Drug Overdose Death Rates Higher in Urban Areas

For Immediate Release: March 17, 2021

Contact: CDC, National Center for Health Statistics, Office of Communication (301) 458-4800
E-mail: paoquery@cdc.gov

Drug overdose death rates are higher overall in U.S. urban counties compared to rural counties, but rates are higher in the rural counties of five states: California, Connecticut, North Carolina, Vermont, and Virginia. These findings are included in a new report to be released on Wednesday by CDC’s National Center for Health Statistics (NCHS).

The report “Urban-Rural Differences in Drug Overdose Death Rates, 1999-2019” examines urban-rural differences in drug overdose death rates, for all drugs and by selected types of opioids and stimulants. Death rates were higher in urban than in rural counties from 1999 through 2003, and again from 2016 through 2019. However, from 2007 through 2015, rates were higher in rural than in urban counties. Drug overdose death rates in urban counties increased from 6.4 per 100,000 population in 1999 to 22.0 in 2019. Rural counties also increased from 4.0 to 19.6 during the same time.

Some of the highlights in the new reports:

  • In 2019, rates were higher in urban counties than in rural counties for 19 states (Alabama, Arizona, Arkansas, Florida, Hawaii, Illinois, Iowa, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Nebraska, New Hampshire, Ohio, Pennsylvania, Tennessee, West Virginia, and Wisconsin).
  • Rates in rural and urban counties were statistically similar in 26 states.
  • Rates of drug overdose deaths involving natural and semisynthetic opioids (drugs such as oxycodone, hydrocodone, and codeine) were higher in rural than in urban counties from 2004 through 2017, but similar in 2018 and 2019, as deaths in rural areas declined.
  • In 2019, the death rate for drug overdose deaths involving cocaine in urban counties was morethan twice the rate in rural counties.

On Wednesday NCHS is also releasing its latest monthly provisional estimates of drug overdose deaths in the U.S., for the one-year period ending in August 2020, showing a nearly 27 percent increase in overdose deaths from the same period a year earlier. This data visualization presents provisional counts for drug overdose deaths occurring within the 50 states and the District of Columbia. The counts represent the number of reported deaths due to drug overdose occurring in the 12-month periods ending in the month indicated.

Both the urban-rural report and the and monthly provisional drug overdose death counts will be available on the NCHS web site at www.cdc.gov/nchs.