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These monthly updates use fatal overdose data updated weekly from the state death certificates and quarterly hospital discharge data for overdose. The definitions of drug overdose are mostly based on ICD-10 and ICD-10-CM. See the technical notes for further details. The 2021 death data are provisional. The tables with overdose rates include a flag for a relative standardized error(RSE) over 25% indicating that the rate is not reliable, following DOH standard. Starting in 2021 there are more [restrictions on publishing death data with small numbers] (https://apps.leg.wa.gov/Wac/default.aspx?cite=246-492-300) leading to suppressions of count between 1 and 9. All the data are based on Washington state, the county or the ACH of residence unless otherwise indicated.


1 Overdose Mortality


1.1 Drug Overdose Mortality County Map For 2016-2020 Combined

The leaflet maps classify every county (Figure 1.1) or ACH (Figure ??) by its drug overdose rates during the combined years of 2016-2020. The county/ACH rate confidence intervals(CI) are compared to the state CI to derive statistically significant difference. The geographies with less than 16 cases are left transparent.

Figure 1.1: County Mortality Drug Overdose Map: 2016-2020


1.2 Latest Quarterly Death Tables From 2017 To 2022 By Geography


The following table provides the latest OD data by quarter from residents of Washington state by county (figure 1.2).

1.2.1 Death By Residence of the Decedents

Figure 1.2: Quarterly Death by county of Residence From 2017 To 2022

1.2.2 Death By Race


The following graph and table provide the latest OD deaths by quarter and race (figure 1.3)

Figure 1.3: Statewide and by Race Quarterly Death From 2018 To 2022

Figure 1.4: Statewide and by Race Quarterly Death From 2018 To 2022

1.3 Overdose Mortality Trend From 2000 To 2020

1.3.1 Mortality Trend Graph From 2000 To 2020 by Year and Drug Type

The following graph (figure 1.5) provide the trends of selected drug overdose deaths from 2000 to 2020.

Hover on the lines for more information. Click or double-click on the legend keys to show or hide drug lines

Figure 1.5: Mortality Trend by Drug type from 2000 to 2020


1.3.2 Mortality Tables By Geography, Drug Type, and Year from 2000 to 2020


The following three tables provide OD mortality at annual, three-year, and five-year levels for the state (figure 1.6), the counties (figure 1.7), and the ACH (figure ??)


Statewide


Figure 1.6: Statewide Mortality Trend by Drug Type From 2000 to 2020


County



Figure 1.7: Mortality Trend by Drug Type, and County of residence From 2000 to 2020

1.3.3 Statewide Mortality Tables By Sex, Drug Type, and Year from 2000 to 2020


The overdose mortality by sex (figure 1.8) is provided only statewide.


Figure 1.8: Mortality Trend by Sex, Drug Type, and Years From 2000 to 2020


1.3.4 Statewide Mortality Tables By Age Group, Drug Type, and Year from 2000 to 2020


The overdose mortality by age group (figure 1.9) is provided statewide.


Figure 1.9: Mortality Trend by Age Group, Drug Type, and Years From 2000 to 2020


2 Overdose Hospitalization


2.1 Drug Overdose Hospitalization County Map For 2015-2019 Combined


The leaflet maps below classify every county (Figure 2.1), and ACH (Figure ??) by their drug overdose rates during the combined years of 2017-2019. The county rate confidence intervals(CI) are compared to the state CI to derive statistically significant difference. The geographies with with less than 16 cases are left transparent


Figure 2.1: County Hospitalization Drug Overdose Map: 2017-2019

2.2 Latest Quarterly Hospitalization Tables


The table below (figure 2.2) provides the latest overdose hospitalization by quarter with comparison from 2016 to 2020.


Figure 2.2: Quarterly Drug Overdose Hospitalization From 2016 To 2020


2.3 Hospitalization Tables By Geography, Drug Type, and Year from 2016 to 2020


The table below (figure 2.3) provides drug overdose hospitalization indicators based exclusively on ICD-10-CM. Thus the data are limited to 2016 onward, and presented as annual grouping.


