Long-Term Trends in Deaths of Despair

This appendix provides methodological details for the Social Capital Project report, “Long-Term Trends in Deaths of Despair.” All estimates derive from publicly available data from the Centers for Disease Control and Prevention (CDC). All age-adjusted rates are benchmarked against the 2000 population distribution across 11 age groups. That is, they assume that each age group’s share of the population is fixed at 2000 levels, so that trends over time are not affected when the American population gets younger or older, except insofar as the age distribution within the 11 age groups changes. See Robert N. Anderson and Harry M. Rosenberg (1998). “Age Standardization of Death Rates: Implementation of the Year 2000 Standard.” National Vital Statistics Reports 47(3). https://www.cdc.gov/nchs/data/nvsr/nvsr47/nvs47_03.pdf.

As noted in the report, prior to 1933, not all states were part of the "death registration area," included in mortality data. Between the late 1800s and the late 1920s, the share of the population included in registration states rose from less than one-third to over 90 percent by the late 1920s. (See https://www.cdc.gov/nchs/data/vsus/VSUS_1949_1.pdf.) Mortality data are available for the entire continental United States beginning in 1933, and data for Alaska and Hawaii are included beginning in 1959 and 1960, respectively. Our analyses indicate that the changing number of states included in the data does not meaningfully affect the long-term trends we estimate. For instance, in 1933, the overall crude death rate for the lower 48 states was 1,068 per 100,000, while it was 1,122 per 100,000 for the 11 states included in the data in both 1900 and 1933. Similarly, the death rates from suicide, alcoholism, and cirrhosis of the liver were 16, 3, and 7 per 100,000 for the lower 48 states and 18, 4, and 9 per 100,000 for the original 11 states. (Sources: https://www.cdc.gov/nchs/data/vsus/vsrates1900_40.pdf, https://www.cdc.gov/nchs/data/vsushistorical/mortstatsh_1900-1904.pdf, and https://www.cdc.gov/nchs/data/vsushistorical/mortstatsh_1933.pdf.) The 1962 and 1963 rates for whites and by race exclude New Jersey. The 1972 mortality data is based on a 50 percent sample, according to the CDC.

The definitions we use for each subcomponent of deaths of despair are shown in Table 1.

Table 1. ICD Codes Used
ICD Version	Years in Use, U.S.	Suicide	Alcohol-Related Deaths	Drug-Related Deaths
1	1900-1909	155-163	56, 112b	59, 175
2	1910-1920	155-163	56, 113b	59, 165
3	1921-1929	165-174	66, 122a	68, 177
4	1930-1938	163-171	75, 124a	76, 179
5	1939-1948	163, 164	77, 124a	79, 179
6	1949-1957	E963, E970-E979	307, 322, 581.1, E880	323, E870-E878
7	1958-1967	E963, E970-E979	307, 322, 581.1, E880	323, E870-E878
8	1968-1978	E950-E959	291, 303, 571.0, E860	304, E850-E859, E980.0-E980.3
9	1979-1998	E950-E959	291, 303, 305.0, 357.5, 425.5, 535.3, 571.0-571.3, 790.3, E860	292, 304, 305.2-305.9, E850-E858, E980.0-E980.5
10	1999-2016	X60-X84, Y87.0	E24.4, F10, G31.2, G62.1, G72.1, I42.6, K29.2, K70, K85.2, K86.0, O35.4, P04.3, Q86.0, R78.0, X45, Y15	F11-16, X40-44, Y10-14

*Code 112b and 113b are approximated for 1900-1920. See the discussion below.

 

Overall Crude Rates

Suicides

Crude rates from 1900 to 1960 are from Robert D. Grove and Alice M. Hetzel (1968). “Vital Statistics Rates in the United States 1940-1960.” Table 65. https://www.cdc.gov/nchs/data/vsus/vsrates1940_60.pdf. Includes International Classification of Diseases (ICD) Codes 155-163 from 1900 to 1920; 165-174 from 1921 to 1929; 163-171 from 1930 to 1938; 163 and 164 from 1939 to 1948; and E963 and E970-E979 from 1949 to 1960.

Crude rates from 1961 to 1967 are from National Center for Health Statistics. “Table 290. Death Rates for 60 Selected Causes, by 10-Year Age Groups, Race, and Sex: United States, 1960-67.” https://www.cdc.gov/nchs/data/dvs/mx196067.pdf. Includes ICD-7 Codes E963-E979.

Crude rates from 1968 to 1978 are from the CDC WONDER Online Database, Compressed Mortality Files, 1968-1978 (https://wonder.cdc.gov/cmf-icd8.html). Included are ICD-8 Codes E950-E959.

Crude rates from 1979 to 1998 are from the CDC WONDER Online Database, Compressed Mortality Files, 1979-1998 (https://wonder.cdc.gov/cmf-icd9.html). Included are ICD-9 Codes E950-E959.

Crude rates from 1999 to 2017 are from the CDC WONDER Online Database, Detailed Mortality Files, 1999-2017 (https://wonder.cdc.gov/ucd-icd10.html). Included are ICD-10 Codes X60-X84 and Y87.0.

 

Alcohol-Related Deaths

Crude rates from 1900 to 1920 were estimated by the Social Capital Project using death rates from alcoholism (Code 56) and cirrhosis (Code 112 from 1900-09 and Code 113 from 1910-20), from Robert D. Grove and Alice M. Hetzel (1968). “Vital Statistics Rates in the United States 1940-1960.” Table 65. https://www.cdc.gov/nchs/data/vsus/vsrates1940_60.pdf. Cirrhosis with mention of alcoholism is available beginning only in 1921. We found the difference between death rates from cirrhosis generally and cirrhosis with mention of alcoholism to be roughly constant at around 7 per 100,000 in the years following 1920 (average of 6.9 using Third Revision ICD Codes 1921-1929, and average of 6.9 for 1921-1934, spanning the Third and Fourth Revisions, with a range from 6.7 to 7.2 for both intervals). When a 1900-20 trend for cirrhosis from alcoholism was estimated by simply subtracting 7 from the cirrhosis death rates, it overlaid the trend for alcoholism very closely, rising and falling in parallel. Therefore, we summed death rates from alcoholism and cirrhosis for each year from 1900 to 1920 and subtracted 7.

