Tracking the Impact of Diseases of Despair in Appalachia—2015 to 2018

Introduction: This study provides an update on mortality due to diseases of despair within the Appalachian Region, comparing 2015 to 2018. Methods: Diseases of despair include: alcohol, prescription drug and illegal drug overdose, suicide, and alcoholic liver disease/cirrhosis of the liver. Analyses are based on National Vital Statistics System (NVSS) mortality data for individuals aged 15-64. Results: Between 2015 and 2017, the diseases of despair mortality rate increased in both Appalachia and the non-Appalachian U.S., and the disparity grew between Appalachia and the rest of the county. In 2018, the disease of despair mortality rate declined by 8 percent in Appalachia, marking the first decline for the Region since 2012. Diseases of despair continue to impact the working-age population, and while males experience a higher burden of mortality due to diseases of despair, the disparity between Appalachia and the rest of the United States is greater for females. Overdose mortality rates in Appalachia increased between 2015 and 2017, followed by a decline in 2018. During this same time frame, suicide also increased notably within the Appalachian region, and the disparity between Appalachia and the non-Appalachian U.S. increased by 50 percent. Implications: These findings document that the diseases of despair continue to have a greater impact in the Appalachian Region than in the rest of the United States. While the declining trends between 2017 and 2018 are promising, data has shown that these rates are likely to increase again, particularly as a result of the COVID-19 pandemic.