Temporal trends in mortality due to unintentional poisoning in the USA, 1999–2020

Background: Unintentional poisoning occurs at all ages and races, and remains one of the leading causes of unintentional injury-related fatalities in the USA. However, more recent and comprehensive population-based unintentional poisoning mortality data are lacking in the USA. This study aimed to comprehensively assess trends in USA mortality due to unintentional poisoning from 1999 to 2020, and identify specific causes of death underlying the temporal trends. Methods: We conducted an analysis of death certificates from 1999 to 2020 to calculate annual mortality due to unintentional poisoning by age, sex, race, census region, state, and cause of death. Joinpoint regression was used to evaluate temporal trends in mortality due to unintentional poisoning. Results: There were 813 390 deaths due to unintentional poisoning during 1999–2020. Adults aged 35–49 years, males, American Indian or Alaska Native, and residents of the Northeast had the highest mortality due to unintentional poisoning. The period from 1999 to 2020 witnessed a more than five-fold increase in the age-adjusted mortality rate due to unintentional poisoning from 4.37 to 26.95 per 100 000 people (average annual percent change = 8.96%, 95% confidence interval: 6.92%–11.04%), with rapidly increasing trends for all ages, sexes, races, regions and states. The increasing trends are particularly concerning among adults aged 50–64 years, females, White, and residents of the Midwest. Additionally, we demonstrated that drug poisoning, especially poisoning by narcotics and psychodysleptics, was the leading cause of death from unintentional poisoning, and mortality due to unintentional poisoning by psychotherapeutic drugs had the most rapid rate of increase. Conclusions: USA mortality due to unintentional poisoning increased rapidly from 1999 to 2020 for all ages, sexes, races, census regions, and states. The rapid increase in mortality due to unintentional poisonings is a national emergency, and drug policy measures such as enhancing prescription drug monitoring, restricting the availability of illicit synthetic opioids, and increasing law enforcement efforts are needed to avert further premature deaths and address health disparities.