which this report is based.
that occurred from October 1, 2016, for analysis in the National Vital
The authors gratefully acknowledge
through September 30, 2017. Statistics System surveillance database.
Hanyu Ni, Robert Anderson, and
Yulei He for reviewing this report
Completeness is the percentage Cause-of-death classification and providing helpful comments.
of drug overdose death records
available in weekly provisional data Mortality statistics are compiled
in accordance with World Health Suggested citation
as compared with final data. Because
drug overdose deaths often require Organization (WHO) regulations Rossen LM, Ahmad FB, Spencer
lengthy investigations, including specifying that WHO member MR, Warner M, Sutton P. Methods
toxicological analysis, death certificates countries classify and code causes to adjust provisional counts of drug
may be initially filed with a manner of death in accordance with the overdose deaths for underreporting.
of death “pending investigation” current revision of the International Vital Statistics Rapid Release; no 6.
or with a preliminary or unknown Statistical Classification of Diseases Hyattsville, MD: National Center
cause of death. Provisional counts of and Related Health Problems, 10th for Health Statistics. August 2018.
drug overdose deaths therefore tend Revision (ICD–10). ICD provides the
to be lower than the final count. basic guidance used in virtually all Copyright information
countries to code and classify causes
Lag time is the time between when of death. It provides not only disease, All material appearing in this
the death occurred and when the injury, and poisoning categories but report is in the public domain
death certificate data is available in also the rules used to select the single and may be reproduced or copied
the provisional data snapshots. This underlying cause of death for tabulation without permission; citation as to
length of time varies due to the time from the conditions reported on the source, however, is appreciated.
it takes for jurisdictions to submit death certificate, as well as definitions,
data, and for the data to be processed tabulation lists, the format of the death National Center for Health Statistics
and coded by the National Center certificate, and regulations on use Charles J. Rothwell, M.S.,
for Health Statistics (NCHS). of the classification. Causes of death M.B.A., Director
for data presented in this report were
Multiplication factor is an coded according to ICD guidelines Jennifer H. Madans, Ph.D.,
adjustment or weight that can be described in annual issues of the Associate Director for Science
applied to provisional counts to NCHS Instruction Manuals (20).
adjust for delayed reporting. Division of Vital Statistics
Provisional data on cause of death are
Provisional count is the number of Delton Atkinson, M.P.H.,
subject to some nonrandom sampling
deaths available in the surveillance M.P.H., P.M.P., Director
error. This is because the delay in
data as of a given date. receiving the report of a death depends Hanyu Ni, Ph.D., M.P.H.,
on the cause of death. Furthermore, for Associate Director for Science
Nature and source of data some deaths, the final cause may not
be available at the time that the death
Provisional mortality was reported. In those cases, the cause
data—Weekly snapshots of death may be reported as unknown
or pending investigation and coded to
In late 2014, NCHS began taking ICD–10 code R99 (other ill-defined
weekly snapshots of its mortality and unspecified causes of mortality). In
data, which include death certificate the final data, some of the deaths with
records from the 50 states, New York unknown cause will be reassigned to
City, and the District of Columbia.
CS294825

U.S. Department of Health and Human Services • Centers for Disease Control and Prevention • National Center for Health Statistics • National Vital Statistics System
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