Mortality trends of substance use disorders among adults in the United States, 1999–2024: a CDC WONDER analysis

Substance use disorders (SUDs) remain a major cause of preventable mortality in the United States. This study evaluated long-term trends and demographic and geographic disparities in SUD-related mortality among U.S. adults from 1999 to 2024. We conducted a retrospective analysis of CDC WONDER mortality data. SUD-related deaths among adults aged ≥ 15 years were identified using ICD-10 codes F10–F19 listed as underlying or contributing causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and stratified by sex, race/ethnicity, age group, census region, state, and urban–rural classification. Joinpoint regression was used to estimate annual percent changes (APCs). Between 1999 and 2024, 7,367,853 SUD-related deaths were recorded among U.S. adults. The overall AAMR increased from 23.4 per 100,000 in 1999 to a peak of 147.9 in 2021 before declining to 125.4 in 2024. Men consistently experienced higher mortality rates than women (138.5 vs. 67.4). American Indian or Alaska Native individuals had the highest mortality burden (114.4), followed by White (104.3) and Black or African American (94.4) populations, while Hispanic individuals had the lowest rates (45.3). Adults aged ≥ 85 years demonstrated the highest mortality burden (588.2). Regionally, the Midwest had the highest mortality rate (123.8), followed by the South (98.2), Northeast (97.5), and West (79.2). State-level mortality ranged from 41.4 in Alabama to 194.4 in Vermont. Nonmetropolitan areas consistently exhibited higher mortality rates than metropolitan areas (121.1 vs. 91.2). Although SUD-related mortality has declined since 2021, the burden remains substantially elevated. Persistent demographic and geographic disparities underscore the need for targeted prevention, harm-reduction, and treatment strategies. Not applicable.