Opioid Overdose Deaths in the United States

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SOCIO DEMOGRAPHIC
Race / Ethnicity
Age
Educational Attainment
ECONOMIC
Injury-prone Employment
BEHAVIORAL HEALTH FACILITIES
PROSPERITY INDEX
Prosperity Index Details
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HOW TO USE THE TOOL METHODOLOGY & DATA PROSPERITY INDEX MORE INFORMATION
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Drug Overdose Mortality Rate
Deaths per 100k population
(Ages 15-64)
USDA Region Drug Overdose Mortality Rate
U.S. Drug Overdose Mortality Rate
See Behavioral Health Resources See Prosperity Index See Demographics
See Prosperity Index See Demographics See Behavioral Health Resources
Total Deaths
Population
Urban / Rural
Choose County Profile Data Time Period
2010-2014
2015-2019
Change from 2010-2014 to 2015-2019
Note: Sociodemographic and economic data are provided to show composition of the total population; they DO NOT reflect the proportions of individuals who died as a result of overdose.
Overall Prosperity Index Score:
SOCIO DEMOGRAPHIC USDA Region United States
Race /Ethnicity
White (non-Hispanic)
African American (non-Hispanic)
Hispanic or Latino
Asian (non-Hispanic)
Native Hawaiian/Pacific Islander (non-Hispanic)
American Indian/Alaska Native (non-Hispanic)
Age
Under 15
15-64
65+
Educational Attainment
At least High School Diploma (25+)
Bachelor's Degree or more (25+)
Disability Status
% Residents with a disability (18-64)
ECONOMIC
Broadband Access (3 or more providers)
Median Household Income
Poverty Rate
Unemployment Rate
Injury-prone Employment
Construction >
Mining and Natural Resources
Manufacturing
Trade, Transportation, & Utilities
Component Score Sub-Component State Average United States
Economic - Risk 5 Poverty Rate
Number of Industry Dependencies
Net Migration per 100 people
Labor Force Participation Rate
Economic - Resilience 5 Self-employment Rate
Business Establishments per 100 workers
Number of Hospitals Beds per 10,000 population
Median Household Income
Social - Risk 5 Digital Distress (1= Low Distress, 2 = Medium Distress, 3 = High Distress)
High School Drop Out Rate
Teen Birth Rate per 1,000 population
All-cause Mortality Rate per 100,000 population
Social - Resilience 5 501 c3 and c4s per 10,000 population
Educational Attainment - Bachelor's Degree or more
Primary Care Providers per 10,000 population
Voter Participation Rate
RESOURCES USDA Region United States
Behavioral Health Workforce
Health Professional Shortage Area: Mental Health
Health Professional Shortage Area: Primary Care
Total number of buprenorphine-waivered physicians
Number of buprenorphine-waivered physicians per 10,000 population
Behavioral Health Facilities
Number of Community Mental Health Centers
Number of Substance Use Facilities
Number of Mental Health Facilities

The prosperity index was developed with support from a Technical Expert Panel convened by USDA Rural Development. The prosperity index provides a single numerical measure designed to reflect the prosperity of a county. For the overall prosperity index score, 1 represents highest prosperity and 5 represents lowest prosperity. For the component scores, 1 represents lowest risk or highest resilience and a score of 5 represents highest risk or lowest resilience.

The prosperity index is calculated for each county in the United States using standardized values of 16 indicators belonging to one of four component classes associated with prosperity. The four components represented are Economic Risk, Economic Resilience, Social Risk, and Social Resilience. Each of these four components is comprised of four indicators reflecting aspects of that dimension that are aggregated to create the component score.

This data is from the Opioid Community Assessment Tool created by NORC at the University of Chicago and can be found at opioidmisusetool.norc.org
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Prosperity Index Methodology

What is the prosperity index?

