Abstract
Objective—This report describes deaths from drug
overdoses in 2020 in U.S. residents in 46 states and New York
City by usual occupation and industry.
Methods—Frequencies, death rates, and proportionate
mortality ratios (PMRs) are presented using the 2020 National
Vital Statistics System mortality data file. Data were restricted
to decedents aged 16–64 for rates and 15–64 for PMRs with
usual occupations and industries in the paid civilian workforce.
Age-standardized drug overdose death rates were estimated for
usual occupation and industry groups overall, and age-adjusted
drug overdose PMRs were estimated for each usual occupation
and industry group overall and by sex, race and Hispanic-origin
group, type of drug, and drug overdose intent. Age-adjusted drug
overdose PMRs were also estimated for individual occupations
and industries.
Results—Drug overdose mortality varied by usual
occupation and industry. Workers in the construction and
extraction occupation group (162.6 deaths per 100,000 workers,
95% confidence interval: 155.8–169.4) and construction industry
group (130.9, 126.0–135.8) had the highest drug overdose
death rates. The highest group-level drug overdose PMRs
were observed in decedents in the construction and extraction
occupation group and the construction industry group (145.4,
143.6–147.1 and 144.9, 143.2–146.5, respectively). Differences
in drug overdose PMRs by usual occupation and industry group
were observed within each sex, within each race and Hispanic-
origin group, by drug type, and by drug overdose intent. Among
individual occupations and industries, the highest drug overdose
PMRs were observed in decedents who worked as fishers and
related fishing occupations and in fishing, hunting, and trapping
industries (193.1, 166.8–222.4 and 186.5, 161.7–214.1,
respectively).
Conclusions—Variation in drug overdose death rates and
PMRs by usual occupation and industry in 2020 demonstrates
the disproportionate burden of the ongoing drug overdose crisis
on certain sectors of the U.S. workforce.
Keywords: worker health • proportionate mortality ratios •
census codes • National Vital Statistics System
Introduction
Deaths from drug overdoses are a major public health
concern in the United States (1,2), particularly in the working-
age population (1). The drug overdose death rate increased in
most years from 1999 through 2020 (3). This trend intensified
during the COVID-19 pandemic; the U.S. drug overdose death
rate in 2021 was 50% higher than in 2019 (1). Increases in drug
overdose deaths in 2020 and 2021 contributed to the overall
rise in deaths involving drug overdose, suicide, or alcohol abuse
during the pandemic (4).
Drug overdose mortality risks vary by occupation, industry,
and work-related characteristics, including workplace injury,
work-related psychosocial stress, precarious employment,
employer-provided health insurance status, and access to paid
sick leave (5–8). Workers in each occupation and industry also
experienced unique stressors during the COVID-19 pandemic
that impacted prevalence and management of substance use
disorders (9–12). This report describes U.S. drug overdose
mortality by usual occupation and industry for 2020 to expand
on and update historical estimates (5). Drug overdose death
rates and proportionate mortality ratios (PMRs) are estimated
for each occupation and industry group overall. Drug overdose
PMRs are also estimated for each individual occupation and
industry and for each occupation and industry group within each
sex, within each race and Hispanic-origin group, by drug type,
and by drug overdose intent.
National Vital
Statistics Reports
Volume 72, Number 7 August 22, 2023
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
National Vital Statistics System
Drug Overdose Mortality by Usual Occupation
and Industry: 46 U.S. States and
New York City, 2020
Rachael M. Billock, Ph.D., Andrea L. Steege, Ph.D., and Arialdi Miniño, M.P.H., Division of Vital Statistics
NCHS reports can be downloaded from: https://www.cdc.gov/nchs/products/index.htm.
2 National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023
Methods
Data sources
Mortality data are drawn from the National Center for Health
Statistics’ National Vital Statistics System 2020 mortality file.
Data on usual occupation and industry are available for 91%
of decedents aged 15 and over and are reported by 46 states
and New York City. Results are only representative of decedents
in these 47 jurisdictions. Occupation and industry data were
also missing for substantial portions of decedents (6%–11%)
in two participating states (13). See Technical Notes for more
information on participating jurisdictions and data availability.
The U.S. Standard Certificate of Death (14) records usual
occupation and industry, or the occupation and industry in which
the decedent spent most of their working life. Occupation is the
type of work that a person performs, or their job (such as teacher
or cashier), while industry is the type of business a person
works in (such as an elementary school or grocery store). Usual
occupation or industry may differ from current occupation and
industry at death. However, usual occupation and industry have
been shown to be reasonable surrogates for current occupation
and industry among currently or recently employed workers
(15). Occupation and industry narratives provided on death
certificates were coded to standardized individual U.S. Census
Bureau occupation and industry codes through a collaboration
with the National Institute for Occupational Safety and Health
(13). Census codes were then aggregated into broad groups
using the National Health Interview Survey simple occupation
and industry recodes (16) to minimize suppression of results
due to small populations. This aggregation may smooth
over contrasting results in some component occupations
and industries. See Technical Notes for more information on
occupation and industry coding.
Cause-of-death statistics presented in this report are
classified using International Classification of Diseases, 10th
Revision (ICD–10) codes. Drug overdose deaths were identified
using the underlying cause of death, which is the disease or
condition responsible for initiating the chain of events leading
to death (17). Drug overdose deaths include unintentional
(ICD–10 codes X40–X44), suicide (X60–X64), and homicide
(X85) overdoses, as well as overdoses of undetermined intent
(Y10–Y14). Type(s) of drugs involved in each overdose death
were determined using multiple cause-of-death ICD–10 codes
for heroin (T40.1), natural and semisynthetic opioids (T40.2),
methadone (T40.3), synthetic opioids other than methadone
(T40.4), cocaine (T40.5), and psychostimulants with abuse
potential (T43.6).
Population estimates from the April 2020 Current Population
Survey (CPS) were applied as denominators for the estimation
of death rates. CPS estimates are weighted to represent the
civilian noninstitutionalized population aged 16–64 in the 47
participating jurisdictions only (18). See Technical Notes for
more information on the use of CPS estimates in the calculation
of death rates.
Statistical Methods
Mortality measures
Drug overdose death rates and PMRs were estimated for
working-age decedents in each occupation and industry group.
Death rates may be applied to compare the number of deaths
from drug overdoses per 100,000 workers between occupation
and industry groups in a standardized way. In contrast, PMRs
evaluate relative drug overdose mortality using a ratio of two
proportions, estimated as the proportion of deaths from drug
overdoses within each group of workers (numerator) compared
with the proportion of deaths from drug overdoses in all
workers (denominator), multiplied by 100 (19). For example, the
unadjusted drug overdose PMR in decedents in construction and
extraction occupations is estimated as:
Drug overdose deaths among
construction and extraction workers
Total deaths among construction and
extraction workers
Drug overdose deaths among all workers
Total deaths among all workers
•
100
In this report, a PMR over 100 indicates that drug overdose
deaths in that occupation (or industry) comprise a greater
proportion of deaths in that set of decedents than across
decedents in all occupations (or industries) combined.
Death rates and PMRs often have similar patterns, but
results may differ within working-age populations that experience
particularly high or low overall mortality. PMRs are mutually
dependent between causes of death because the percentages
of deaths from all causes within a worker group must sum to
100 (19). For example, the proportion of deaths attributed to
drug overdoses (and therefore the drug overdose PMR) may
be lower in occupation groups with higher underlying mortality
rates and higher baseline prevalence of competing causes of
death. Because higher income is associated with longer life
expectancy (20), if drug overdose death rates were equal within
all occupation and industry groups, elevated drug overdose
PMRs within high-income occupations and industries would be
expected due to lower baseline prevalence of competing causes
of death within these working-age populations. PMRs identify
the worker populations with the highest proportions of deaths
from drug overdoses, rather than the worker populations with
the highest absolute risks of death from drug overdoses as
estimated by death rates (19).
Death rates
Data were restricted to U.S. resident decedents aged 16–64
in the paid civilian workforce. Decedents aged 15 were excluded
because they are not represented in CPS workforce population
denominator estimates (18). Decedents with unpaid or military
occupations or industries were also excluded from estimation
of drug overdose death rates by occupation or industry because
population estimates for these groups are not available from
CPS (18). People with unpaid occupations and industries include
National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023 3
homemakers, people with disabilities preventing work, people
who are incarcerated, and students, among others. (13).