Crude rates from 1921 to 1948 were estimated by the Social Capital Project by summing death rates from alcoholism (from Grove and Hetzel (1968), Table 65, Code 66 for 1920-29, Code 75 for 1930-38, and Code 77 for 1939-48) and from cirrhosis with mention of alcoholism. The sources for cirrhosis with mention of alcoholism include Bureau of the Census (1938). “Vital Statistics—Special Reports,” 7(1), p. 670. https://babel.hathitrust.org/cgi/pt?id=osu.32435063006076&view=1up&seq=680 (for 1921-37); National Center for Health Statistics (1940). “Vital Statistics of the United States, 1938. Part I, Natality and Mortality Data for the United States Tabulated by Place of Occurrence with Supplemental Tables for Hawaii, Puerto Rico, and the Virgin Islands.” https://www.cdc.gov/nchs/data/vsus/VSUS_1938_1.pdf; National Center for Health Statistics (1941). “Vital Statistics of the United States, 1939. Part I, Natality and Mortality Data for the United States Tabulated by Place of Occurrence with Supplemental Tables for Hawaii, Puerto Rico, and the Virgin Islands.” https://www.cdc.gov/nchs/data/vsus/VSUS_1939_1.pdf; National Center for Health Statistics (1943). “Vital Statistics of the United States, 1940. Part I, Natality and Mortality Data for the United States Tabulated by Place of Occurrence with Supplemental Tables for Hawaii, Puerto Rico, and the Virgin Islands.” https://www.cdc.gov/nchs/data/vsus/vsus_1940_1.pdf; National Center for Health Statistics (1943). “Vital Statistics of the United States, 1941. Part I, Natality and Mortality Data for the United States Tabulated by Place of Occurrence with Supplemental Tables for Hawaii and Puerto Rico.” https://www.cdc.gov/nchs/data/vsus/VSUS_1941_1.pdf; National Center for Health Statistics (1944). “Vital Statistics of the United States, 1942. Part I, Natality and Mortality Data for the United States Tabulated by Place of Occurrence with Supplemental Tables for Hawaii, Puerto Rico, and the Virgin Islands.” https://www.cdc.gov/nchs/data/vsus/VSUS_1942_1.pdf; National Center for Health Statistics (1945). “Vital Statistics of the United States, 1943. Part I, Natality and Mortality Data for the United States Tabulated by Place of Occurrence with Supplemental Tables for Hawaii, Puerto Rico, and the Virgin Islands.” https://www.cdc.gov/nchs/data/vsus/VSUS_1943_1.pdf; National Center for Health Statistics (1946). “Vital Statistics of the United States, 1944. Part I, Natality and Mortality Data for the United States Tabulated by Place of Occurrence with Supplemental Tables for Hawaii, Puerto Rico, and the Virgin Islands.” https://www.cdc.gov/nchs/data/vsus/VSUS_1944_1.pdf; National Center for Health Statistics (1947). “Vital Statistics of the United States, 1945. Part I, Natality and Mortality Data for the United States Tabulated by Place of Occurrence with Supplemental Tables for Hawaii, Puerto Rico, the Virgin Islands, and Alaska.” https://www.cdc.gov/nchs/data/vsus/vsus_1945_1.pdf; National Center for Health Statistics (1948). “Vital Statistics of the United States, 1946. Part I, Natality and Mortality Data for the United States Tabulated by Place of Occurrence with Supplemental Tables for Hawaii, Puerto Rico, the Virgin Islands, and Alaska.” https://www.cdc.gov/nchs/data/vsus/VSUS_1946_1.pdf; National Center for Health Statistics (1949). “Vital Statistics of the United States, 1947. Part I, Natality and Mortality Data for the United States Tabulated by Place of Occurrence with Supplemental Tables for Hawaii, Puerto Rico, the Virgin Islands, and Alaska.” https://www.cdc.gov/nchs/data/vsus/VSUS_1947_1.pdf; and National Center for Health Statistics (1950). “Vital Statistics of the United States, 1948. Part I, Natality and Mortality Data for the United States Tabulated by Place of Occurrence with Supplemental Tables for Hawaii, Puerto Rico, the Virgin Islands, and Alaska.” https://www.cdc.gov/nchs/data/vsus/VSUS_1948_1.pdf.

