US Deaths From Suicide, Drugs, Alcohol Reach Crisis Levels

Pauline Anderson

June 12, 2019

Deaths from suicide, alcohol, and drug overdoses are reaching crisis levels across the nation, although individual states are affected in dramatically different ways, a new report shows.

The Commonwealth Fund’s 2019 Scorecard on State Health System Performances reveals there are regional epidemics for each of these causes of death.

"Drug overdose mortality is disproportionately impacting states in the eastern part of the country, and suicide and alcohol-related deaths are occurring at higher rates in the west," report author Sara R. Collins, PhD, vice president of healthcare coverage and access, The Commonwealth Fund, New York City, told reporters attending a press teleconference.

Although there had been increased access to healthcare in several states following Affordable Care Act insurance expansions, the report shows these earlier gains have now stalled, said Collins.

The report also showed that rising healthcare costs continue to drive up employer premiums "adding to the financial burden that many American families in all states face," she added.

The report assesses all 50 states and the District of Columbia on 47 measures of access to healthcare, quality of care, service use, costs of care, health outcomes, and income-based healthcare disparities. Researchers compared states on each measure to other states nationally as well as to states within a particular region.

Hawaii, Massachusetts, and Minnesota came out at the top based on their overall ranking, followed by Washington, Connecticut, and Vermont. Arkansas, Nevada, Texas, Oklahoma, and Mississippi were at the bottom.

The report’s lead author, David C. Radley, PhD, MPH, senior scientist for the tracking health system performance program, The Commonwealth Fund, noted that California made the biggest gain in overall ranking, having jumped 12 spots from number 26 to number 14.

The Scorecard includes regional comparisons, which allows users to compare individual states with neighbouring ones that may share similar socioeconomic and political circumstances, said Radley.

The leaders in eight regions of the country were:

  • Wisconsin in the Great Lakes area

  • New York among mid-Atlantic states

  • Massachusetts in New England

  • Minnesota among plains states

  • Colorado in the rocky mountain area

  • Virginia in the southeast

  • Arizona in the southwest

  • Hawaii in the far west

Zero Reduction in Mortality

Nationally, drug overdose deaths have more than doubled since 2005 while alcohol-related deaths (including acute causes like alcohol poisoning and chronic causes such as liver cirrhosis) were up 37%, and suicides were up by 28%.

The epidemic of drug overdose deaths has hit West Virginia, Ohio, and Delaware particularly hard. Between 2005 and 2017, the rate of death from drug overdoses more than doubled nationally, but in Ohio the rate grew by 325%. In Delaware, it was up 393% and in West Virginia it was up 450%.

Opioid use disorder and the emergence of highly lethal synthetic opioids such as fentanyl and carfentanil have fuelled the rise in drug overdose deaths, the report notes.

However, in some states deaths from suicide and alcohol dominate. In 2017, Montana, Nebraska, the Dakotas, Oregon, and Wyoming saw higher rates of death from suicide and alcohol than from drugs.

But deaths from all three causes rose at least 3% in all 50 states between 2005 and 2017.

"There were no states where mortality from these causes declined," said Radley.

In addition to synthetic opioids making their way into the illicit drug supply, some research has linked higher rates of deaths from drugs, as well as from alcohol and suicide, to poor economic opportunities, said Radley.

Another contributing element could be opioid prescribing practices, an area that has seen some policy action, he said.

Although there have been increased levels of health insurance coverage and more people accessing needed care, "gains experienced following the Affordable Care Act coverage expansions have largely stalled and even eroded in some states," said Radley.

He noted that uninsured rates varied widely across states in 2017. Massachusetts had the lowest rate, with about one in 20 adults lacking coverage, while Texas had highest rate, with about one in four lacking coverage, he said.

Lack of Insurance

Five of the 17 states that have yet to expand Medicaid coverage — Georgia, Oklahoma, Mississippi, Florida, and Texas — had the highest adult uninsured rates in 2017.

Radley noted the growing number of residents who skip needed medical care because of the cost. "This may stem from more people being uninsured but also from greater cost-sharing among people who have insurance through their employer."

The report also noted growth in healthcare premiums of employer plans. In 2017, premium contributions for working families in 11 states accounted for 8% or more of their state median income. In Louisiana, average premium contributions topped 10% of median income, said Radley.

He emphasized the role of healthcare pricing.

"Higher prices are associated with higher overall spending and higher spending is linked to higher premiums that can burden working families and create barriers, preventing people from getting the care that they need," he said.

Some states are attempting to turn the tide. Their efforts to counter the surge in drug overdose deaths include improving access to opioid overdose reversal medications such as naloxone and passing legislation that sets guidelines or limits for opioid prescriptions.

Many states are taking steps to expand access to high-quality care.

Another report author, Susan L. Hayes, MPA, senior researcher for tracking health system performance, The Commonwealth Fund, used West Virginia as an example. One of the hardest hit states in terms of the drug overdose epidemic, West Virginia recently began providing Medicaid coverage for newborns exposed prenatally to opioids.

But while many states have assumed greater responsibility for improving health system performance, they require a strong federal partnership to build and sustain their progress, the authors note.

The Fund has set up a health system data center that allows users to focus on areas of interest and create graphs, tables, and maps.

The Commonwealth Fund is a private, nonprofit foundation supporting independent research on health policy reform and a high-performance health system.

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