The prosperity index was developed with support from a Technical Expert Panel (TEP) convened by Betty-Ann Bryce, while detailed to the White House Office of National Drug Control Policy as Special Advisor for Rural Affairs from the U.S. Department of Agriculture, Rural Development agency. TEP members represented a diverse group of stakeholders with a wide range of expertise. The TEP included: Anita Chandra (RAND Corporation), Courtney Cuthbertson (University of Illinois at Urbana-Champaign), Alison Davis (University of Kentucky), Marjory Givens (Wisconsin Public Health Institute; County Health Rankings), Shannon Monnat (Syracuse University), Robert Pack (East Tennessee State University), Laura Palombi (University of Minnesota), Khary Rigg (University of South Florida), David Terrell (Indiana Communities Institute, Paul State University) Brian Smedley (National Collaborative for Health Equity), and Sarah Willen (University of Connecticut).

The prosperity index provides a single numerical measure designed to reflect the prosperity of a county. For the overall prosperity index score, 1 represents most prosperous counties and 5 represents least prosperous counties. For the component scores, 1 represents lowest risk or highest resilience and a score of 5 represents highest risk or lowest resilience.

The prosperity index is calculated for each county in the United States using standardized values of 16 indicators belonging to one of four component classes associated with prosperity. The four components represented are Economic Risk, Economic Resilience, Social Risk, and Social Resilience. Each of these four components is comprised of four indicators reflecting aspects of that dimension that are aggregated to create the component score.

Prosperity Graph
How should the prosperity index be interpreted?

The economic dimensions, risk and resilience, provide two numerical measures for the degree to which a county is economically vulnerable to, or protected from the effects of public health and well-being challenges and crises. The economic risk experienced by a county is qualified or mitigated by its level of economic resilience, the strength of its protective factors.

Similarly, social risk and social resilience both have a role in determining the vulnerability of a county. Taking both economic factors and societal factors into consideration gives the most complete picture of the county and can help users refine focus for initiatives that seek to improve quality of life by reducing risk and increasing resilience.

The index may provide benefit to public health officials in counties where a certain level of vulnerability may exist even though a crisis has not yet been experienced. Proactive exploration of the index and digging deeper into the factors that it highlights will allow end users to reduce the likelihood or severity of these crises.

What are the indicators?

Indicators were selected based on several criteria, including the ability to influence the indicator at the local level, the availability of county-level data that is consistently reported and publically available, and data that could be considered indicators of community-level prosperity. Indicators that were suggested but ultimately not included in the prosperity index due to data limitations or challenges are: access to transportation, income inequality, and access to early childhood education.

Component Indicator Data Source Calculation Method
Economic – Risk Poverty Rate U.S. Census Bureau, ACS 5-year estimates (2014-2019) Percentage of individuals below poverty
Number of Industry Dependencies USDA Economic Research Service (2015) Total number of industry-dependencies calculated from binary indicators for industry-dependence (mining, farming, manufacturing, recreation)
Net Migration per 100 people ICPSR Net Migration (2000-2010) Calculated using 2000 and 2010 Census data. Net migration is the balance of in-migrants minus out-migrants. Negative net migration implies that the number of emigrants exceeded the number of immigrants in the county (more people left the county than moved to the county).
Labor Force Participation Rate U.S. Census Bureau, ACS 5-year estimates (2015-2019) Among the civilian non-institutionalized population aged 25 to 54, the percentage that is working or actively looking for work
Economic – Resilience Self-employment Rate U.S. Census Bureau, ACS 5-year estimates (2015-2019) Percentage of total workforce self-employed in own incorporated business
Business Establishments per 100 workers U.S. Census - County Business Patterns (2018) Number distinct business establishments per workers 16 years and older
Number of Hospital Beds per 10,000 population HRSA Area Health Resources Files (2019-2020) Number of hospital beds per 10,000 population
Median Household Income U.S. Census Bureau, ACS 5-year estimates (2015-2019) Median household income in the past 12 months (in 2017 inflation-adjusted dollars)
Social – Risks Digital Distress Purdue Center for Regional Development: Digital Distress Indicator (2015-2019)
  • 1 = Low digital distress
  • 2 = Medium digital distress
  • 3 = High digital distress
(Based on data from ACS on internet subscription, access, and computing devices.)
High School Drop Out Rate U.S. Census Bureau, ACS 5-year estimates (2015-2019) Percentage of persons aged 16 to 19 years who neither graduated from, nor are currently enrolled in, high school
Teen Birth Rate per 1,000 population CDC NCHS (2018) Estimated teen birth rates for females aged 15 to 19 years per 1,000
All-cause Mortality Rate per 1,000 population* CDC NCHS NVSS – Multiple cause of death data (2019) Number of deaths of all causes per 1,000 population (age-adjusted)
Social – Resilience 501 c3 and c4s per 10,000 population Internal Revenue Service (IRS) (2020) Number of 501 c3 and c4 organizations per 10,000 population
Educational Attainment- Bachelor’s Degree or more U.S. Census Bureau, ACS 5-year estimates (2015-2019) Percentage of population 25 years and older with a Bachelor's, Master's, Professional, or Doctorate degree
Primary Care Providers per 10,000 population HRSA Area Health Resources Files (2019-2020) Number of primary care physicians, nurse practitioners, and physician assistants per 10,000 population
Voter Participation Rate^ MIT Election Data and Science Lab (2018) Percentage of eligible voters that voted in the 2016 presidential election

