Exploring Opioid Overdose Death Rate Trajectories in the United States

Previous CDC analyses show factors contributing to increased opioid overdose deaths (ie death rate trajectories across years; see first section of this notebook). However, exploring the underlying variance of these trajectories, such as within different locations, may lead to more precise targeting of interventions, public health marketing, policy recommendations, and resource allocation.

This notebook shows the power of the HEAL platform to accomplish taking a deep dive into this underlying variance. Specifically, the HEAL platform provides a workspace for easy accessibility to (1) publication data for reproducibility and (2) more fine-grained and/or raw data to explore the underlying variance of published data and findings.

Summary of findings

  1. Prior widely circulated CDC analyses show synthetic opioids drive much of the increase in opioid overdose death rates in recent years (see Hedegaard et al 2020 and CDC presentations) using the CDC Wonder database

  2. However, synthetic opioids have considerable variance when looking at the state level of death rates. That is, distinct groups/clusters of states have high 2019 opioid overdose death rate while others have considerably lower increases in death rates.

  3. Mapping 2019 death rates show the high increasing group of states is quite restricted to the Northeast region of the US.
  4. Future studies may want to hone in on the Northeast to understand social determinants and other factors (ie clinics) of high synthetic opioid death rates at a finer grained level such as the county level. The HEAL platform makes such data, for example clinic locations in the Opioid Environmental Policy Scan repository, to do these analyses easier.

Load in necessary packages and define functions

Pull file objects using the Gen3 SDK

Reproduce visualizations directly from Hedegaard et al., 2020 data brief

Figure 1 : Gender

These data show both (1) the rate of increase (driven by increase in more recent years) and (2) overall baseline deaths are higher for males than females. Note, these are adjusted for age related effects.

Figure 2: Age categories

Clearly, the rate of change in recent years is driven by adults (25-54). Additionally, the young adults (25-34) showed a lower death rate in the early 2000s compared to the other adult groups. However, in more recent years, the 25-34 group has reached the level of middle aged adults.

This disturbing trend could be one avenue for exploratory analyses that data from the HEAL platform could address --- by having a richer set of data.

Figure 3: Opioid Types

Deeper dive into the variance associated with opioid overdose increases directly from CDC Wonder data

By having more granular data readily available on the HEAL platform, you can explore the variance underlying the "cleaned up publication data" (also available on the HEAL platform).

Reproduce opioid type figure from publication using direct CDC Wonder data

Conclusions from adding information about variance (ie 95% confidence intervals) to the opioid type plot:

While there is a large increase in synthetic opioid (in red) use in recent years, there is also differences among individual states.

So, the question is: what are the individual death rate trajectories for individual states? Are there patterns/clusters amongst states that can inform how to target public policy/health interventions?

Clearly, by looking at individual state trajectories, we can see there are is a clear separation of states small and large increases in reported opioid death rates.

With these drastic increases for some states, the rate of change appears to be highly correlated with the most recent reported death rates.

Therefore, in subsequent exploration, I compare death rates in 2019 amongst individual states (note another approach would be to look at model outputs using exponential growth functions in a hiearchical linear model format).

Investigate distribution of 2019 synthetic opioid overdoses across states

As can be seen from state trajectories, the distribution is heavily skewed towards small death rates.

The black line in the figure represents the 50% mark for death rates. This means that the majority of state death rates are under 11 deaths per 100k.It also appears that there may be several clusters of state death rates that will help us "categorize" state groupings.

Now the question is: what are these states? Are they clustered in one region? If so, we could allocate our resources (and future analyses) to understanding how to help these states or uncover underlying causes.

From the list of states ranked from highest to lowest death rates, one can see that they are clustered in the northeast/east coast region (for the most part).

But, this bar chart only does not allow us to quickly visualize the spatial relationship amongst states. For this, we need to plot it out on a USA map...

Mapping 2019 State Death Rates to determine spatial associations/groupings

Note, this uses plotly (interactive tool). Hover over individual states to view the quantitative metrics.

First, lets map the death rates continuously (ie no groupings).

Clearly, from the map, we can see the highest ranked death rates of states are clustered in the north east with one cluster below New york and one above. Note, the northern states of MT,WY,ND do not report opioid deaths.

But to better describe this relationship (and evidence that there may be groupings from our distribution), lets use KMeans Clustering to group.

Using KMeans clustering to group state death rates

Just from looking at the data, we see our exploratory insights now explicit.

That is, the same northeastern states we saw, are now in the same cluster

Next steps

(1) to hone in on at a county level within the states of this region to further understand the geographic make up of this trend available in the HEAL platform.

(2) Predict and/or explain overdoses with social determinants by leveraging other datasets within the HEAL platform.