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Drug Overdose and Firearm Homicide Contributed Significantly to U.S. Mortality Rates from 1999-2020 

, by Maura Kate Costello, M.A.

Graph that indicates the increase in age-adjusted mortality rates over time.

Trends in age-standardized mortality rates due to external causes in the U.S., 1999-2020

Credit: JAMA Internal Medicine

In a study of death rates in the U.S. from 1999-2020, investigators found a rapid rise in death rates due to unintentional poisoning (drug overdoses) and firearm homicides; increases further accelerated in 2019 and 2020 due to the COVID-19 pandemic. These findings were published in the journal JAMA Internal Medicine on July 3, 2023. 

External causes of deaths, including both intentional and unintentional injury, and poisoning deaths, have contributed substantially to recent declines in life expectancy in the U.S., with additional declines in 2020 due to COVID-19; by contrast, other high-income countries have experienced overall increases in life expectancy. Studies have suggested the COVID-19 pandemic further increased deaths from external causes as a result of socioeconomic hardship, psychosocial stress, and reduced access to health care. However, changes in trends by gender and race and ethnicity over time over time and differences in rates of external causes of death by intent (homicide, suicide, unintentional) are not fully understood. 

Using death certificate data from the National Center for Health Statistics, Wayne Lawrence, Dr.P.H., M.P.H., research fellow in the Metabolic Epidemiology Branch, and colleagues evaluated mortality trends by intent, sex, age, and race and ethnicity. They found over three million deaths from 1999-2019 were due to external causes, and the most rapid rise in death rates was attributable to unintentional poisoning (drug overdose) and firearm homicides. Many of these external causes of death had outsized effects among racial and ethnic minoritized populations and their communities. 

These findings underscore the urgent need for systemic changes to reduce deaths from firearm, drug overdose, and other injuries. Targeted public health interventions at the local, state, and national level are needed to counter the persistent increasing trend in external causes of death.  


Lawrence W et al. Trends in mortality from poisonings, firearms, and all other injuries by intent in the US, 1999-2020. JAMA Internal Medicine. July 2023.

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