*The all-cause mortality data did not have mortality rates for about 80 counties. For these counties the mortality subcomponent did not contribute a positive or negative result to the overall score (effectively a mean imputation).

^The voter turnout indicator was not readily available for Alaska since the raw data included voter totals by Congressional House District. A proportional allocation method based on population overlap was devised to estimate the voter turnout for each county (borough) in Alaska.

How is the prosperity index calculated?

The prosperity index is calculated for each county in the United States using standardized values of 16 indicators belonging to one of four component classes associated with prosperity. The four components represented are Economic Risk, Economic Resilience, Social Risk, and Social Resilience. Each of these 4 components is comprised of 4 subcomponents reflecting aspects of that dimension that are aggregated to create the component score.

Each indicator, also known as a subcomponent, was scaled to have a mean of 0 and a standard deviation of 1. This is referred to as the standardized subcomponent value. Then a clustering algorithm grouped all of the counties into 5 homogenous groups according to the standardized values thus providing a score (1 through 5) for each county for each subcomponent.

At the component level, the 4 subcomponent standardized values within the component are summed to create a component value. The counties are then clustered according to the component value to create the component scores 1 through 5.

Finally the component values are summed for each county to create the prosperity value. The counties are then grouped into 5 classes with 1 representing the most prosperous and 5 representing the least prosperous. This 1-to-5 score is the final prosperity index score.

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Methodology & Data Sources

The interactive tool was created in JavaScript using the Leaflet library. Data was processed using SAS and converted from shapefile to TopoJSON using the Mapshaper web client. Several data sources were accessed in the development of this tool (more information on the data sources used in the prosperity index can be found here):

  1. CDC National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS) Multiple Cause of Death File
  2. U.S. Census Bureau, American Community Survey
  3. Bureau of Labor Statistics Quarterly Census of Employment and Wages
  4. Federal Communications Commission
  5. Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioral Health Treatment Locator
  6. USDA Economic Research Service

The tool presents age-adjusted mortality rates for the population aged 15 to 64. The combined population estimates for the time period (either 2010-2014 or 2015-2019) are the denominator for the mortality rates. Five-year average mortality rates were used for this tool in order to maximize the number of counties with a reliable age-adjusted mortality rate. If a county has fewer than 20 deaths over the five-year time period, the mortality rate is considered “unreliable” and we present the crude mortality rate. For counties with fewer than 10 deaths over the five-year time period, the number of deaths is suppressed, and therefore a mortality rate is not provided. However, when possible, we have calculated the maximum crude mortality rate based on the population and the assumption of less than 10 deaths.

The table below describes each of the data sources and definitions for the variables included in the tool.

