Introduction
Psychotropic drug−implicated (PDI) mortality—deaths in which psychotropic drugs were
a contributing but not underlying cause of death—increased over 2 decades, with circulatory
mortality as the primary cause leading to such deaths. Trends in PDI circulatory mortality
over a 22-year period and its patterning in U.S. deaths are described.
Methods
Deaths extracted from the Centers for Disease Control and Prevention's Wide-ranging
Online Data for Epidemiologic Research Multiple Causes of Death database from 1999
to 2020 were analyzed to generate annual counts and rates for drug-implicated deaths
due to diseases of the circulatory system, including by specific drug, sex, race/ethnicity,
age, and state.
Results
During a period when overall age-adjusted circulatory mortality rates declined, PDI
circulatory mortality more than doubled, from 0.22 per 100,000 in 1999 to 0.57 per
100,000 by 2020, now representing 1 in 444 circulatory deaths. Although PDI deaths
from ischemic heart diseases are proportionally aligned with overall circulatory deaths
(50.0% vs 48.5%), PDI deaths from hypertensive diseases represent a larger proportion
(19.8% vs 8.0%). Psychostimulants generated the greatest escalation for PDI circulatory
deaths (0.029−0.332 per 100,000). The sex gap in PDI mortality rates widened (0.291
females, 0.861 males). PDI circulatory mortality is particularly notable for Black
Americans and midlife Americans, with considerable geographic variability.
Conclusions
Circulatory mortality with psychotropic drugs as a contributing cause escalated over
2 decades. Trends in PDI mortality are not evenly distributed across the population.
Greater engagement with patients about their substance use is needed to intervene
in cardiovascular deaths. Prevention and clinical intervention could contribute to
reinvigorating previous trends of declining cardiovascular mortality.
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Publication history
Published online: March 07, 2023
Publication stage
In Press Journal Pre-ProofIdentification
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© 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