Age-standardized drug overdose death rates for the
population aged 16–64 were computed based on age-specific
death rates in each occupation and industry group and the
2000 U.S. standard population as deaths per 100,000 workers
(Technical Notes). Direct age-standardization was performed
using 10-year categories, excluding age 15 (16–24, 25–34,
35–44, 45–54, and 55–64). However, the traditional age groups
of the 2000 U.S. standard population (15–24, 25–34, 35–44,
45–54, and 55–64) were used in applying the age-specific
adjustment weights.
CPS is a population-based survey, and occupation and
industry group-level denominators are estimates of worker
population size (18). Sampling variance data are not available
from CPS for the specific study populations. Parameters from
a proxy series were applied to estimate approximate population
denominator standard errors that account for sampling variance
under the CPS design effect (21). No hypothesis tests were
performed to compare death rates between worker populations
given the large number of comparisons and the uncertainty in
denominator sampling variance estimates. A higher rate within
one worker population compared with another does not indicate a
statistically significant difference. Death rates were not estimated
for occupation and industry groups within demographic and
geographic subpopulations because subpopulation denominator
estimates may be unstable or for individual occupations and
industries because denominator estimates are not available. See
Technical Notes for more information on the estimation of age-
standardized drug overdose death rates and confidence intervals
(CIs).
PMRs
Data were restricted to U.S. resident decedents aged 15–64
in the paid civilian workforce. Decedents with unpaid or military
occupations or industries were excluded (13) to minimize any
healthy worker effect (bias due to differences in underlying health
among workers and nonworkers [13]) in comparative analyses.
Drug overdose PMRs were estimated for each usual
occupation and industry group overall in reference to the
proportion of deaths from drug overdoses in all decedents with
paid civilian usual occupations or industries. PMRs were also
estimated for all individual occupations and industries. PMRs
were internally adjusted to the age distributions of U.S. resident
decedents aged 15–64 who were identified in usual occupations
and industries in the paid civilian workforce (13). Age adjustment
was performed using 10-year age groups (15–24, 25–34, 35–44,
45–54, and 55–64).
Drug overdose mortality was further characterized by
individual census occupation codes within the construction and
extraction occupation group, which experienced particularly
high drug overdose PMRs in 2020. Within the construction and
extraction occupation group, individual census occupation codes
with less than 500 total deaths from all causes were combined
into an “all other construction occupations” category and an
“extraction occupations” category to produce occupation-level
PMRs with reasonable precision.
Drug overdose PMRs were also estimated by occupation and
industry group in decedents of each sex and race and Hispanic-
origin group in stratified analyses, calculated in reference to the
proportion of deaths from drug overdoses in all decedents of
that demographic group with paid civilian usual occupations or
industries. PMRs within each demographic group were internally
adjusted to the separate age distributions of decedents of that
demographic group using the same 10-year age categories as
described previously.
Finally, drug overdose PMRs were estimated by occupation
and industry group for deaths involving each type of drug in
stratified analyses, calculated in reference to the proportion of
deaths from drug overdoses involving that type of drug in all
decedents with paid civilian usual occupations or industries.
Similar analyses were performed by occupation and industry
group and drug overdose intent in stratified analyses, excluding
homicidal overdoses from presentation due to small numbers
across all worker populations. Age adjustment was performed as
described previously for all drug overdose deaths.
PMRs are described in comparison with the total population
for overall estimates or in comparison with the subpopulation
for stratified estimates against a referent PMR value of 100.0
in each population. PMRs are considered elevated if the lower
bound of the 95% CI is over 100.0. No hypothesis tests were
performed to compare PMRs between worker populations, given
the large number of comparisons, and a higher PMR within one
worker population compared with another does not indicate a
statistically significant difference. PMRs based on fewer than 20
deaths were suppressed. National Center for Health Statistics
data presentation standards for proportions were applied to
percentages shown in Tables 1–6 and I–1 through I–10 (22).
See Technical Notes for more information on estimation of
age-adjusted PMRs and CIs.
Race and Hispanic origin were classified according to the
1997 Office of Management and Budget standards (23) and differ
from bridged-race groups used in National Center for Health
Statistics reports before 2018. Groups presented are American
Indian and Alaska Native non-Hispanic (subsequently, American
Indian and Alaska Native), Asian non-Hispanic (subsequently,
Asian), Black non-Hispanic (subsequently, Black), White non-
Hispanic (subsequently, White), and Hispanic. PMRs for each
usual occupation and industry group in Native Hawaiian or Other
Pacific Islander non-Hispanic and multiple-race non-Hispanic
workers are not presented due to small numbers. See Technical
Notes for more information on the classification of race and
Hispanic origin.
Results
Drug overdose death rates by usual occupation
and industry group
Drug overdose death rates varied across usual occupation
groups in 2020 (Figure 1, Table 1). Workers in eight usual
occupation groups, including construction and extraction (162.6
deaths per 100,000 workers, 95% CI: 155.8–169.4); food
4 National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023
Figure 1. Drug overdose death rates among U.S. decedents aged 16–64, by usual occupation group: 46 states and
New York City, 2020
NOTES: The overall drug overdose death rate among 2020 decedents aged 16–64 in 46 states and New York City with paid civilian usual occupations is shown as a vertical line at 42.1
deaths per 100,000 workers. Death rates are directly standardized for age using 10-year age categories. See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
0 20 40 60 80 100 120 140 160 180 200
70.7Transportation and material moving
39.0
Sales and related
27.4
Protective service
53.3
Production
74.0
Personal care and service
22.6
Office and administrative support
18.6
Management
15.9Life, physical, and social science
19.1
Legal
69.9
Installation, maintenance, and repair
37.5
Healthcare support
17.2
Healthcare practitioners and technical
117.9
Food preparation and serving-related
51.3
Farming, fishing, and forestry
5.9
Education, training, and library
162.6
Construction and extraction
9.1
Computer and mathematical
22.6
Community and social services
10.9
Business and financial operations
70.0
Building and grounds cleaning and maintenance
45.7
Arts, design, entertainment, sports, and media
16.8
Architecture and engineering
Drug overdose death rate per 100,000 workers
National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023 5
preparation and serving-related (117.9, 110.8–125.0); personal
care and service (74.0, 68.7–79.4); transportation and material
moving (70.7, 67.9–73.6); building and grounds cleaning and
maintenance (70.0, 65.7–74.3); installation, maintenance, and
repair (69.9, 65.6–74.1); production (53.3, 50.6–56.1); and
farming, fishing, and forestry (51.3, 44.4–58.2) experienced
age-standardized drug overdose death rates with larger absolute
values and CIs compared with the drug overdose death rate
among workers in all occupations combined (42.1, 41.6–42.6).
Drug overdose death rates also differed by usual industry
group in 2020 (Figure 2, Table 2). Workers in seven usual
industry groups, including construction (130.9 deaths per
100,000 workers, 95% CI: 126.0–135.8); accommodation and
food services (99.6, 94.8–104.4); other services (except public
administration) (64.6, 61.3–68.0); management, administrative,
and waste services (61.1, 57.7–64.5); mining (60.9, 51.7–70.1);
arts, entertainment, and recreation (56.9, 52.0–61.7); and
transportation and warehousing (52.0, 49.2–54.7) experienced
Figure 2. Drug overdose death rates among U.S. decedents aged 16–64, by usual industry group: 46 states and
New York City, 2020
NOTES: The overall drug overdose death rate among 2020 decedents aged 16–64 in 46 states and New York City with paid civilian usual industries is shown as a vertical line at 41.3 deaths
per 100,000 workers. Death rates are directly standardized for age using 10-year age categories. National Health Interview Survey administrative, support, and waste services and
management of companies and enterprises industry groups are combined to align with the Current Population Survey's management, administrative, and waste services industry category.
See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
19.2
28.9
52.0
38.9
24.1
12.8
16.0
64.6
60.9
39.7
61.1
27.5
26.3
12.9
6.0
130.9
56.9
39.9
99.6
0 30 60 90 120 150
Wholesale trade
Utilities
Transportation and warehousing
Retail trade
Real estate, rental, and leasing
Public administration
Professional, scientific, and technical services
Other services (except public administration)
Mining
Manufacturing
Management, administrative, and waste services
Information
Healthcare and social a
ssistance
Finance and insurance
Education services
Construction
Arts, entertainment, and recreation
Agriculture, forestry, fishing, and hunting
Accommodation and food services
Drug overdose death rate per 100,000 workers
6 National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023
age-standardized drug overdose death rates with larger absolute
values and CIs compared with the drug overdose death rate
among workers in all industries combined (41.3, 40.8–41.8).