Crude rates from 1949 to 1960 were estimated by the Social Capital Project by summing death rates from alcoholism and alcoholic psychosis (from Grove and Hetzel (1968), Table 65, Codes 307 and 322) and from cirrhosis with mention of alcoholism (Code 581.1) and alcohol poisoning (Code E880). The sources for cirrhosis with mention of alcoholism and alcohol poisoning include National Center for Health Statistics (1951). “Vital Statistics of the United States, 1949. Part I, Natality, Mortality, Marriage, Divorce, Morbidity, and Life Table Data for the United States. General Tables by Place of Occurrence with Supplemental Tables for Hawaii, Puerto Rico, Virgin Islands and Alaska.” https://www.cdc.gov/nchs/data/vsus/VSUS_1949_1.pdf; National Center for Health Statistics (1953). “Vital Statistics of the United States, 1950. Volume III, Mortality Data.” https://www.cdc.gov/nchs/data/vsus/VSUS_1950_3.pdf; National Center for Health Statistics (1954). “Vital Statistics of the United States, 1951. Volume II, Mortality Data.” https://www.cdc.gov/nchs/data/vsus/VSUS_1951_2.pdf; National Center for Health Statistics (1955). “Vital Statistics of the United States, 1952. Volume II, Mortality Data.” https://www.cdc.gov/nchs/data/vsus/VSUS_1952_2.pdf; National Center for Health Statistics (1955). “Vital Statistics of the United States, 1953. Volume II, Mortality Data.” https://www.cdc.gov/nchs/data/vsus/VSUS_1953_2.pdf; National Center for Health Statistics (1956). “Vital Statistics of the United States, 1954. Volume II, Mortality Data.” https://www.cdc.gov/nchs/data/vsus/VSUS_1954_2.pdf; National Center for Health Statistics (1957). “Vital Statistics of the United States, 1955. Volume II, Mortality Data.” https://www.cdc.gov/nchs/data/vsus/VSUS_1955_2.pdf; National Center for Health Statistics (1958). “Vital Statistics of the United States, 1956. Volume II, Mortality Data.” https://www.cdc.gov/nchs/data/vsus/VSUS_1956_2.pdf; National Center for Health Statistics (1959). “Vital Statistics of the United States, 1957. Volume II, Mortality Data.” https://www.cdc.gov/nchs/data/vsus/VSUS_1957_2.pdf; National Center for Health Statistics (1964). “Vital Statistics of the United States, 1958. Volume II, Mortality Data.” https://www.cdc.gov/nchs/data/vsus/VSUS_1958_2.pdf; National Center for Health Statistics (1964). “Vital Statistics of the United States, 1959. Volume II, Mortality Statistics for the United States and Each State.” https://www.cdc.gov/nchs/data/vsus/VSUS_1959_2.pdf; and National Center for Health Statistics (1963). “Vital Statistics of the United States, 1960. Volume II, Mortality, Part A.” https://www.cdc.gov/nchs/data/vsus/VSUS_1960_2A.pdf.

Crude rates from 1961 to 1967 were estimated by the Social Capital Project by summing death rates from alcoholism (Code 322), alcoholic psychosis (Code 307), cirrhosis with mention of alcoholism (Code 581.1), and alcohol poisoning (Code E880). The sources include National Center for Health Statistics (1964). “Vital Statistics of the United States, 1961. Volume II, Mortality, Part A.” https://www.cdc.gov/nchs/data/vsus/VSUS_1961_2A.pdf; National Center for Health Statistics (1964). “Vital Statistics of the United States, 1961. Volume II, Mortality, Part A.” https://www.cdc.gov/nchs/data/vsus/VSUS_1961_2A.pdf; National Center for Health Statistics (1964). “Vital Statistics of the United States, 1962. Volume II, Mortality, Part A.” https://www.cdc.gov/nchs/data/vsus/VSUS_1962_2A.pdf; National Center for Health Statistics (1965). “Vital Statistics of the United States, 1963. Volume II, Mortality, Part A.” https://www.cdc.gov/nchs/data/vsus/mort63_2a.pdf; National Center for Health Statistics (1966). “Vital Statistics of the United States, 1964. Volume II, Mortality, Part A.” https://www.cdc.gov/nchs/data/vsus/mort64_2a.pdf; National Center for Health Statistics (1967). “Vital Statistics of the United States, 1965. Volume II, Mortality, Part A.” https://www.cdc.gov/nchs/data/vsus/mort65_2a.pdf; National Center for Health Statistics (1968). “Vital Statistics of the United States, 1966. Volume II, Mortality, Part A.” https://www.cdc.gov/nchs/data/vsus/mort66_2a.pdf; and National Center for Health Statistics (1969). “Vital Statistics of the United States, 1967. Volume II, Mortality, Part A.” https://www.cdc.gov/nchs/data/vsus/mort67_2a.pdf.

Crude rates from 1968 to 1978 are from the CDC WONDER Online Database, Compressed Mortality Files, 1968-1978 (https://wonder.cdc.gov/cmf-icd8.html). Included are ICD-8 Codes 291.0 (Delirium tremens), 291.1 (Korsakov's psychosis (alcoholic)), 291.2 (Other alcoholic hallucinosis), 291.3 (Alcoholic paranoia), 291.9 (Other and unspecified), 303.0 (Episodic excessive drinking), 303.1 (Habitual excessive drinking), 303.2 (Alcoholic addiction), 303.9 (Other and unspecified alcoholism), 571.0 (Alcoholic cirrhosis of the liver), E860 (Accidental poisoning by alcohol).

Crude rates from 1979 to 1998 are from the CDC WONDER Online Database, Compressed Mortality Files, 1979-1998 (https://wonder.cdc.gov/cmf-icd9.html). Included are ICD-9 Codes 291.0 (Alcohol withdrawal delirium), 291.1 (Alcohol amnestic syndrome), 291.2 (Other alcoholic dementia), 291.3 (Alcohol withdrawal hallucinosis), 291.4 (Idiosyncratic alcohol intoxication), 291.5 (Alcoholic jealousy), 291.8 (Other specified alcoholic psychosis), 291.9 (Unspecified alcoholic psychosis), 303 (Alcohol dependence syndrome), 305.0 (Alcohol abuse), 357.5 (Alcoholic polyneuropathy); 425.5 (Alcoholic cardiomyopathy); 535.3 (Alcoholic gastritis); 571.0 (Alcoholic fatty liver); 571.1 (Acute alcoholic hepatitis); 571.2 (Alcoholic cirrhosis of liver); 571.3 (Alcoholic liver damage, unspecified); 790.3 (Excessive blood level of alcohol); E860.0 (Alcoholic beverages); E860.1 (Other and unspecified ethyl alcohol and its products); E860.2 (Methyl alcohol); E860.3 (Isopropyl alcohol); E860.4 (Fusel oil); E860.8 (Other specified alcohols); E860.9 (Unspecified alcohol).