Figure 2.3: Overdose Hospitalization by Drug Type, Geography and Years From 2016 to 2020

3 README Notes


Data Sources

The death data were last updated on 2022-06-27.

  • Deaths and hospitalization data are from DOH’s Center for Health Statistics (Death Certificates and Comprehensive Hospital Abstract Reporting System (CHARS)).

  • All the cases are Washington residents, and residents of the county and/or the ACH mentioned.

  • Drug type in the report is based on CDC definitions:

    Overdose death: “any_drug”, “any_opioid”, “Prescription_opioid”, “heroin”, “methadone”, “natural_semi_synth”, “non_heroin_opioid”, “prescription_opioid_non_fentanyl”, synth_not_methadone”, “psycho_stimulant”, and “cocaine”.

    Overdose hospitalization: “any_drug”, “any_opioid”, “Non-heroin opioid”, and “heroin”.

Definitions

3.1 Death Data


  • Except for methamphetamine and fentanyl(see below for both), drug overdose deaths (any_drug) are first selected using the underlying cause of death with any of the following ICD-10 codes:

    X40-X44: Accidental poisonings by drugs
    X60-X64: Intentional self-poisoning by drugs
    X85: Assault by drug poisoning
    Y10-Y14: Drug poisoning of undetermined intent

Once a case is a drug overdose as defined above, the following drugs can be defined from the multiples causes of death as follow:

any_opioid:

T40.0 (Opium), T40.1 (Heroin),T40.2 (Natural and semi-synthetic opioids),T40.3 (Methadone), T40.4 (Synthetic opioids, other than methadone),T40.6 (Other and unspecified narcotics).

prescription_opioid: T40.2,T40.3, T40.4

prescription_opioid_non_fentanyl: T40.2,T40.3

heroin: T40.1

natural_semi_synth(etic): T40.2

methadone: T40.3

synth_not_methadone: T40.4

cocaine: T40.5

psycho_stimulant: T43.6

methamphetamine: Drug overdose as defined earlier with "methamphetamine" mentioned in the textual cause of death. methamphetamine is restricted to deaths of drug overdose where the keyword “methamphetamine”, with some spelling variations, are found in the cause of death description.
This is the regular expression used to capture methamphetamine: "m[ea]?th[ae]?m?[po]?h[ae]?ta?ma?i?ne|\\bmeth\\b|amphetamine|methamp[hea]?[hea]?t[ae]mine" This definition will miss methamphetamine-induced deaths with an immediate cause of death of stroke or multiple organ failure, coded in the underlying cause of death field instead of overdose. This may also include cases of methamphetamine where psycho-stimulant(T43.6) was not coded.

fentanyl: Drug overdose as defined earlier with "fentanyl" mentioned in the textual cause of death. fentanyl is restricted to deaths of drug overdose where the keyword “fentanyl” and known fentanyl analogs, with some spelling variations, are found in the cause of death description.
This is the regular expression used to capture fentanyl and fentanyl analogs: "f[ea]nt[ea]n[iy]l?|car[ft]entan[iy]l|ANPP|47700".
Cases that match the literal fentanyl may not be defined as synth_not_methadone(T40.4) in the multiple cause of death fields.

3.2 Hospitalization Data

3.2.1 Hospital Discharge Drug Indicators

  • Hospitalizations are based on the patient’s county of residence

  • Hospitalization discharges from Out-of-state hospitals, federal hospitals, rehabilitation centers, and psychiatric hospitals, and those who died before discharge are excluded from the numbers

  • The intent when known is restricted to unintentional, intentional self-harm, assault and undetermined intent

  • The encounters are limited to initial encounter or missing encounter

  • Explicit exclusion of cases involving heroin overdose from the non-heroin opioid cases

  • Since the last quarter of 2015, only ICD-10-CM is used. The deprecation of ICD-9-CM makes tracking trend across 2015 unreliable

  • Opioid overdoses were identified by searching for the appropriate ICD-9-CM and ICD-10-CM in all the multiple diagnosis codes and e-codes fields available. No limitations were made on the number of diagnosis and e-code fields.