Drug overdose PMRs by usual occupation and
industry
Drug overdose PMRs—the proportion of deaths from drug
overdoses within each group compared with the proportion of
deaths from drug overdoses among all workers—varied across
usual occupation groups in 2020 (Figure 3, Table 3). Decedents
in five usual occupation groups, including construction and
extraction (145.4, 95% CI: 143.6–147.1); food preparation and
serving-related (130.4, 128.1–132.8); building and grounds
cleaning and maintenance (108.3, 105.3–111.4); personal care
and service (108.1, 104.5–111.7); and installation, maintenance,
and repair (106.0, 102.9–109.1) experienced PMRs with
the lower bound of the 95% CI over 100.0 (the PMR among
decedents in all occupations combined).
Drug overdose PMRs also differed by usual industry
group and showed similar patterns as those observed within
occupation groups in 2020 (Figure 4, Table 4). Decedents in
four usual industry groups, including construction (144.9, 95%
CI: 143.2–146.5); accommodation and food services (123.9,
121.8–125.9); administrative, support, and waste services
(111.2, 108.2–114.2); and other services (except public
administration) (107.9, 105.1–110.6) experienced PMRs with
the lower bound of the 95% CI over 100.0.
Individual census occupations and industries showed
variation in drug overdose PMRs. Among individual
occupations, the highest PMR was observed among decedents
who worked as fishers and related fishing workers (193.1,
95% CI: 166.8–222.4), followed by sailors and marine oilers
(179.3, 138.3–228.5); roofers (177.4, 163.6–192.0); forest
and conservation workers (177.1, 114.6–261.4); and drywall
installers, ceiling tile installers, and tapers (175.1, 149.0–204.4)
(Figure 5, Table I–1). Among individual industries, the highest
PMR was observed in decedents who worked in fishing,
hunting, and trapping (186.5, 161.7–214.1), followed by water
transportation (157.4, 126.3–194.0), barber shops (150.8,
130.7–173.1), and construction (144.9, 143.2–146.5) industries
(Figure 6, Table I–2).
Drug overdose PMRs within construction and
extraction occupations
Decedents in the construction and extraction occupation
group and the construction industry group experienced elevated
group-level drug overdose PMRs, as discussed previously
(Figures 3 and 4), and 5 of the 10 individual occupations with
the highest drug overdose PMRs are in the construction and
extraction occupation group (Figure 5, Table I–1). Construction
and extraction occupations encompass a wide range of job
duties and working environments; PMRs are presented for
the component census occupations to show occupation-level
variation in drug overdose PMRs within this group. The
construction industry group includes a single industry (census
industry code 0770), so more detailed estimates cannot be
presented by industry.
Among construction and extraction occupations, the
highest PMRs were observed among decedents who worked
as roofers (177.4, 95% CI: 163.6–192.0); drywall installers,
ceiling tile installers, and tapers (175.1, 149.0–204.4);
painters, construction, and maintenance (162.1, 150.9–174.0);
brickmasons, blockmasons, and stonemasons (159.5,
141.4–179.2); and structural iron and steel workers (159.5,
132.4–190.4) (Figure 7, Table 5).
Decedents in construction and extraction occupations
were nearly all male (98.3%) and often were identified as White
(66.9%) (Table 6). Compared with all deaths in decedents in
construction and extraction occupations, deaths from drug
overdoses within this population tended to occur more often in
decedents who resided in the Midwest (20.5% compared with
18.9%) and Northeast (21.3% compared with 15.6%), were
White (75.1% compared with 66.9%) and aged 25–34 (23.9%
compared with 9.7%) and 35–44 (29.7% compared with 14.4%).
Drug overdose PMRs by usual occupation and
industry group and sex
Most occupation and industry groups showed similar
patterns in drug overdose death frequencies (Tables I–3 and
I–4) and PMRs among decedents of each sex, although slight
differences were observed between male and female decedents.
The highest PMRs in male decedents were observed in those
in construction and extraction occupations (137.7, 95% CI:
136.0–139.3) (Table 7) and in construction industries (138.1,
136.5–139.6) (Table 8). The highest PMRs in female decedents
were seen in those in construction and extraction (153.8,
132.3–177.7) and food preparation and serving-related (153.4,
149.4–157.5) (Table 7) occupations and in accommodation and
food services (145.6, 142.1–149.0) industries (Table 8).
Drug overdose PMRs by usual occupation and
industry group and race and Hispanic origin
Decedents in construction and extraction occupations and
construction industries experienced among the highest drug
overdose death frequencies (Tables I–5 and I–6) and PMRs in
all race and Hispanic-origin groups. The highest drug overdose
PMRs among Asian, Black, and White decedents were observed
in those in construction and extraction occupations (208.4, 95%
CI: 151.4–279.8; 154.0, 147.6–160.3; and 143.2, 141.2–145.1,
respectively) (Table 9) and in construction industries (195.1,
144.3–257.9; 160.4, 154.2–166.6; and 141.2, 139.4–143.0,
respectively) (Table 10). The highest drug overdose PMRs
among Hispanic decedents were observed in those in personal
care and service occupations (122.2, 108.6–137.1) and in arts,
entertainment, and recreation industries (124.0, 105.9–144.2).
The highest drug overdose PMRs among American Indian
and Alaska Native decedents were seen in those in farming,
fishing, and forestry occupations (129.1, 78.8–199.4) and in
manufacturing industries (123.9, 90.0–166.3).
National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023 7
Figure 3. Drug overdose proportionate mortality ratios among U.S. decedents aged 15–64, by usual occupation
group: 46 states and New York City, 2020
NOTES: Overall relative mortality from drug overdoses among 2020 decedents aged 15–64 in 46 states and New York City with paid civilian usual occupations is shown as a vertical line at
proportionate mortality ratio equal to 100. Proportionate mortality ratio 95% confidence intervals were estimated using separate formulas for populations with 1,000 or fewer and over 1,000
total observed deaths from drug overdoses. Proportionate mortality ratios are internally adjusted for age using 10-year age categories. See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
99.3
Transportation and material moving
98.2
Sales and related
52.6
Protective service
90.7
Production
108.1
Personal care and service
75.1
Office and administrative support
71.0
Management
75.3
Life, physical, and social science
85.9
Legal
106.0
Installation, maintenance, and repair
96.3
Healthcare support
84.8
Healthcare practitioners and technical
130.4
Food preparation and serving-related
82.7
Farming, fishing, and forestry
42.2
Education, training, and library
145.4
Construction and extraction
60.0
Computer and mathematical
79.5
Community and social services
66.6
Business and financial operations
108.3
Building and grounds cleaning and maintenance
97.0
Arts, design, entertainment, sports, and media
65.3Architecture and engineering
Drug overdose proportionate mortality ratio
0 30 60 90 120 150
8 National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023
Drug overdose deaths by usual occupation and
industry group and drug type
Deaths from drug overdoses involving specific drug type(s)
showed some variation across usual occupation (Table I–7)
and industry (Table I–8) groups. Synthetic opioids other than
methadone (including fentanyl, fentanyl analogs, and tramadol)
were involved in 64.0% of deaths from drug overdoses in
decedents with paid civilian usual occupations and industries.
This drug class comprised the largest proportion of drug overdose
deaths within every occupation and industry group. Decedents in
construction and extraction occupations experienced the highest
PMRs from drug overdoses involving psychostimulants with
abuse potential (169.7, 95% CI: 165.9–173.4), heroin (166.4,
161.4–171.3), synthetic opioids other than methadone (151.5,
149.2–153.7), and methadone (141.3, 128.0–155.5) (Table 11).