Crude rates from 1999 to 2017 are from the CDC WONDER Online Database, Detailed Mortality Files, 1999-2017 (https://wonder.cdc.gov/ucd-icd10.html). Included are ICD-10 Codes E24.4 (Alcohol-induced pseudo-Cushing syndrome); F10 (Mental and behavioural disorders due to abuse of alcohol); G31.2 (Degeneration of nervous system due to alcohol); G62.1 (Alcoholic polyneuropathy); G72.1 (Alcoholic myopathy); I42.6 (Alcoholic cardiomyopathy); K29.2 (Alcoholic gastritis); K70 (Alcoholic liver disease); K85.2 (Alcohol-induced acute pancreatitis); K86.0 (Alcohol-induced chronic pancreatitis); O35.4 (Maternal care for (suspected) damage to fetus from alcohol); P04.3 (Newborn affected by maternal use of alcohol); Q86.0 (Fetal alcohol syndrome (dysmorphic)); R78.0 (Finding of alcohol in blood); X45 (Accidental poisoning by and exposure to alcohol); and Y15 (Poisoning by and exposure to alcohol, undetermined intent).

 

Drug-Related Deaths

Crude rates from 1900 to 1948 are from Robert D. Grove and Alice M. Hetzel (1968). “Vital Statistics Rates in the United States 1940-1960.” Table 65. https://www.cdc.gov/nchs/data/vsus/vsrates1940_60.pdf. Includes ICD Codes 175 from 1900 to 1909; 165 from 1910 to 1920; 177 from 1921 to 1929; and 179 from 1930 to 1948. These generally reflect deaths from acute poisoning (other than from gases). Adding chronic poisoning changes the levels modestly but does not affect the trend.

Crude rates from 1949 to 1960 include ICD Codes 323 and E870-E878 and are from National Center for Health Statistics (1951). “Vital Statistics of the United States, 1949. Part I, Natality, Mortality, Marriage, Divorce, Morbidity, and Life Table Data for the United States. General Tables by Place of Occurrence with Supplemental Tables for Hawaii, Puerto Rico, Virgin Islands and Alaska.” https://www.cdc.gov/nchs/data/vsus/VSUS_1949_1.pdf and the other sources listed under Alcohol-Related Deaths, above, for the same years.

Crude rates from 1961 to 1967 include ICD Codes 323 and E870-E878 and are from National Center for Health Statistics (1964). “Vital Statistics of the United States, 1961. Volume II, Mortality, Part A.” https://www.cdc.gov/nchs/data/vsus/VSUS_1961_2A.pdf and the other sources listed under Alcohol-Related Deaths, above, for the same years.

Crude rates from 1968 to 1978 are from the CDC WONDER Online Database, Compressed Mortality Files, 1968-1978 (https://wonder.cdc.gov/cmf-icd8.html). Included are ICD-8 Codes 304 (Drug dependence), E850-E859 (Accidental poisoning by drugs and medicaments), E980.0 (Barbituric acid and derivatives (drug overdose - undetermined intent)), E980.1 (Salicylates and congeners (drug overdose -undetermined intent)), E980.2 (Psychotherapeutic agents (drug overdose - undetermined intent)), E980.3 (Other and unspecified drugs (drug overdose - undetermined intent)).

Crude rates from 1979 to 1998 are from the CDC WONDER Online Database, Compressed Mortality Files, 1979-1998 (https://wonder.cdc.gov/cmf-icd9.html). Included are ICD-9 Codes 292 (Drug psychoses), 304 (Drug dependence), 305.2 (Cannabis abuse), 305.3 (Hallucinogen abuse); 305.4 (Barbiturate and similarly acting sedative or hypnotic abuse); 305.5 (Opioid abuse); 305.6 (Cocaine abuse); 305.7 (Amphetamine or related acting sympathomimetic abuse); 305.8 (Antidepressant type abuse); 305.9 (Other, mixed, or unspecified drug abuse); E850-E858 (Accidental poisoning by drugs, medicinal substances, and biologicals), E980.0 (Analgesics, antipyretics, and antirheumatics), E980.1 (Barbiturates), E980.2 (Other sedatives and hypnotics), E980.3 (Tranquilizers and other psychotropic agents), E980.4 (Other specified drugs and medicinal substances), E980.5 (Unspecified drug or medicinal substance).

Crude rates from 1999 to 2017 are from the CDC WONDER Online Database, Detailed Mortality Files, 1999-2017 (https://wonder.cdc.gov/ucd-icd10.html). Included are ICD-10 Codes F11 (Mental and behavioural disorders due to use of opioids), F12 (Mental and behavioural disorders due to use of cannabinoids), F13 (Mental and behavioural disorders due to use of sedatives or hypnotics), F14 (Mental and behavioural disorders due to use of cocaine), F15 (Mental and behavioural disorders due to use of other stimulants, including caffeine), F16 (Mental and behavioural disorders due to use of hallucinogens), X40 (Accidental poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics), X41 (Accidental poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified), X42 (Accidental poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified), X43 (Accidental poisoning by and exposure to other drugs acting on the autonomic nervous system), X44 (Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances), Y10 (Poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics, undetermined intent), Y11 (Poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified, undetermined intent), Y12 (Poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified, undetermined intent), Y13 (Poisoning by and exposure to other drugs acting on the autonomic nervous system, undetermined intent), Y14 (Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, undetermined intent).

 

Overall Age-Adjusted Rates

Suicides

Age-adjusted rates from 1900 to 1949 are from National Center for Health Statistics. “HIST293. Age-Adjusted Death Rates for Selected Causes by Race and Sex Using Year 2000 Standard Population: Death Registration States, 1900-32 and United States 1933-49.” https://www.cdc.gov/nchs/data/dvs/hist293_1900_49.pdf. Includes ICD Codes 155-163 from 1900 to 1920; 165-174 from 1921 to 1929; 163-171 from 1930 to 1938; 163 and 164 from 1939 to 1948; and E963 and E970-E979 in 1949.

Age-adjusted rates from 1950 to 1959 are from National Center for Health Statistics. “HIST293. Age-Adjusted Death Rates for Approximately 64 Selected Causes, by Race and Sex: United States, 1950-59.” https://www.cdc.gov/nchs/data/dvs/hist293_1950_59.pdf. Includes ICD Codes E963 and E970-E979.

Age-adjusted rates from 1960 to 1967 are from National Center for Health Statistic. “HIST293. Age-Adjusted Death Rates for 60 Selected Causes, by Race and Sex Using 2000 Standard Population: United States, 1960-67.” https://www.cdc.gov/nchs/data/mortab/aadr6067.pdf. Includes ICD Codes E963 and E970-E979.