  • For ICD-9-CM, the first listed/principal diagnosis code or any mention of a relevant external cause of injury code (previously first-listed/principal diagnosis code or first-listed external cause of injury)

  • For ICD-10-CM, any mention of a drug poisoning in any diagnosis code field.

  • Any Drug

ICD-10-CM: T36-T50 (Poisoning by drugs, medicaments and biological substances)

ICD-9-CM: In the principal diagnosis, 960-979 (Poisoning By Drugs, Medicinal And Biological Substances)
Or in any external cause or diagnosis fields with E850-E858 (Accidental poisoning by drugs, medicinal substances, and biologicals) E950.0-E950.5 (Suicide and self-inflicted poisoning by solid or liquid substances), E962.0 (Assault by drugs and medicinal substances) E980.0-E980.5 (Poisoning by solid or liquid substances undetermined whether accidentally or purposely inflicted)

  • Any Opioid

    ICD-10-CM: T40.0X (Poisoning by opium), T40.1X (Poisoning by heroin), T40.2X (Poisoning by other Opioids), T40.3X (Poisoning by methadone), T40.4X (Poisoning by synthetic narcotics), T40.60 (Poisoning by unspecified narcotics), T40.69 (Poisoning by other narcotics)

ICD-9-CM: Principal diagnosis with 965.00(Poisoning by opium), 965.02(Poisoning by methadone),965.09(Poisoning by other opiates and related narcotics), 965.01 (Poisoning by heroin)
Or in any external cause or diagnosis fields with E850.1(Accidental poisoning by methadone), E850.2(Accidental poisoning by other opiates and related narcotics), E850.0(Accidental poisoning by heroin)

  • Heroin

Poisoning by heroin with or without other opioid

ICD-10-CM: T40.1X(Poisoning by heroin)

ICD-9-CM: Principal diagnosis with 965.01(Poisoning by heroin) Or in any external cause or diagnosis fields with E850.0(Accidental poisoning by heroin)

  • Non-Heroin Opioid

Any opioid, while excluding cases associated with heroin

3.2.2 ICD-10-CM More Detail


From the 2016 and latest hospital discharge data, the overdose indicators below have been used. See the CSTE Injury toolkit for more information.


The regular expression version is provided at the end of each definiton.


1. Any drug:
Any diagnosis of T36-T50

       AND a 6th character of 1,2,3, or 4 for T36.9, T37.9, T39.9, T41.4, T42.7, T43.9, T45.9, T47.9, and T49.9, or a 5th character of 1,2,3, or 4 for all the others T36-T50

       AND a 7th character of A or missing

(?!(T3[679]9|T414|T427|T4[3579]9))(T3[6-9]|T4[0-9]|T50)..[1-4](A|$)|((T3[679]9|T414|T427|T4[3579]9)[1-4].(A|$))

2. Any Opioid:
Any diagnosis of T40.0X, T40.1X, T40.2X, T40.3X, T40.4X, T40.60, T40.60

       AND a 6th character of 1,2,3, or 4 

       AND a 7th character of A or missing

(T40[0-4].|T406[09])[1-4](A|$)

3. Heroin:
Any diagnosis of T40.1X

      AND a 6th character of 1,2,3, or 4 

      AND a 7th character of A or missing

T401.[1-4](A|$)

4. Non-Heroin Opioid:
Any diagnosis of T40.0X, T40.2X, T40.3X, T40.4X,T40.60, T40.69

      AND a 6th character of 1,2,3, or 4 

      AND a 7th character of A or missing

      Then exclude any cases of heroin as defined above

(T40[0234].|T406[09])[1-4](A|$)