Decedents in food preparation and serving-related occupations
experienced the highest PMR from drug overdoses involving
Figure 4. Drug overdose proportionate mortality ratios among U.S. decedents aged 15–64, by usual industry group:
46 states and New York City, 2020
NOTES: Overall relative mortality from drug overdoses among 2020 decedents aged 15–64 in 46 states and New York City with paid civilian usual industries is shown as a vertical line at
proportionate mortality ratio equal to 100. Proportionate mortality ratio 95% confidence intervals were estimated using separate formulas for populations with 1,000 or fewer and over 1,000
total observed deaths from drug overdoses. Proportionate mortality ratios are internally adjusted for age using 10-year age categories. See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
87.6
82.0
86.3
92.0
94.8
50.7
75.9
107.9
88.7
87.7
56.3
85.1
86.0
70.6
42.2
144.9
103.3
70.8
111.2
123.9
0
30 60 90 120 150
Wholesale trade
Utilities
Transportation and warehousing
Retail trade
Real estate, rental, and leasing
Public administration
Professional, scientific, and technical services
Other services (except public administration)
Mining
Manufacturing
Management of companies and enterprises
Information
Healthcare and social
assistance
Finance and insurance
Education services
Construction
Arts, entertainment, and recreation
Agriculture, forestry, fishing, and hunting
Administrative, support, and waste services
Accommodation and food services
Drug overdose proportionate mortality ratio
National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023 9
Figure 5. Ten individual census occupations with the highest drug overdose proportionate mortality ratios among
U.S. decedents aged 15–64: 46 states and New York City, 2020
NOTES: Overall relative mortality from drug overdoses among 2020 decedents aged 15–64 in 46 states and New York City with paid civilian usual occupations is shown as a vertical line at
proportionate mortality ratio equal to 100. Proportionate mortality ratio 95% confidence intervals were estimated using separate formulas for populations with 1,000 or fewer and over 1,000
total observed deaths from drug overdoses. Proportionate mortality ratios are internally adjusted for age using 10-year age categories. Proportionate mortality ratios based on fewer than
20 drug overdose deaths across all age groups are suppressed and are not included in this ranking. Proportionate mortality ratios with 95% confidence intervals for the 20 census
occupations with the highest drug overdose proportionate mortality ratios are available in Table 3. See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
159.5
159.5
159.9
162.1
168.4
175.1
177.1
177.4
179.3
193.1
0 50 100 150 200 250 300
Structural iron and steel workers
Brickmasons, blockmasons, and
stonemasons
Helpers―installation, maintenance,
and repair workers
Painters, construction, and
maintenance
Waiters and waitresses
Drywall installers, ceiling tile
installers, and tapers
Forest and conservation workers
Roofers
Sailors and marine oilers
Fishers and related fishing workers
Drug overdose proportionate mortality ratio
cocaine (144.6, 138.9–150.3), and decedents in healthcare
practitioner and technical occupations experienced the highest
PMR from drug overdoses involving natural and semisynthetic
opioids (139.3, 126.1–153.6). When evaluated by industry,
decedents in construction industries experienced the highest
PMRs from drug overdoses involving each drug type (Table 12).
Drug overdose deaths by usual occupation and
industry group and drug overdose intent
Drug overdose intent also differed across usual occupation
(Table I–9) and industry (Table I–10) groups. Most deaths from
drug overdoses across all occupation groups were attributed
to unintentional overdoses (91.8%), followed by overdoses
of undetermined (4.2%) and suicidal (3.8%) intent. A similar
distribution of drug overdose intents was observed among
10 National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023
deaths from drug overdoses across all industry groups. The
largest proportions of drug overdose deaths attributed to
suicidal intent were seen in decedents in education, training, and
library occupations (18.1%) and education services industries
(14.1%). Decedents in construction and extraction occupations
experienced the highest PMRs from overdoses of undetermined
intent (148.9, 136.6–162.0) and unintentional drug overdoses
(148.4, 146.6–150.3) (Table 13). Decedents with healthcare
practitioner and technical occupations experienced the highest
PMR from overdoses with suicidal intent (248.6, 215.0–286.1).
When evaluated by industry, decedents in construction industries
experienced the highest PMRs from overdoses of undetermined
intent (151.1, 139.2–163.7) and unintentional drug overdoses
(147.7, 146.0–149.5), while decedents in professional, scientific,
and technical services industries had the highest PMR from
overdoses with suicidal intent (183.5, 157.4–212.6) (Table 14).
Figure 6. Ten individual census industries with the highest drug overdose proportionate mortality ratios among U.S.
decedents aged 15–64: 46 states and New York City, 2020
NOTES: Overall relative mortality from drug overdoses among 2020 decedents aged 15–64 in 46 states and New York City with paid civilian usual industries is shown as a vertical line at
proportionate mortality ratio equal to 100. Proportionate mortality ratio 95% confidence intervals were estimated using separate formulas for populations with 1,000 or fewer and over 1,000
total observed deaths from drug overdoses. Proportionate mortality ratios are internally adjusted for age using 10-year age categories. PMRs based on fewer than 20 drug overdose deaths
across all age groups are suppressed and are not included in this ranking. Proportionate mortality ratios with 95% confidence intervals for the 20 census industries with the highest drug
overdose proportionate mortality ratios are available in Table 4. See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
0 50 100 150 200 250
Drug overdose proportionate mortality ratio
Employment services
Nail salons and other personal care services
Coal mining
Electronic and precision equipment repair
and maintenance
Landscaping services
Labor unions
Construction
Barber shops
Water transportation
Fishing, hunting, and trapping
127.1
131.4
131.7
135.1
136.7
140.8
144.9
150.8
157.4
186.5
National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023 11
Discussion
Deaths from drug overdoses differentially impact some
worker groups in the United States. Death rates and PMRs from
drug overdoses in 2020 varied across usual occupation and
industry groups, and PMRs varied across individual occupations
and industries. PMRs for drug overdoses involving each type of
drug and drug overdose intent also differed by usual occupation
and industry group. Patterns in drug overdose deaths in 2020
were similar to those observed in previous analyses of drug
overdose mortality from 2007 through 2012 by occupation
(5) but reflect the increasing availability of and mortality from
synthetic opioids other than methadone—a category that
includes fentanyl and fentanyl analogs more importantly, but
also, less significantly, tramadol and others—in the intervening
period (1).
Differences in drug overdose deaths across occupations
and industries are hypothesized to result from two intersecting
Figure 7. Drug overdose proportionate mortality ratios for construction and extraction usual occupations among U.S.
decedents aged 15–64: 46 states and New York City, 2020
NOTES: Overall relative mortality from drug overdoses among 2020 decedents aged 15–64 in 46 states and New York City with paid civilian usual occupations is shown as a vertical line at
proportionate mortality ratio equal to 100. Proportionate mortality ratio 95% confidence intervals were estimated using separate formulas for populations with 1,000 or fewer and over 1,000
total observed deaths from drug overdoses. Proportionate mortality ratios are internally adjusted for age using 10-year age categories. All other construction occupations include all census
occupation codes 6200–6765 with fewer than 500 total deaths in 2020, and extraction occupations include all census occupation codes 6800–6940. Proportionate mortality ratios with
95% confidence intervals are available in Table 5. See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
97.2
134.5
102.5
107.3
125.2
135.7
138.5
147.6
148.0
155.5
157.0
158.6
159.5
159.5
162.1
175.1
177.4
0 50 100 150
200
250
Extraction occupations
All other construction occupations
Highway maintenance workers
Operating engineers and other
construction equipment operators
First-line supervisors of construction
trades and extraction workers
Electricians
Pipelayers, plumbers, pipefitters,
and steamfitters
Carpet, floor, and tile installers
an
d finishers
Construction laborers
Sheet metal workers
Cement masons, concrete finishers,
and terrazzo workers
Carpenters
Structural iron and steel workers
Brickmasons, blockmasons, and
stonemasons
Painters, construction, and maintenance
Drywall installers, ceiling tile
installers, and tapers
Roofers
Drug overdose proportionate mortality ratio
12 National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023
pathways: physical pain due to acute injury or cumulative
physical trauma at work and work-related psychosocial stress
(8). Physical work tasks, repetitive motions, ergonomic
stress, other physical workplace exposures, and precarious
employment are common risk factors for injury at work (24).
Work-related injuries are frequently treated with prescription
pain medication, including prescription opioids, and increasing
opioid doses prescribed for work-related injuries are associated
with higher incidence of death in workers’ compensation data
(25). Job insecurity and lack of paid sick leave have been shown
to increase the likelihood that an injured worker returns to
work prematurely or works through an injury due to financial
pressures, potentially increasing the likelihood of prescription
medication misuse and nonprescription substance use to
manage pain (26). Work-related psychosocial stressors are also
associated with increased prevalence of mental health conditions
that may worsen substance use disorders (8) and contribute to
deaths from drug overdoses.