Age-adjusted rates from 1968 to 1978 are from the CDC WONDER Online Database, Compressed Mortality Files, 1968-1978 (https://wonder.cdc.gov/cmf-icd8.html). Included are ICD-8 Codes E950-E959.

Age-adjusted rates from 1979 to 1998 are from the CDC WONDER Online Database, Compressed Mortality Files, 1979-1998 (https://wonder.cdc.gov/cmf-icd9.html). Included are ICD-9 Codes E950-E959.

Age-adjusted rates from 1999 to 2017 are from the CDC WONDER Online Database, Detailed Mortality Files, 1999-2017 (https://wonder.cdc.gov/ucd-icd10.html). Included are ICD-10 Codes X60-X84 and Y87.0.

 

Alcohol-Related Deaths

Age-adjusted rates from 1959 to 1967 were computed directly by SCP staff, using annual CDC mortality microdata and intercensal population estimates. For the mortality data, see National Bureau of Economic Research, "Mortality Data—Vital Statistics NCHS' Multiple Cause of Death Data, 1959-2017," https://www.nber.org/data/vital-statistics-mortality-data-multiple-cause-of-death.html. NBER notes that, “The chief of the NCHS mortality branch has said that while the 1959-1967 files are generally ok, they have not been rigorously verified. ‘Counts by selected causes and demographic groups seem to match up with VSUS, but because in some cases these files had to be reconstructed and pieced together from different sources-some were damaged or lost-we cannot at this time be certain as to their accuracy.’” Denominator population data used for rate calculation from CDC, “Population by age groups, race, and sex for the Death Registration States, 1900?32, and for the United States, 1933?59,” https://www.cdc.gov/nchs/data/dvs/pop0059.pdf, and "Intercensal Population by age groups, race, and sex for 1960-97," https://www.cdc.gov/nchs/data/dvs/pop6097.pdf. Data are age-adjusted to the 2000 standard population using 11 discrete age groups, as detailed in the report, “Age Standardization of Death Rates: Implementation of the Year 2000 Standard,” https://www.cdc.gov/nchs/data/nvsr/nvsr47/nvs47_03.pdf. Included are ICD-7 Codes 307, 322, 581.1, E880.

Age-adjusted rates from 1968 to 1978 are from the CDC WONDER Online Database, Compressed Mortality Files, 1968-1978 (https://wonder.cdc.gov/cmf-icd8.html). Included are ICD-8 Codes 291.0 (Delirium tremens), 291.1 (Korsakov's psychosis (alcoholic)), 291.2 (Other alcoholic hallucinosis), 291.3 (Alcoholic paranoia), 291.9 (Other and unspecified), 303.0 (Episodic excessive drinking), 303.1 (Habitual excessive drinking), 303.2 (Alcoholic addiction), 303.9 (Other and unspecified alcoholism), 571.0 (Alcoholic cirrhosis of the liver), E860 (Accidental poisoning by alcohol).

Age-adjusted rates from 1979 to 1998 are from the CDC WONDER Online Database, Compressed Mortality Files, 1979-1998 (https://wonder.cdc.gov/cmf-icd9.html). Included are ICD-9 Codes 291.0 (Alcohol withdrawal delirium), 291.1 (Alcohol amnestic syndrome), 291.2 (Other alcoholic dementia), 291.3 (Alcohol withdrawal hallucinosis), 291.4 (Idiosyncratic alcohol intoxication), 291.5 (Alcoholic jealousy), 291.8 (Other specified alcoholic psychosis), 291.9 (Unspecified alcoholic psychosis), 303 (Alcohol dependence syndrome), 305.0 (Alcohol abuse), 357.5 (Alcoholic polyneuropathy); 425.5 (Alcoholic cardiomyopathy); 535.3 (Alcoholic gastritis); 571.0 (Alcoholic fatty liver); 571.1 (Acute alcoholic hepatitis); 571.2 (Alcoholic cirrhosis of liver); 571.3 (Alcoholic liver damage, unspecified); 790.3 (Excessive blood level of alcohol); E860.0 (Alcoholic beverages); E860.1 (Other and unspecified ethyl alcohol and its products); E860.2 (Methyl alcohol); E860.3 (Isopropyl alcohol); E860.4 (Fusel oil); E860.8 (Other specified alcohols); E860.9 (Unspecified alcohol).

Age-adjusted rates from 1999 to 2017 are from the CDC WONDER Online Database, Detailed Mortality Files, 1999-2017 (https://wonder.cdc.gov/ucd-icd10.html). Included are ICD-10 Codes E24.4 (Alcohol-induced pseudo-Cushing syndrome); F10 (Mental and behavioural disorders due to abuse of alcohol); G31.2 (Degeneration of nervous system due to alcohol); G62.1 (Alcoholic polyneuropathy); G72.1 (Alcoholic myopathy); I42.6 (Alcoholic cardiomyopathy); K29.2 (Alcoholic gastritis); K70 (Alcoholic liver disease); K85.2 (Alcohol-induced acute pancreatitis); K86.0 (Alcohol-induced chronic pancreatitis); O35.4 (Maternal care for (suspected) damage to fetus from alcohol); P04.3 (Newborn affected by maternal use of alcohol); Q86.0 (Fetal alcohol syndrome (dysmorphic)); R78.0 (Finding of alcohol in blood); X45 (Accidental poisoning by and exposure to alcohol); and Y15 (Poisoning by and exposure to alcohol, undetermined intent).