Variable Data Source Definition
Drug Overdose Mortality Rate CDC NCHS NVSS – Multiple cause of death data (2010-2014; 2015-2019) Age-adjusted mortality rate for population aged 15 to 64. Underlying cause-of-death codes: X40-X44, X60-X64, X85, and Y10-Y14.
Opioid Overdose Mortality Rate CDC NCHS NVSS – Multiple cause of death data (2010-2014; 2015-2019) Age-adjusted mortality rate for population aged 15 to 64. Underlying cause-of-death codes: X40-X44, X60-X64, X85, and Y10-Y14. Multiple cause-of-death codes: T40.0, T40.1, T40.2, T40.3, T40.4, T40.6.
*Note: There are variations in reporting across states for the ICD-10 codes on contributing causes. Therefore, these estimates should be used with caution.
Urban/Rural USDA Economic Research Services (ERS) 2013 Urban Influence Codes (UIC)

Urban = Metropolitan counties, UIC Codes 1-2

Rural = Nonmetropolitan counties, UIC Codes 3-12
Race/Ethnicity U.S. Census Bureau, ACS 5-year estimates (2010-2014; 2015-2019) Percentage of total population:
  • White (non-Hispanic)
  • African American (non-Hispanic)
  • Hispanic or Latino
  • Asian (non-Hispanic)
  • Native Hawaiian/Pacific Islander (non-Hispanic)
  • American Indian/Alaska Native (non-Hispanic)
Age U.S. Census Bureau, ACS 5-year estimates (2010-2014; 2015-2019) Percentage of total population:
  • Under 15 years old
  • Age 15 to 64
  • 65 years and above
Educational Attainment U.S. Census Bureau, ACS 5-year estimates (2010-2014; 2015-2019) Percentage of population 25 years and over in the United States:
  • Completed high school (at least high school graduate, includes equivalency)
  • Completed college (Bachelor’s degree OR graduate or professional degree)
Disability Status U.S. Census Bureau, ACS 5-year estimates (2010-2014; 2015-2019) Percentage of civilian non-institutionalized population ages 18-64 with a disability
Broadband Access Federal Communications Commission (FCC)

Percentage of population with 3 or more broadband providers
Median Household Income U.S. Census Bureau, ACS 5-year estimates (2010-2014; 2015-2019)

Median household income in the past 12 months (in 2018 inflation-adjusted dollars)

Median household income in the past 12 months (in 2014 inflation-adjusted dollars)
Poverty Rate U.S. Census Bureau, ACS 5-year estimates (2010-2014; 2015-2019) Among the population for whom poverty status is determined, the percentage of the population that has an income in the past 12 months below the poverty level
Unemployment Rate U.S. Census Bureau, ACS 5-year estimates (2010-2014; 2015-2019) Among the population 16 years and over, the percentage of the labor force that is unemployed
Injury-prone Employment Bureau of Labor Statistics Quarterly Census of Employment and Wages (2010-2014 average employment; 2015-2019 average employment) Percent of employed population that is employed in the following:
  • Manufacturing
  • Construction
  • Mining and Natural Resources
  • Trade, Transportation, and Utilities
Behavioral Health Facilities Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Services Locator Location of substance use and mental health facilities reported in the SAMHSA Treatment Services Locator, as of February 1, 2021
Native American Reservations U.S. Geological Survey Indian Lands shapefile (2013)

The cartographic boundary files are simplified representations of selected geographic areas from the National Atlas of the United States
Persistent Poverty Counties USDA Economic Research Service (ERS) (2013) Persistent poverty county is defined as: 20 percent or more of residents were poor as measured by each of the 1980, 1990, 2000 censuses, and 2007-11 American Community Survey 5-year average.
Economic Development Districts (EDDs) U.S. Economic Development Administration EDDs are multi-jurisdictional entities, commonly composed of multiple counties and in certain cases even cross-state borders. They help lead the locally-based, regionally driven economic development planning process that leverages the involvement of the public, private and non-profit sectors to establish a strategic blueprint (i.e., an economic development roadmap) for regional collaboration.
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More Information

About USDA Rural Development

USDA Rural Development provides loans and grants to help expand economic opportunities and create jobs in rural areas. This assistance supports infrastructure improvements; business development; housing; community facilities such as schools, public safety and health care; and high-speed internet access in rural areas.

www.rd.usda.gov

Additional Resources

For more information on USDA’s response to the opioid crisis, please visit https://www.usda.gov/topics/opioids.

