In the most detailed study yet on the topic, published yesterday in the Journal of the American Medical Association, researchers from the University of Washington found that these deaths aren't distributed evenly around the country. Though overdose deaths are not disproportionately rural overall, a trio of maps in the article shows that Appalachian coal country is in particularly bad shape, with more OD deaths per capita than almost anywhere else in the country. The mortality rate has increased fifty-fold there and in a few other hotspots across the country. And the amount of opioids prescribed per person is extremely high.
Self-harm is much more prevalent in Western states, but has increased greatly since 1980 in not just Western states, but in other Midwestern rural areas and the Dakotas. Deaths due to interpersonal violence are concentrated in the South, especially in the Mississippi Delta region, the Black Belt, rural Alaska, and around Indian reservations in the Dakotas and the Southwest. The greatest increase in interpersonal violence deaths has been in the Mississippi Delta, but also in Fremont County, Wyoming, on which sits most of the Wind River Indian Reservation. The reservation has been noted in the past for having a high suicide and crime rate.
In general the high rate of variation in deaths of despair suggests that different factors are at play in different areas, which means that a one-size-fits-all approach to fixing it would be unwise, Perry writes.
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| Overdose deaths per 100,000 people (Washington University map; click on the image to enlarge it) |
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