 

Drug-Related Deaths

Age-adjusted rates from 1959 to 1967 were computed directly by SCP staff, using annual CDC mortality microdata and intercensal population estimates. For the mortality data, see National Bureau of Economic Research, "Mortality Data—Vital Statistics NCHS' Multiple Cause of Death Data, 1959-2017," https://www.nber.org/data/vital-statistics-mortality-data-multiple-cause-of-death.html. NBER notes that, “The chief of the NCHS mortality branch has said that while the 1959-1967 files are generally ok, they have not been rigorously verified. ‘Counts by selected causes and demographic groups seem to match up with VSUS, but because in some cases these files had to be reconstructed and pieced together from different sources-some were damaged or lost-we cannot at this time be certain as to their accuracy.’” Denominator population data used for rate calculation from CDC, “Population by age groups, race, and sex for the Death Registration States, 1900?32, and for the United States, 1933?59,” https://www.cdc.gov/nchs/data/dvs/pop0059.pdf, and "Intercensal Population by age groups, race, and sex for 1960-97," https://www.cdc.gov/nchs/data/dvs/pop6097.pdf. Data are age-adjusted to the 2000 standard population using 11 discrete age groups, as detailed in the report, “Age Standardization of Death Rates: Implementation of the Year 2000 Standard,” https://www.cdc.gov/nchs/data/nvsr/nvsr47/nvs47_03.pdf. Included are ICD-7 Codes 323, E870-878.

Age-adjusted rates from 1968 to 1978 are from the CDC WONDER Online Database, Compressed Mortality Files, 1968-1978 (https://wonder.cdc.gov/cmf-icd8.html). Included are ICD-8 Codes 304 (Drug dependence), E850-E859 (Accidental poisoning by drugs and medicaments), E980.0 (Barbituric acid and derivatives (drug overdose - undetermined intent)), E980.1 (Salicylates and congeners (drug overdose -undetermined intent)), E980.2 (Psychotherapeutic agents (drug overdose - undetermined intent)), E980.3 (Other and unspecified drugs (drug overdose - undetermined intent)).

Age-adjusted rates from 1979 to 1998 are from the CDC WONDER Online Database, Compressed Mortality Files, 1979-1998 (https://wonder.cdc.gov/cmf-icd9.html). Included are ICD-9 Codes 292 (Drug psychoses), 304 (Drug dependence), 305.2 (Cannabis abuse), 305.3 (Hallucinogen abuse); 305.4 (Barbiturate and similarly acting sedative or hypnotic abuse); 305.5 (Opioid abuse); 305.6 (Cocaine abuse); 305.7 (Amphetamine or related acting sympathomimetic abuse); 305.8 (Antidepressant type abuse); 305.9 (Other, mixed, or unspecified drug abuse); E850-E858 (Accidental poisoning by drugs, medicinal substances, and biologicals), E980.0 (Analgesics, antipyretics, and antirheumatics), E980.1 (Barbiturates), E980.2 (Other sedatives and hypnotics), E980.3 (Tranquilizers and other psychotropic agents), E980.4 (Other specified drugs and medicinal substances), E980.5 (Unspecified drug or medicinal substance).

Age-adjusted rates from 1999 to 2017 are from the CDC WONDER Online Database, Detailed Mortality Files, 1999-2017 (https://wonder.cdc.gov/ucd-icd10.html). Included are ICD-10 Codes F11 (Mental and behavioural disorders due to use of opioids), F12 (Mental and behavioural disorders due to use of cannabinoids), F13 (Mental and behavioural disorders due to use of sedatives or hypnotics), F14 (Mental and behavioural disorders due to use of cocaine), F15 (Mental and behavioural disorders due to use of other stimulants, including caffeine), F16 (Mental and behavioural disorders due to use of hallucinogens), X40 (Accidental poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics), X41 (Accidental poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified), X42 (Accidental poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified), X43 (Accidental poisoning by and exposure to other drugs acting on the autonomic nervous system), X44 (Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances), Y10 (Poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics, undetermined intent), Y11 (Poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified, undetermined intent), Y12 (Poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified, undetermined intent), Y13 (Poisoning by and exposure to other drugs acting on the autonomic nervous system, undetermined intent), Y14 (Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, undetermined intent).

 

Crude Rates by Age and for Non-Hispanic Whites Ages 45-54

As noted in our report, it is not possible to separate Hispanic and non-Hispanic whites prior to 1999 so our estimates include Hispanic whites from 1900 to 1997. Our checks indicate this has a minimal impact on the trends and levels we report. We looked separately at trends for all whites (including Hispanics) from 1999 to 2017. The difference in levels in 1999 is fairly small, and the rise thereafter is only somewhat less steep than when Hispanics are excluded.

The 1962 and 1963 rates for whites exclude New Jersey, which did not report deaths by race in those years.

Suicides and All-Cause Mortality

Crude rates from 1900 to 1939 are from National Center for Health Statistics. “HIST 290. Death Rates from Selected Causes, by 10-year Age Groups, Race, and Sex: Death-Registration States, 1900-1932, and United States, 1933-1939.” https://www.cdc.gov/nchs/data/dvs/hist290_0039.pdf.

Crude rates from 1940 to 1949 are from National Center for Health Statistics. “Table 2. Death Rates from Selected Causes, by 10-Year Age Groups, Race, and Sex: United States, 1940?1949.” https://www.cdc.gov/nchs/data/dvs/mx194049.pdf.

Crude rates from 1950 to 1959 are from National Center for Health Statistics. “HIST 290F. Death Rates for Approximately 64 Selected Causes, by 10-Year Age Groups, Race, and Sex: United States, 1950-59.” https://www.cdc.gov/nchs/data/dvs/mx1950_59.pdf.

Crude rates from 1960 to 1967 are from National Center for Health Statistics. “Table 290. Death Rates for 60 Selected Causes, by 10-Year Age Groups, Race, and Sex: United States, 1960-67.” https://www.cdc.gov/nchs/data/dvs/mx196067.pdf.

Crude rates from 1968 to 1978 are from the CDC WONDER Online Database, Compressed Mortality Files, 1968-78 (https://wonder.cdc.gov/cmf-icd8.html).

Crude rates from 1979 to 1998 are from the CDC WONDER Online Database, Compressed Mortality Files, 1979-98 (https://wonder.cdc.gov/cmf-icd9.html).