Workers in construction and extraction occupations and
the construction industry experienced elevated drug overdose
death rates and PMRs in 2020. Construction and extraction
workers are more likely to report recent drug use than workers
in many other occupations and industries (27,28) and have
been repeatedly found to experience high mortality from drug
overdoses (5–7,26,29). Drug overdose mortality in these
workers has been partially attributed to work-related injuries and
subsequent pain management practices (30). Workers in these
occupations and industries may be required to work at heights;
climb ladders, scaffolds, or poles; make repetitive motions; and
work in awkward postures (31), increasing risk of both acute
and chronic work-related injuries (32). Construction workers
who have experienced work-related injuries are nearly four times
more likely than uninjured workers to use prescription opioids
(30), and workers in construction and mining industries are
more likely to be prescribed opioids after a work-related injury
than workers in other industries (33). Many workers in individual
occupations and industries with elevated PMRs share elements
of risk profiles with these worker groups. For example, fishers
and related fishing workers, sailors and marine oilers, and forest
and conservation workers may carry out similarly physical job
tasks (31).
Although decedents in construction and extraction
occupations and construction industries experienced some of
the highest drug overdose PMRs in all race and Hispanic-origin
groups, the highest PMRs in Hispanic and American Indian and
Alaska Native decedents were observed in other occupation and
industry groups. Hispanic construction workers are less likely
to use prescription opioid and nonopioid analgesics (measured
by filled outpatient prescriptions) than White construction
workers (30). Hispanic construction workers are more likely to
be uninsured than non-Hispanic construction workers, impairing
health care and prescription access in this population (34).
Overrepresentation of some demographic groups in selected
occupations and industries may also contribute to observed
differences in drug overdose PMR patterns across race and
Hispanic-origin groups.
Workers in food preparation and serving-related
occupations and accommodation and food services industries
also experienced elevated drug overdose death rates and PMRs
in group-level analyses, including PMR analyses stratified by sex
and race and Hispanic origin. Many workers in these occupations
and industries spend much of their workday standing,
walking, running, and making repetitive motions (31) that may
contribute to work-related injuries (32). Job instability, lack of
paid sick leave, and lack of health insurance are also common
(8,27). Work-related stress, particularly among workers who
interact with customers, and comparatively relaxed workplace
norms around substance use that have been shown in some
accommodation and food services workplaces are associated
with heightened prevalence of substance use (35,36). Workers in
accommodation and food services industries report the highest
rates of both illegal drug use and substance use disorders among
all workers (28).
Most occupation and industry groups with elevated drug
overdose death rates compared with all occupations and
industries combined also displayed elevated drug overdose
PMRs. However, some worker groups showed differences in
effect direction or magnitude across the two measures, likely
due to differences in baseline mortality that impact PMRs.
One exception occurred among workers in farming, fishing,
and forestry occupations, who experienced an elevated drug
overdose death rate but had a drug overdose PMR below the
PMR among decedents in all occupations combined. High drug
overdose death rates and comparatively lower drug overdose
PMRs may reflect high mortality from other causes in these
worker populations, reducing the proportions of deaths from
drug overdose. These results are consistent with the nature of
PMRs, which vary according to the distribution of causes of
deaths within a given population and provide insight only into
differences in the proportion of deaths from the cause of interest,
rather than absolute risk (19).
Rates of drug overdose deaths involving synthetic opioids
other than methadone have increased each year since 2013
(1). This drug class was involved in nearly two-thirds of drug
overdose deaths in working-age decedents with paid civilian
usual occupations and industries in 2020, comprising the largest
proportion of drug overdose deaths within every occupation and
industry group. In contrast, from 2007 through 2012, overdose
deaths involving synthetic opioids other than methadone
comprised only 6.9% of all deaths from drug overdoses identified
in occupational mortality surveillance (5). Synthetic opioids
other than methadone such as fentanyl and fentanyl analogs
may be mixed into other drug supplies or pressed and sold as
counterfeit prescription pills. This contributes to drug overdose
deaths involving synthetic opioids other than methadone across
all populations (37,38).
The broad occupation and industry groups primarily
assessed in this report contain diverse ranges of individual
occupations, industries, and workforces. For example,
decedents in the farming, fishing, and forestry occupation group
experienced a drug overdose PMR below 100. However, fishers
and related fishing workers and forest and conservation workers
experienced elevated drug overdose PMRs when assessed
National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023 13
as individual occupations relative to all drug overdose deaths.
Similarly, decedents in the transportation and warehousing
industry group experienced a drug overdose PMR below 100,
while decedents in water transportation industries experienced
an elevated drug overdose PMR when assessed as an individual
industry. Further variation within each individual occupation and
industry is likely.
Overall death rates and PMRs were standardized or adjusted
for age but were not adjusted for other factors that may impact
the likelihood of death from drug overdose because this report
aims to describe drug overdose mortality across worker
populations, rather than infer causal relationships between
work and drug overdose mortality. Stratified analyses highlight
variations in drug overdose PMRs within each sex and race and
Hispanic-origin group by occupation and industry group. PMRs
measure relative cause-specific mortality. If decedents within
some demographic populations experience heightened death
rates from competing causes of death, including COVID-19, and
are overrepresented within specific occupations or industries,
drug overdose PMRs within these worker populations may
be correspondingly suppressed. A higher PMR within one
population compared with another does not indicate greater
risk of drug overdose mortality, nor many deaths from drug
overdoses, because PMR is estimated relative to the number
and distribution of all deaths within a given population (19).
These results may not be representative of drug overdose deaths
in other years, given large numbers of deaths in some worker
populations due to COVID-19 in 2020 (12). Drug overdose death
rates and PMRs as estimated here combine the prevalence of
drug use, likelihood of drug overdose, and likelihood of fatal
drug overdose, each of which may vary across occupation and
industry groups. Low numbers of deaths also produced wide
CIs for some populations. Additionally, individual characteristics
not captured on death certificates may vary differentially across
occupations and industries and influence observed deaths from
drug overdoses. Such characteristics include personal and
employer use of injury prevention strategies, socioeconomic
status, and substance use disorder treatment accessibility.
Usual occupation and industry were only available for
decedents in 46 states and New York City, and estimates are only
representative of those jurisdictions. Death certificates record
usual occupation and industry, rather than current occupation
and industry (13). This report restricted drug overdose analyses
to working-age decedents to minimize this limitation (15).
However, many decedents aged 65 and over may have been
working at the time of overdose or initiation of substance
use or abuse, and many decedents aged 15–64 may not have
been working or may have been working in other occupations
and industries, particularly because of unprecedented shifts in
employment during COVID-19-related shutdowns (39). Death
rate and PMR estimates may be biased due to differential
misclassification for occupations and industries with large
employment changes in spring 2020. Death rates and PMRs
as estimated here are not causal measures and effect estimates
should be interpreted as hypothesis-generating only, given the
large number of comparisons and lack of hypothesis testing
performed in this report.
The variation observed in drug overdose death rates and
PMRs by usual occupation and industry during 2020 highlights
the uneven burden of drug overdose deaths on subsets of the
U.S. workforce as a significant health equity issue. Findings in this
report may inform the strategic priority to monitor, analyze, and
communicate trends in drug overdoses within the framework for
preventing overdoses and substance use-related harms (40,41).
