{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T20:56:30Z","timestamp":1793912190082,"version":"4.8.0"},"reference-count":18,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\u2018Deaths of despair\u2019 (DoD)\u2014including suicide, drug overdose and alcohol-related fatalities\u2014have been a growing, 21st century public health issue in the USA. This study quantifies the contributions of age, sex, race\/ethnicity and cause or manner of death to changes in the DoD mortality rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The yearly counts of DoD (1999\u20132023) for people aged 15 years and older were extracted from CDC Wide-ranging Online Data for Epidemiologic Research. Joinpoint regression was conducted to identify the time point(s) when the change of trend occurred. Decomposition analysis was then conducted for data from 1999 to 2020\u2009to examine the contribution of different subgroups between time points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The crude mortality rate of DoD increased from 28.60 per 100\u2009000 population (62\u2009660 deaths) in 1999 to 71.99 (198 266 deaths) in 2023. The joinpoint analysis showed a statistically significant increase from 1999 to 2014 (annual percent change (APC)=2.94%, 95% CI 2.12% to 3.88%) and from 2014 to 2021 (APC=7.27%, 95% CI 2.15% to 11.64%) (average APC (AAPC) 1999\u20132023=3.96%, 95% CI 3.59% to 4.40%). The decomposition analysis revealed that between 1999 and 2014, persons aged 25\u201364 contributed 88.72% of the increase, and 98.17% involving non-Hispanic white individuals. Male and drug-related fatalities each contributed about 60% of the increase. While there was no proportional change in the age contributions to increase deaths from 2014 to 2020, only 66.70% of this increase involved non-Hispanic white individuals. During this latter period, male and drug-related fatalities each contributed about 75% of the increase.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The major contributors to the rise in DoD were deaths among the population aged 25\u201364, men, non-Hispanic white individuals, and most were drug-related, but the proportion of contributions changed over time.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/ip-2025-046063","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T17:20:26Z","timestamp":1775064026000},"page":"ip-2025-046063","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Deaths of despair in the USA, 1999\u20132023: a decomposition analysis"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1377-8853","authenticated-orcid":false,"given":"Cheuk Yui","family":"Yeung","sequence":"first","affiliation":[{"name":"School of Social Work, University of Maryland Baltimore, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera Yu","family":"Men","sequence":"additional","affiliation":[{"name":"School of Social Work, University of Maryland Baltimore, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1596-4120","authenticated-orcid":false,"given":"Paul Siu Fai","family":"Yip","sequence":"additional","affiliation":[{"name":"Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR, China"},{"name":"Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric D","family":"Caine","sequence":"additional","affiliation":[{"name":"Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA"},{"name":"Canandaigua VA Center of Excellence for Suicide Prevention, Canandaigua, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"2026040110201752000_ip-2025-046063v1.1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1518393112"},{"key":"2026040110201752000_ip-2025-046063v1.2","doi-asserted-by":"publisher","DOI":"10.1353\/eca.2017.0005"},{"key":"2026040110201752000_ip-2025-046063v1.3","doi-asserted-by":"crossref","unstructured":"Case A , Deaton A . The lives and deaths of the more (and less) educated. Deaths of despair and the future of capitalism. Princeton: Princeton University Press, 2020.","DOI":"10.1515\/9780691217062"},{"key":"2026040110201752000_ip-2025-046063v1.4","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-069905","article-title":"Comparing trends in mid-life \u201cdeaths of despair\u201d in the USA, Canada and UK, 2001-2019: is the USA an anomaly?","volume":"13","author":"Dowd","year":"2023","journal-title":"BMJ Open"},{"key":"2026040110201752000_ip-2025-046063v1.5","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.puhe.2024.07.015","article-title":"Deaths of despair-associated mortality rates globally: a 2000-2019 sex-specific disparities analysis","volume":"236","author":"Shirzad","year":"2024","journal-title":"Public Health (Fairfax)"},{"key":"2026040110201752000_ip-2025-046063v1.6","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2024-222089"},{"key":"2026040110201752000_ip-2025-046063v1.7","unstructured":"United States Congress Joint Economic Committee . Methodological appendix to \u201cLong-term trends in deaths of despair\". 2019."},{"key":"2026040110201752000_ip-2025-046063v1.8","unstructured":"Das Gupta P . Standardization and decomposition of rates: a user\u2019s manual. 1993."},{"key":"2026040110201752000_ip-2025-046063v1.9","doi-asserted-by":"publisher","DOI":"10.1136\/injuryprev-2011-040177"},{"key":"2026040110201752000_ip-2025-046063v1.10","doi-asserted-by":"crossref","unstructured":"King J , Matthews B . Das Gupta Standardisation and Decomposition. 2025.","DOI":"10.32614\/CRAN.package.DasGuptR"},{"key":"2026040110201752000_ip-2025-046063v1.11","doi-asserted-by":"publisher","DOI":"10.2307\/2281213"},{"key":"2026040110201752000_ip-2025-046063v1.12","doi-asserted-by":"publisher","DOI":"10.1111\/add.16318"},{"key":"2026040110201752000_ip-2025-046063v1.13","doi-asserted-by":"publisher","DOI":"10.1097\/YCO.0000000000000717"},{"key":"2026040110201752000_ip-2025-046063v1.14","unstructured":"Centers for Disease Control and Prevention . CDC reports nearly 24% decline in U.S. drug overdose deaths. 2025."},{"key":"2026040110201752000_ip-2025-046063v1.15","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1001\/jamapsychiatry.2025.3584","article-title":"Structural Drivers of the Drop in Opioid Overdose Deaths in the US","volume":"83","author":"Stringfellow","year":"2026","journal-title":"JAMA Psychiatry"},{"key":"2026040110201752000_ip-2025-046063v1.16","doi-asserted-by":"publisher","DOI":"10.1126\/science.aea6130"},{"key":"2026040110201752000_ip-2025-046063v1.17","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2018.304585"},{"key":"2026040110201752000_ip-2025-046063v1.18","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2017.304041"}],"container-title":["Injury Prevention"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/ip-2025-046063","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T17:20:27Z","timestamp":1775064027000},"score":1,"resource":{"primary":{"URL":"https:\/\/injuryprevention.bmj.com\/lookup\/doi\/10.1136\/ip-2025-046063"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":18,"alternative-id":["10.1136\/ip-2025-046063"],"URL":"https:\/\/doi.org\/10.1136\/ip-2025-046063","relation":{},"ISSN":["1353-8047","1475-5785"],"issn-type":[{"value":"1353-8047","type":"print"},{"value":"1475-5785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]}}}