Crude rates from 1999 to 2017 are from the CDC WONDER Online Database, Detailed Mortality Files, 1999-present (https://wonder.cdc.gov/ucd-icd10.html).

 

Alcohol-Related Deaths and Drug-Related Deaths

Crude rates from 1959 to 1967 were computed directly by SCP staff, using annual CDC mortality microdata and intercensal population estimates. For the mortality data, see National Bureau of Economic Research, "Mortality Data—Vital Statistics NCHS' Multiple Cause of Death Data, 1959-2017," https://www.nber.org/data/vital-statistics-mortality-data-multiple-cause-of-death.html. NBER notes that, “The chief of the NCHS mortality branch has said that while the 1959-1967 files are generally ok, they have not been rigorously verified. ‘Counts by selected causes and demographic groups seem to match up with VSUS, but because in some cases these files had to be reconstructed and pieced together from different sources-some were damaged or lost-we cannot at this time be certain as to their accuracy.’” Denominator population data used for rate calculation from CDC, “Population by age groups, race, and sex for the Death Registration States, 1900?32, and for the United States, 1933?59,” https://www.cdc.gov/nchs/data/dvs/pop0059.pdf, and "Intercensal Population by age groups, race, and sex for 1960-97," https://www.cdc.gov/nchs/data/dvs/pop6097.pdf.

Crude rates from 1968 to 1978 are from the CDC WONDER Online Database, Compressed Mortality Files, 1968-78 (https://wonder.cdc.gov/cmf-icd8.html).

Crude rates from 1979 to 1998 are from the CDC WONDER Online Database, Compressed Mortality Files, 1979-1998 (https://wonder.cdc.gov/cmf-icd9.html).

Crude rates from 1999 to 2017 are from the CDC WONDER Online Database, Detailed Mortality Files, 1999-2017 (https://wonder.cdc.gov/ucd-icd10.html).

 

Crude and Age-Adjusted Rates by Sex and by Race

The racial categories available in the data change over time. Between 1900 and 1967, the distinction is simply between whites and nonwhites. From 1968 to 1998, CDC WONDER distinguishes between whites, blacks, and others. Since 1999, the categories in CDC WONDER have included Hispanics and non-Hispanic whites, blacks, American Indians and Alaska Natives, and Asians and Pacific Islanders. The 1962 and 1963 rates by race exclude New Jersey, which did not report deaths by race in those years.

Suicides

Crude rates from 1900 to 1939 are from National Center for Health Statistics. “HIST 290. Death Rates from Selected Causes, by 10-year Age Groups, Race, and Sex: Death-Registration States, 1900-1932, and United States, 1933-1939.” https://www.cdc.gov/nchs/data/dvs/hist290_0039.pdf.

Crude rates from 1940 to 1949 are from National Center for Health Statistics. “Table 2. Death Rates from Selected Causes, by 10-Year Age Groups, Race, and Sex: United States, 1940?1949.” https://www.cdc.gov/nchs/data/dvs/mx194049.pdf.

Crude rates from 1950 to 1959 are from National Center for Health Statistics. “HIST 290F. Death Rates for Approximately 64 Selected Causes, by 10-Year Age Groups, Race, and Sex: United States, 1950-59.” https://www.cdc.gov/nchs/data/dvs/mx1950_59.pdf.

Crude rates from 1960 to 1967 are from National Center for Health Statistics. “Table 290. Death Rates for 60 Selected Causes, by 10-Year Age Groups, Race, and Sex: United States, 1960-67.” https://www.cdc.gov/nchs/data/dvs/mx196067.pdf.

Age-adjusted rates from 1900 to 1949 are from National Center for Health Statistics. “HIST293. Age-Adjusted Death Rates for Selected Causes by Race and Sex Using Year 2000 Standard Population: Death Registration States, 1900-32 and United States 1933-49.” https://www.cdc.gov/nchs/data/dvs/hist293_1900_49.pdf.

Age-adjusted rates from 1950 to 1959 are from National Center for Health Statistics. “HIST293. Age-Adjusted Death Rates for Approximately 64 Selected Causes, by Race and Sex: United States, 1950-59.” https://www.cdc.gov/nchs/data/dvs/hist293_1950_59.pdf.

Age-adjusted rates from 1960 to 1967 are from National Center for Health Statistic. “HIST293. Age-Adjusted Death Rates for 60 Selected Causes, by Race and Sex Using 2000 Standard Population: United States, 1960-67.” https://www.cdc.gov/nchs/data/mortab/aadr6067.pdf.

Crude and age-adjusted rates from 1968 to 1978 are from the CDC WONDER Online Database, Compressed Mortality Files, 1968-1978 (https://wonder.cdc.gov/cmf-icd8.html).

Crude and age-adjusted rates from 1979 to 1998 are from the CDC WONDER Online Database, Compressed Mortality Files, 1979-1998 (https://wonder.cdc.gov/cmf-icd9.html).

Age-adjusted rates from 1999 to 2017 are from the CDC WONDER Online Database, Detailed Mortality Files, 1999-2017 (https://wonder.cdc.gov/ucd-icd10.html).

 