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16 National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023
List of Detailed Tables
1. Drug overdose death rates among U.S. residents aged
16–64, by usual occupation group: 46 states and
New York City, 2020 ............................... 17
2. Drug overdose death rates among U.S. residents aged
16–64, by usual industry group: 46 states and
New York City, 2020 .............................. 17
3. Drug overdose proportionate mortality ratios among
U.S. decedents aged 15–64, by usual occupation group:
46 states and New York City, 2020 .................... 18
4. Drug overdose proportionate mortality ratios among U.S.
decedents aged 15–64, by usual industry group: 46 states
and New York City, 2020 ........................... 19
5. Drug overdose proportionate mortality ratios among
U.S. decedents aged 15–64, by usual occupation in the
construction and extraction occupation group: 46 states
and New York City, 2020
........................... 19
6. Demographic characteristics of decedents with all paid
civilian usual occupations and construction and extraction
occupations among U.S. decedents aged 15–64: 46 states
and New York City, 2020
........................... 20
7. Drug overdose proportionate mortality ratios among U.S.
decedents aged 15–64, by sex and usual occupation group:
46 states and New York City, 2020 .................... 21
8. Drug overdose proportionate mortality ratios among U.S.
decedents aged 15–64, by sex and usual industry group:
46 states and New York City, 2020 .................... 22
9. Drug overdose proportionate mortality ratios among U.S.
decedents aged 15–64, by race and Hispanic origin and
usual occupation group: 46 states and New York City,
2020. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
10. Drug overdose proportionate mortality ratios in U.S.
decedents aged 15–64, by race and Hispanic origin
and usual industry group: 46 states and New York City,
2020. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
11. Drug overdose proportionate mortality ratios among
U.S. decedents aged 15–64 for deaths involving specific
types of drugs, by usual occupation group: 46 states and
New York City, 2020
............................... 25
12. Drug overdose proportionate mortality ratios among
U.S. decedents aged 15–64 for deaths involving specific
types of drugs, by usual industry group: 46 states and
New York City, 2020
............................... 26
13. Drug overdose proportionate mortality ratios among U.S.
decedents aged 15–64, by overdose intent and usual
occupation group: 46 states and New York City, 2020 ..... 27
14. Drug overdose proportionate mortality ratios among U.S.
decedents aged 15–64, by overdose intent and usual
industry group: 46 states and New York City, 2020 ....... 28
List of Internet Tables
(Available from: https://www.cdc.gov/nchs/data/nvsr/nvsr72/
nvsr72-07-tables.pdf.)
I–1. Drug overdose proportionate mortality ratios among U.S.
decedents aged 15–64 among census occupation groups with
20 or more deaths from drug overdoses: 46 states and
New York City, 2020
I–2. Drug overdose proportionate mortality ratios among U.S.
decedents aged 15–64 among census industry groups with 20
or more deaths from drug overdoses: 46 states and
New York City, 2020
I–3. Drug overdose deaths in U.S. decedents aged 15–64, by sex and
usual occupation group: 46 states and New York City, 2020
I–4. Drug overdose deaths in U.S. decedents aged 15–64, by sex and
usual industry group: 46 states and New York City, 2020
I–5. Drug overdose deaths in U.S. decedents aged 15–64, by race
and Hispanic origin and usual occupation group: 46 states and
New York City, 2020
I–6. Drug overdose deaths in U.S. decedents aged 15–64, by race
and Hispanic origin and usual industry group: 46 states and
New York City, 2020
I–7. Drug overdose deaths in U.S. decedents aged 15–64, by type of
drug involved and usual occupation group: 46 states and
New York City, 2020
I–8. Drug overdose deaths in U.S. decedents aged 15–64, by type of
drug involved and usual industry group: 46 states and
New York City, 2020
I–9. Drug overdose deaths in U.S. decedents aged 15–64, by
overdose intent and usual occupation group: 46 states and
New York City, 2020
I–10. Drug overdose deaths in U.S. decedents aged 15–64, by
overdose intent and usual industry group: 46 states and
New York City, 2020
National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023 17
Table 1. Drug overdose death rates among U.S. residents aged 16–64, by usual occupation group: 46 states and New York City,
2020
Usual occupation group
Number of drug
overdose deaths (percent)
Age-standardized drug overdose
death rate per 100,000 workers
(95% confidence interval)
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60,123 (100.0) 42.1 (41.6–42.6)
Architecture and engineering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503 (0.8) 16.8 (14.8–18.8)
Arts, design, entertainment, sports, and media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,370 (2.3) 45.7 (41.9–49.5)
Building and grounds cleaning and maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,387 (5.6) 70.0 (65.7–74.3)
Business and financial operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 900 (1.5) 10.9 (10.0–11.8)
Community and social services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 563 (0.9) 22.6 (20.0–25.2)
Computer and mathematical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 519 (0.9) 9.1 (8.1–10.1)
Construction and extraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,660 (21.1) 162.6 (155.8–169.4)
Education, training, and library . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 547 (0.9) 5.9 (5.4–6.5)
Farming, fishing, and forestry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 542 (0.9) 51.3 (44.4–58.2)
Food preparation and serving-related . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,459 (10.7) 117.9 (110.8–125.0)
Healthcare practitioners and technical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,637 (2.7) 17.2 (16.1–18.3)
Healthcare support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,674 (2.8) 37.5 (34.8–40.1)
Installation, maintenance, and repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,314 (5.5) 69.9 (65.6–74.1)
Legal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271 (0.5) 19.1 (14.5–23.8)
Life, physical, and social science . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244 (0.4) 15.9 (13.4–18.4)
Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,922 (4.9) 18.6 (17.5–19.8)
Office and administrative support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,277 (5.5) 22.6 (21.5–23.6)
Personal care and service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,479 (4.1) 74.0 (68.7–79.4)
Production . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,843 (6.4) 53.3 (50.6–56.1)
Protective service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 755 (1.3) 27.4 (24.6–30.2)
Sales and related . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,902 (8.2) 39.0 (37.4–40.7)
Transportation and material moving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,355 (12.2) 70.7 (67.9–73.6)
NOTES: Death rates are directly standardized for age using 10-year age categories. Occupation group drug overdose death rates are estimated among workers aged 16–64 in 46 states and
New York City with paid civilian usual occupations. See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
Table 2. Drug overdose death rates among U.S. residents aged 16–64, by usual industry group: 46 states and New York City,
2020
Usual industry group
Number of drug
overdose deaths (percent)
Age-standardized drug overdose
death rate per 100,000 workers
(95% confidence interval)
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58,917 (100.0) 41.3 (40.8–41.8)
Accommodation and food services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,846 (13.3) 99.6 (94.8–104.4)
Agriculture, forestry, fishing, and hunting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 787 (1.3) 39.9 (35.7–44.1)
Arts, entertainment, and recreation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,547 (2.6) 56.9 (52.0–61.7)
Construction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13,645 (23.2) 130.9 (126.0–135.8)
Education services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 841 (1.4) 6.0 (5.5–6.5)
Finance and insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 948 (1.6) 12.9 (11.9–13.9)
Healthcare and social assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,168 (8.8) 26.3 (25.3–27.3)
Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 739 (1.3) 27.5 (24.7–30.3)
Management, administrative, and waste services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,667 (6.2) 61.1 (57.7–64.5)
Manufacturing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,486 (9.3) 39.7 (38.0–41.3)
Mining . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494 (0.8) 60.9 (51.7–70.1)
Other services (except public administration) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,243 (7.2) 64.6 (61.3–68.0)
Professional, scientific, and technical services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,855 (3.1) 16.0 (15.0–17.0)
Public administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 956 (1.6) 12.8 (11.7–14.0)
Real estate, rental, and leasing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 626 (1.1) 24.1 (21.3–26.9)
Retail trade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,432 (9.2) 38.9 (37.4–40.5)
Transportation and warehousing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,682 (6.2) 52.0 (49.2–54.7)
Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383 (0.7) 28.9 (24.6–33.2)
Wholesale trade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 572 (1.0) 19.2 (16.9–21.4)
NOTES: Death rates are directly standardized for age using 10-year age categories. Industry group drug overdose death rates are estimated among workers aged 16–64 in 46 states and
New York City with paid civilian usual industries. National Health Interview Survey administrative, support, and waste services and management of companies and enterprises industries are
combined to align with the Current Population Survey’s management, administrative, and waste services industry category. See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
18 National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023
Table 3. Drug overdose proportionate mortality ratios among U.S. decedents aged 15–64, by usual occupation group: 46 states
and New York City, 2020
Usual occupation group Total deaths
Drug overdose deaths
N (percent)
Age-adjusted drug overdose
proportionate mortality ratio
(95% confidence interval)
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605,947 60,126 (9.9) 100.0 …
Architecture and engineering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,732 503 (5.2) 65.3 (59.7–71.2)
Arts, design, entertainment, sports, and media . . . . . . . . . . . . . . . . . . . . . 12,402 1,370 (11.0) 97.0 (92.4–101.6)
Building and grounds cleaning and maintenance . . . . . . . . . . . . . . . . . . . . 32,051 3,388 (10.6) 108.3 (105.3–111.4)
Business and financial operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,208 900 (5.9) 66.6 (62.3–71.1)
Community and social services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,152 563 (6.9) 79.5 (73.1–86.4)
Computer and mathematical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,816 519 (5.9) 60.0 (54.9–65.3)
Construction and extraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81,546 12,660 (15.5) 145.4 (143.6–147.1)
Education, training, and library . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,259 547 (3.6) 42.2 (38.7–45.8)
Farming, fishing, and forestry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,554 542 (8.3) 82.7 (75.9–89.9)
Food preparation and serving-related . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37,954 6,461 (17.0) 130.4 (128.1–132.8)
Healthcare practitioners and technical . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22,710 1,637 (7.2) 84.8 (80.8–88.8)
Healthcare support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,166 1,674 (9.8) 96.3 (92.1–100.5)
Installation, maintenance, and repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32,763 3,314 (10.1) 106.0 (102.9–109.1)
Legal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,687 271 (7.4) 85.9 (76.0–96.7)
Life, physical, and social science . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,337 244 (7.3) 75.3 (66.1–85.3)
Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47,822 2,922 (6.1) 71.0 (68.3–73.7)
Office and administrative support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46,362 3,277 (7.1) 75.1 (72.5–77.7)
Personal care and service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21,208 2,479 (11.7) 108.1 (104.5–111.7)
Production . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47,066 3,843 (8.2) 90.7 (88.1–93.3)
Protective service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,121 755 (5.0) 52.6 (48.9–56.4)
Sales and related . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47,605 4,902 (10.3) 98.2 (95.8–100.6)
Transportation and material moving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73,426 7,355 (10.0) 99.3 (97.4–101.3)
… Category not applicable.