5. Stimulant:
Any diagnosis of T40.5X, T43.60, T43.61, T43.62, T43.63, T43.64, T43.69

      AND a 6th character of 1,2,3, or 4 

      AND a 7th character of A or missing

((T405.|T436[0-49])[1-4])(A|$)

6. Cocaine:
Any diagnosis of T40.5X

      AND a 6th character of 1,2,3, or 4 

      AND a 7th character of A or missing

T405.[1-4](A|$)

7. Non-Cocaine Stimulant:
Any diagnosis of T43.60, T43.61, T43.62, T43.63, T43.64, T43.69

      AND a 6th character of 1,2,3, or 4 

      AND a 7th character of A or missing

      Then exclude any cases of cocaine as defined above

T436[0-49][1-4](A|$)


3.3 Race Definitions

A. The determination of suicide is based on the underlying cause of death in the death certificate as coded by the National Center for health Statistics NCHS and provided by DOH-CHS

B. The racial groups in this file was created following these steps. Note that NH stands for Non-Hispanic:

  1. Any Hispanic ethnicity is counted as Hispanic as Race
  2. When there is no Hispanic ethnicity mentioned and only one of the following 5 races was checked in the death certificate that race is considered as followed:
  • American Indian/Alaskan Native Only-NH
  • Asian Only-NH
  • Black Only-NH
  • Native Hawaiian and Other Pacific Islander only – NH
  • White Only-NH
  1. When there is no Hispanic ethnicity mentioned and more than one of the above races were checked, the decedent is counted as Multi-Race-NH
  2. The Other category represents all the missing, unknown and unclassifiable races. In this document “Other” lumped also “Native Hawaiian and Other Pacific Islander only – NH”, and “Multi-Race-NH”.

3.4 Accountable Communities of Health


Visit the ACH’s Website for more information


Abbreviation ACH counties
BHT Better Health Together Adams,Ferry,Lincoln,Pend Oreille,Stevens,Spokane
CPAA Cascade Pacific Action Alliance Cowlitz,Grays Harbor,Lewis,Mason,Pacific,Thurston,Wahkiakum
GC ACH Greater Columbia Asotin,Benton,Columbia,Franklin,Garfield,Kittitas,Walla Walla,Whitman,Yakima
HealthierHere HealthierHere King
NCACH North Central Chelan,Douglas,Grant,Okanogan
NSACH North Sound Island,San Juan,Skagit,Snohomish,Whatcom
OCH Olympic Community of Health Clallam,Jefferson,Kitsap
Pierce Pierce County Pierce
SWWA RHA Southwest Washington Regional Health Alliance Klickitat,Clark,Skamania

3.5 Using the Data

Key Limitation:

The 2021 and 2022 data are preliminary. The death and hospitalizations numbers are based on data available at the time this dashboard was produced. Some causes of death may be pending investigation, or hospitals may not have submitted all data for the quarter by the time the dashboard is developed. The numbers are expected to change in future releases.

2021 and 2022 death files were last updated: on 2022-06-27

Download Data Tables:

  • To filter the tables, enter any keyword (words from the different fields) in the search box. The keyword can be a full or partial name of a county or the abbreviation of an ACH, a year or a quarter. Separate the keywords with space (example : “sno q1 2018”).

  • To show any hidden column, use the scroll bar at the bottom of the table

  • To download or copy the filtered table, click the buttons csv or copy

  • To get more information from the map click on the county. A county with a lower age-adjusted rate of drug overdose, and non overlapping CI with the state’s is assumed to have a significantly lower rate of overdose rate compared to the State’s rate. Similarly a county with a higher rate, and non-overlapping CI is considered significantly higher. A county which CI overlaps with the State’s is assumed to have a rate not statistically different from the state’s rate.

  • For the trend graphs double-click on the legend keys to show only that specific drug, or click once to remove it.

Planned release schedule:

These data will be updated and made available to all the LHJs on a quarterly basis.

Contacts

Email to Injury Data at