Alcohol-Related Deaths and Drug-Related Deaths

Crude and age-adjusted rates from 1959 to 1967 were computed directly by SCP staff, using annual CDC mortality microdata and intercensal population estimates. For the mortality data, see National Bureau of Economic Research, "Mortality Data—Vital Statistics NCHS' Multiple Cause of Death Data, 1959-2017," https://www.nber.org/data/vital-statistics-mortality-data-multiple-cause-of-death.html. NBER notes that, “The chief of the NCHS mortality branch has said that while the 1959-1967 files are generally ok, they have not been rigorously verified. ‘Counts by selected causes and demographic groups seem to match up with VSUS, but because in some cases these files had to be reconstructed and pieced together from different sources-some were damaged or lost-we cannot at this time be certain as to their accuracy.’” Denominator population data used for rate calculation from CDC, “Population by age groups, race, and sex for the Death Registration States, 1900?32, and for the United States, 1933?59,” https://www.cdc.gov/nchs/data/dvs/pop0059.pdf, and "Intercensal Population by age groups, race, and sex for 1960-97," https://www.cdc.gov/nchs/data/dvs/pop6097.pdf. The latter source does not provide nonwhite population estimates for 1962 or 1963, because New Jersey did not report data by race. Since deaths cannot be divided between whites and nonwhites in New Jersey in those two years, we estimate a population denominator for those two years that excludes New Jersey residents. To do so, we estimate the share of the 1962 and 1963 national population comprised of Americans other than New Jersey residents, using https://www2.census.gov/programs-surveys/popest/tables/1980-1990/state/asrh/st6070ts.txt. We then apply this fraction to the national 1962 and 1963 population totals in https://www.cdc.gov/nchs/data/dvs/pop6097.pdf. That document also provides the number of whites who are not from New Jersey in each of those years. We subtract non-New-Jersey whites from the non-New-Jersey total population to get non-New-Jersey nonwhites in each year. Finally, we estimate the number of non-New-Jersey deaths by race using the microdata and divide by the non-New-Jersey population by race.

Crude and age-adjusted rates from 1968 to 1978 are from the CDC WONDER Online Database, Compressed Mortality Files, 1968-78 (https://wonder.cdc.gov/cmf-icd8.html).

Crude and age-adjusted rates from 1979 to 1998 are from the CDC WONDER Online Database, Compressed Mortality Files, 1979-1998 (https://wonder.cdc.gov/cmf-icd9.html).

Crude and age-adjusted rates from 1999 to 2017 are from the CDC WONDER Online Database, Detailed Mortality Files, 1999-2017 (https://wonder.cdc.gov/ucd-icd10.html).

 

Crude and Age-Adjusted Rates using Case-Deaton Definitions

As noted in our report, in our analyses we modify the definition of “deaths of despair” used by Anne Case and Angus Deaton in their research, as well as the definitions of the subcomponents. (For their definitions, see the data appendix to their “Mortality and Morbidity in the 21st Century” at https://www.brookings.edu/wp-content/uploads/2017/03/casedeaton_sp17_dataappendix.pdf.)

While our suicide rates are estimated exactly the same as theirs, we modify what kinds of deaths are included in our categories of alcohol- and drug-related deaths. Case and Deaton include within deaths of despair “alcoholic liver disease and cirrhosis,” but they exclude a number of diseases and mental disorders explicitly recorded as linked to alcohol abuse, and they group deaths from alcohol poisoning with drug overdoses. We include in “alcohol-related deaths” these other categories, based in part on a CDC document for guidance (https://www.cdc.gov/niosh/ltas/pdf/niosh-119-table-2007.pdf). See the details above in the section on overall crude mortality rates from alcohol-related deaths. At the same time, many cirrhosis deaths are unrelated to alcoholism, so we include in alcohol-related deaths only those explicitly linked to alcohol.

In addition to excluding alcohol poisoning deaths from our “drug-related deaths”—Case and Deaton’s category is comprised of accidental and intent undetermined drug overdose and alcohol poisoning—we include a number of mental disorders related to drug abuse. See the details above in the section on overall crude mortality rates from drug-related deaths.

For comparative purposes, we provide long-term estimates consistent with their definitions. Since Case and Deaton are tracking recent trends, they rely solely on ICD-9 and ICD-10 codes, as follows:

• Suicide: ICD-9 codes E950-E959 and ICD-10 codes X60-84, Y87.0.
• Poisoning involving “accidental and intent undetermined drug overdose and alcohol poisoning”: ICD-9 codes E850-E860 and E980, and ICD-10 codes X40-45, Y10-15, Y45, Y47, and Y49.
• Alcoholic liver disease and cirrhosis: ICD-9 code 571 and ICD-10 codes K70, K73, and K74.

To extend the Case-Deaton series back to 1968, we estimate crude and age-adjusted rates for the entire population and crude rates for whites between the ages of 45 and 54 using the CDC WONDER Online Database, including the Compressed Mortality Files, 1968-78 (https://wonder.cdc.gov/cmf-icd8.html), the Compressed Mortality Files, 1979-1998 (https://wonder.cdc.gov/cmf-icd9.html), and the Detailed Mortality Files, 1999-2017 (https://wonder.cdc.gov/ucd-icd10.html). From 1968 to 1978, we use ICD-8 codes E950-E959 for suicides, code 571 for alcoholic liver disease and cirrhosis, and codes E850-E860 and E980 for poisonings. From 1979 to 2017, we use the same ICD-9 and ICD-10 definitions as them. As noted above, prior to 1999, Hispanic whites cannot be separated from non-Hispanic whites, so all whites are included.

 

Trends in Unhappiness (Percent "Not Too Happy")

Figure 8 of the paper shows trends in unhappiness from four sources. (See Table 2, below, for the individual data points.) The question wording and response options for all four sources is the same: “Taken all together, how would you say things are these days—would you say that you are very happy, pretty happy, or not too happy?” Figure 8 in the paper and Table 2 below display the percent responding “not too happy.” The 1963 and 1965 estimates are from Survey Research Service Amalgam and the 1972 through 2016 estimates are from the General Social Survey. The National Opinion Research Center (NORC) conducted the surveys for both SRSA and the GSS. Pew Research Center estimates run from 1996 to 2018. Gallup estimates run from 1977 to 2008. All estimates except from the GSS were obtained from the Roper Center’s iPoll database. The Gallup estimate for 1981 averages estimates from three surveys that year. The Pew estimates are averages from two surveys each in 2003, 2005, 2008, 2009, 2012, and 2016; from four surveys in 2011; and from five in 2014. GSS estimates were obtained from the GSS Data Explorer online tool on NORC’s website. We replace GSS estimates for 1972, 1980, and 1985-87 with ones from Betsey Stevenson and Justin Wolfers (2008). “Happiness Inequality in the United States.” Journal of Legal Studies 37: S33-S79, Table A1. Their estimates correct for the effects of survey changes that artificially affected responses to the happiness question.