NOTES: Proportionate mortality ratios are internally adjusted to the age distribution of all U.S. resident decedents aged 15–64 with paid civilian usual occupations using 10-year age
categories. Proportionate mortality ratio 95% confidence intervals are estimated using separate formulas for populations with 1,000 or fewer and over 1,000 total observed deaths from drug
overdoses. See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023 19
Table 5. Drug overdose proportionate mortality ratios among U.S. decedents aged 15–64, by usual occupation in the construction
and extraction occupation group: 46 states and New York City, 2020
Usual occupation Total deaths
Drug overdose deaths
N (percent)
Age-adjusted drug overdose
proportionate mortality ratio
(95% confidence interval)
All construction and extraction occupations . . . . . . . . . . . . . . . . . . . . . . . . . 81,546 12,660 (15.5) 145.4 (143.6–147.1)
Roofers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,977 609 (20.5) 177.4 (163.6–192.0)
Drywall installers, ceiling tile installers, and tapers . . . . . . . . . . . . . . . . . . 983 160 (16.3) 175.1 (149.0–204.4)
Painters, construction, and maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . 4,990 768 (15.4) 162.1 (150.9–174.0)
Brickmasons, blockmasons, and stonemasons . . . . . . . . . . . . . . . . . . . . . 1,979 283 (14.3) 159.5 (141.4–179.2)
Structural iron and steel workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 748 122 (16.3) 159.5 (132.4–190.4)
Carpenters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,003 1,821 (15.2) 158.6 (154.7–162.4)
Cement masons, concrete finishers, and terrazzo workers . . . . . . . . . . . . . 703 107 (15.2) 157.0 (128.6–189.7)
Sheet metal workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 793 121 (15.3) 155.5 (129.0–185.8)
Construction laborers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28,898 5,205 (18.0) 148.0 (146.1–149.8)
Carpet, floor, and tile installers and finishers . . . . . . . . . . . . . . . . . . . . . . . 1,449 232 (16.0) 147.6 (129.2–167.9)
Pipelayers, plumbers, pipefitters, and steamfitters . . . . . . . . . . . . . . . . . . . 4,439 637 (14.4) 138.5 (128.0–149.7)
Electricians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,074 860 (14.2) 135.7 (126.8–145.1)
First-line supervisors of construction trades and extraction workers . . . . . 6,493 747 (11.5) 125.2 (116.3–134.5)
Operating engineers and other construction equipment operators . . . . . . . 3,398 341 (10.0) 107.3 (96.2–119.3)
Highway maintenance workers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577 50 (8.7) 102.5 (76.1–135.1)
All other construction occupations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,388 328 (13.7) 134.5 (120.4–149.9)
Extraction occupations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,654 269 (10.1) 97.2 (85.9–109.5)
NOTES: Proportionate mortality ratios are internally adjusted to the age distribution of all U.S. resident decedents aged 15–64 with paid civilian usual occupations using 10-year age
categories. Proportionate mortality ratio 95% confidence intervals are estimated using separate formulas for populations with 1,000 or fewer and over 1,000 total observed deaths from drug
overdoses. All other construction occupations include census occupation codes 6200–6765 with fewer than 500 total deaths, and extraction occupations include all census occupation codes
6800–6940. See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
Table 4. Drug overdose proportionate mortality ratios among U.S. decedents aged 15–64, by usual industry group: 46 states and
New York City, 2020
Usual industry group Total deaths
Drug overdose deaths
N (percent)
Age-adjusted drug overdose
proportionate mortality ratio
(95% confidence interval)
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597,865 58,920 (9.9) 100.0 …
Accommodation and food services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48,730 7,848 (16.1) 123.9 (121.8–125.9)
Administrative, support, and waste services . . . . . . . . . . . . . . . . . . . . . . . 29,733 3,642 (12.2) 111.2 (108.2–114.2)
Agriculture, forestry, fishing, and hunting . . . . . . . . . . . . . . . . . . . . . . . . . 12,161 787 (6.5) 70.8 (66.0–76.0)
Arts, entertainment, and recreation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13,086 1,547 (11.8) 103.3 (98.8–107.8)
Construction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89,123 13,645 (15.3) 144.9 (143.2–146.5)
Education services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25,321 841 (3.3) 42.2 (39.4–45.1)
Finance and insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,981 948 (6.3) 70.6 (66.1–75.2)
Healthcare and social assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66,589 5,168 (7.8) 86.0 (83.8–88.2)
Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,027 739 (8.2) 85.1 (79.1–91.5)
Management of companies and enterprises . . . . . . . . . . . . . . . . . . . . . . . . 556 26 (4.7) 56.3 (36.8–82.5)
Manufacturing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70,876 5,486 (7.7) 87.7 (85.6–89.9)
Mining . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,578 494 (8.9) 88.7 (81.1–96.9)
Other services (except public administration) . . . . . . . . . . . . . . . . . . . . . . 39,836 4,243 (10.7) 107.9 (105.1–110.6)
Professional, scientific, and technical services . . . . . . . . . . . . . . . . . . . . . . 25,815 1,855 (7.2) 75.9 (72.4–79.4)
Public administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24,426 956 (3.9) 50.7 (47.5–54.0)
Real estate, rental, and leasing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,628 626 (8.2) 94.8 (87.5–102.5)
Retail trade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55,420 5,432 (9.8) 92.0 (89.9–94.2)
Transportation and warehousing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46,665 3,682 (7.9) 86.3 (83.7–88.9)
Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,462 383 (7.0) 82.0 (74.0–90.6)
Wholesale trade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,852 572 (8.3) 87.6 (80.6–95.1)
… Category not applicable.
NOTES: Proportionate mortality ratios are internally adjusted to the age distribution of all U.S. resident decedents aged 15–64 with paid civilian usual industries using 10-year age categories.
Proportionate mortality ratio 95% confidence intervals are estimated using separate formulas for populations with 1,000 or fewer and over 1,000 total observed deaths from drug overdoses.
