Deaths of Despair: A Major and Increasing Contributor to United States Deaths

Objective:The International Classification of Disease (ICD) assumes that each disease entity is distinct.The hypothesis that each disease entity may have similar underlying and contributory factors have led to the emerging concept of "deaths of despair."Our objective was to explore temporal trends in the occurrence of United States (US) deaths of despair from 1999 to 2021. Methods:We utilized the previously defined definition as a constellation of 19 underlying causes: chronic hepatitis; liver fibrosis/cirrhosis; suicide/sequelae of suicide; poisoning (accidental or undetermined intent) or exposure to nonopioid analgesics, antipyretics, rheumatic, antiepileptic's, sedative hypnotics, antiparkinson and psychotropic drugs; narcotics, psychodysleptics, drugs acting on the central nervous system, and alcohol.We used mortality data for those 25 to 74 years of age from 1999 to 2021 to calculate annual percent changes (APC) as measures of effect size and joinpoint regression to test for statistical significance.We used the US Centers for Disease Control and Prevention (CDC) Wide-Ranging Data for Epidemiologic Research (WONDER) and the Multiple Cause of Death files.Results: Using this definition, deaths of despair were the fifth leading cause of US mortality in 2021.From1999 to 2021, the APC for deaths of despair increased 2.5-fold among people aged 25-to 74-years.Conclusions: Using this definition, deaths of despair would have been the 5 th leading cause of death in the US in 2021.Healthcare providers should have an increased awareness of deaths of despair.Public health practitioners may consider new initiatives to prevent deaths of despair locally, regionally, and nationally.