For more information on federal funding opportunities, information, training programs, treatment options, and other resources focused on addressing substance use disorder and the opioid crisis in rural communities, please visit the Rural Community Toolbox (RCT), available at www.ruralcommunitytoolbox.org.

More About NORC at the University of Chicago

NORC at the University of Chicago is an objective, non-partisan research institution that delivers reliable data and rigorous analysis to guide critical programmatic, business, and policy decisions. Since 1941, NORC has conducted groundbreaking studies, created and applied innovative methods and tools, and advanced principles of scientific integrity and collaboration. Today, government, corporate, and nonprofit clients around the world partner with NORC to transform increasingly complex information into useful knowledge.

www.norc.org

Contact

For more information please contact:

Betty-Ann Bryce

Rural Health Liaison, USDA

Betty-Ann.Bryce@usda.gov

(202) 720-9634


Eric Young

NORC Senior External Affairs Manager

young-eric@norc.org

(301) 634-9536


Michael Meit

Senior Fellow and Co-Director, NORC Walsh Center for Rural Health Analysis

meit-michael@norc.org

(301) 634-9324

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Embed table for Menifee County, KY in 2011 - 2015

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Using the “Opioid Misuse Community Assessment" Tool

This tool allows researchers, policymakers, journalists, and the general public to create county-level maps illustrating the relationship between community and population demographics and fatal drug overdoses—including opioids—in the United States. Insights derived from this tool can be used to target resources and interventions, and inform media coverage related to overdose deaths in the U.S.

Base-Layer Data: Fatal Overdose Rates by County

The base layer shows the fatal overdose rate by county at two points in time. Darker-colored counties have higher overdose rates. Lighter-colored counties have lower overdose death rates. You can use the List of Counties to link directly to data on a particular county, or click on it on the map.

Overdose Type

Click on the dot under “timeframe” in the upper-right section of the screen to change the years represented by the overdose layer.

Timeframe

Click on the dot in the “timeframe” slider in the upper-right section of the screen to change the years represented by the overdose layer.

State/County

To view state-level data, click the "state/county" drop down in the upper-right section of the screen and select "State".

Rural vs. Urban

Use the “urban/rural” drop down to compare data from rural and urban counties.

Second-Layer Data: Community and Population Demographics by County

Choose variables from the left-hand column to layer county-level economic and demographic data on top of the baseline fatal overdose data. By showing the variables as translucent circles of varying sizes, the tool allows users to clearly see how a given measure relates to the baseline fatal overdose rate. For example, choosing “Poverty Rate” will demonstrate the relationship between an individual county’s poverty rate and its overdose mortality rate.

Additionally, behavioral health facilities (substance use and/or mental health facilities) can be added to the map. Zoom in further to see the location of these facilities. Click on the dot to see the facility name and address. The prosperity index can also be added as an overlay on the overdose map.

Contextual Overlays

On the right hand side of the screen, there is a drop down for “Map Overlays.” Available map overlays include: geolocations of Native American Reservations; outline of persistent poverty counties; location of major highways; and Economic Development District regions.

County Fact Sheets

For each county, there are three fact sheets, which can be found by clicking on “View Details” when selecting a county. The fact sheets include: 1) Demographic Information; 2) Behavioral Health Resources; and 3) Prosperity Index. For all three fact sheets, county, state, and national data are provided, to provide benchmarks for counties.

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Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioral Health Treatment Services Locator.

Data as of February 1, 2021.

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Prosperity Index

The prosperity index was developed with support from a Technical Expert Panel convened by USDA Rural Development. The prosperity index provides a single numerical measure designed to reflect the prosperity of a county. Counties with a value of 1 are the highest ranked and are among the most prosperous in the country while those with a 5 are the lowest ranked and the least prosperous.

The economic dimensions, economic risk and resilience, provide two numerical measures for the degree to which a county is economically vulnerable to, or protected from the effects of health and well-being challenges and crises. Similarly, social risk and social resilience also play roles in determining the vulnerability of a county. Risks experienced by a county are qualified or mitigated by its level of resilience, the strength of its protective factors. Taking both economic factors and social factors into consideration can help users develop and refine initiatives that seek to improve health and equity by reducing risk and increasing resilience.

For more information, click here.

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