See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
20 National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023
Table 6. Demographic characteristics of decedents with all paid civilian usual occupations and construction and extraction
occupations among U.S. decedents aged 15–64: 46 states and New York City, 2020
Demographic characteristic
Total deaths
N (percent)
Drug overdose deaths
N (percent)
Construction and
extraction deaths
N (percent)
Construction and
extraction drug overdose
deaths N (percent)
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 605,947 60,126 81,546 12,660
Age group (years)
15–24. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,147 (2.8) 3,954 (6.6) 2,585 (3.2) 593 (4.7)
25–34. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51,684 (8.5) 15,792 (26.3) 7,945 (9.7) 3,027 (23.9)
35–44. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74,898 (12.4) 16,483 (27.4) 11,769 (14.4) 3,764 (29.7)
45–54. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137,761 (22.7) 13,151 (21.9) 18,167 (22.3) 2,937 (23.2)
55–64. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324,457 (53.5) 10,746 (17.9) 41,080 (50.4) 2,339 (18.5)
Sex
Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193,403 (31.9) 15,188 (25.3) 1,403 (1.7) 183 (1.4)
Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412,544 (68.1) 44,938 (74.7) 80,143 (98.3) 12,477 (98.6)
Race and Hispanic origin
Hispanic
1
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80,181 (13.2) 6,981 (11.6) 14,308 (17.5) 1,666 (13.2)
Non-Hispanic, single race:
American Indian and Alaska Native . . . . . . . . . . . . . 7,027 (1.2) 548 (0.9) 1,252 (1.5) 115 (0.9)
Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,071 (2.5) 595 (1.0) 549 (0.7) 44 (0.3)
Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118,234 (19.5) 9,315 (15.5) 10,115 (12.4) 1,205 (9.5)
Native Hawaiian or Other Pacific Islander . . . . . . . . 1,530 (0.3) 64 (0.1) 151 (0.2) 12 (0.1)
White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379,121 (62.6) 41,926 (69.7) 54,537 (66.9) 9,503 (75.1)
Non-Hispanic, two or more races . . . . . . . . . . . . . . . 4,783 (0.8) 697 (1.2) 634 (0.8) 115 (0.9)
Census region
Midwest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133,359 (22.0) 13,388 (22.3) 15,406 (18.9) 2,598 (20.5)
Northeast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101,663 (16.8) 12,675 (21.1) 12,724 (15.6) 2,691 (21.3)
South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249,684 (41.2) 22,936 (38.1) 37,513 (46.0) 5,344 (42.2)
West . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121,241 (20.0) 11,127 (18.5) 15,903 (19.5) 2,027 (16.0)
1
People of Hispanic origin may be of any race.
NOTES: Percentages may not add to 100 due to rounding. Death counts for Asian, American Indian and Alaska Native, and Hispanic people might be affected by misclassification of race and
Hispanic origin on death certificates; see Technical Notes in this report for more information. Midwest is Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota,
Ohio, South Dakota, and Wisconsin; Northeast is Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, and Vermont; South is Alabama, Arkansas,
Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia; West is Alaska, California, Colorado, Hawaii,
Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023 21
Table 7. Drug overdose proportionate mortality ratios among U.S. decedents aged 15–64, by sex and usual occupation group:
46 states and New York City, 2020
Usual occupation group
Age-adjusted drug overdose proportionate mortality ratio
(95% confidence interval)
Female Male
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 … 100.0 …
Architecture and engineering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74.3 (54.4–99.1) 61.2 (55.8–67.1)
Arts, design, entertainment, sports, and media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102.6 (92.2–113.8) 95.1 (89.8–100.4)
Building and grounds cleaning and maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110.1 (102.0–118.7) 106.7 (103.3–110.1)
Business and financial operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68.0 (61.3–75.3) 70.5 (64.6–76.7)
Community and social services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89.6 (79.4–100.8) 78.0 (69.2–87.7)
Computer and mathematical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54.0 (42.5–67.7) 59.4 (54.0–65.2)
Construction and extraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153.8 (132.3–177.7) 137.7 (136.0–139.3)
Education, training, and library . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43.8 (39.1–48.8) 49.7 (43.3–56.7)
Farming, fishing, and forestry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60.8 (42.4–84.6) 81.5 (74.6–88.9)
Food preparation and serving-related . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153.4 (149.4–157.5) 121.6 (118.6–124.5)
Healthcare practitioners and technical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101.8 (96.6–106.9) 76.7 (69.9–84.0)
Healthcare support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113.0 (108.2–117.8) 85.0 (74.6–96.4)
Installation, maintenance, and repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106.6 (83.2–134.4) 100.2 (97.2–103.2)
Legal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.9 (85.0–119.0) 80.8 (67.5–95.9)
Life, physical, and social science . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66.6 (50.6–86.1) 78.7 (67.8–90.9)
Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68.0 (63.1–73.2) 72.0 (68.9–75.1)
Office and administrative support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84.1 (80.6–87.7) 75.8 (71.9–79.8)
Personal care and service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116.9 (112.1–121.7) 114.0 (108.3–119.8)
Production . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87.8 (80.6–95.5) 88.8 (86.0–91.5)
Protective service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64.2 (54.2–75.5) 48.9 (45.1–52.9)
Sales and related . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108.7 (104.8–112.6) 94.8 (91.8–97.9)
Transportation and material moving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102.1 (94.8–109.9) 95.2 (93.3–97.2)
… Category not applicable.
NOTES: Proportionate mortality ratios are internally adjusted to the separate age distributions of all U.S. resident decedents of each sex aged 15–64 with paid civilian usual occupations using
10-year age categories. Proportionate mortality ratio 95% confidence intervals are estimated using separate formulas for populations with 1,000 or fewer and over 1,000 total observed deaths
from drug overdoses. Proportionate mortality ratios based on fewer than 20 deaths across all age groups within that sex group are suppressed. See Technical Notes in this report for more
information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
22 National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023
Table 8. Drug overdose proportionate mortality ratios among U.S. decedents aged 15–64, by sex and usual industry group:
46 states and New York City, 2020
Usual industry group
Age-adjusted drug overdose proportionate mortality ratio
(95% confidence interval)
Female Male
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 … 100.0 …
Accommodation and food services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145.6 (142.1–149.0) 115.1 (112.5–117.6)
Administrative, support, and waste services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109.1 (100.3–118.4) 109.2 (106.0–112.4)
Agriculture, forestry, fishing, and hunting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66.1 (51.8–83.1) 68.6 (63.7–73.8)
Arts, entertainment, and recreation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108.8 (98.0–120.4) 100.9 (95.9–106.0)
Construction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126.5 (112.2–142.1) 138.1 (136.5–139.6)
Education services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42.3 (38.4–46.5) 48.7 (44.0–53.6)
Finance and insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75.1 (68.2–82.5) 72.8 (66.7–79.4)
Healthcare and social assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99.5 (96.9–102.0) 82.9 (78.7–87.1)
Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.8 (70.4–94.4) 86.5 (79.5–94.0)
Management of companies and enterprises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . * … * …
Manufacturing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85.8 (80.0–91.9) 85.8 (83.5–88.0)
Mining . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . * … 84.6 (77.2–92.5)
Other services (except public administration) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120.2 (114.7–125.7) 103.5 (100.3–106.6)
Professional, scientific, and technical services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85.6 (79.0–92.6) 72.8 (68.6–77.0)
Public administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60.7 (54.4–67.6) 47.2 (43.5–51.0)
Real estate, rental, and leasing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97.7 (84.3–112.7) 95.0 (86.3–104.3)
Retail trade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102.7 (99.0–106.5) 88.6 (85.9–91.3)
Transportation and warehousing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89.9 (81.7–98.8) 82.7 (80.0–85.4)
Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68.3 (46.4–96.9) 80.1 (72.0–89.0)
Wholesale trade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70.8 (53.9–91.3) 87.3 (79.9–95.2)
… Category not applicable.
* Estimate does not meet National Center for Health Statistics standards of reliability or precision.
NOTES: Proportionate mortality ratios are internally adjusted to the separate age distributions of all U.S. resident decedents of each sex aged 15–64 with paid civilian usual industries using
10-year age categories. Proportionate mortality ratio 95% confidence intervals are estimated using separate formulas for populations with 1,000 or fewer and over 1,000 total observed deaths
from drug overdoses. Proportionate mortality ratios based on fewer than 20 deaths across all age groups within that sex group are suppressed. See Technical Notes in this report for more
information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023 23
Table 9. Drug overdose proportionate mortality ratios among U.S. decedents aged 15–64, by race and Hispanic origin and usual
occupation group: 46 states and New York City, 2020
Usual occupation group
Age-adjusted drug overdose proportionate mortality ratio (95% confidence interval)
Hispanic
1
Non-Hispanic, single race
American Indian and
Alaska Native Asian Black White
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 … 100.0 … 100.0 … 100.0 … 100.0 …
Architecture and engineering . . . . . . . . . . . . . . 60.2 (41.4–84.5) * … * … 43.6 (28.7–63.4) 65.1 (59.1–71.6)
Arts, design, entertainment, sports,
and media . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120.6 (101.7–141.9) * … 130.0 (81.4–196.8) 94.1 (81.2–108.5) 91.8 (86.1–97.8)
Building and grounds cleaning and
maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . 92.3 (84.0–101.1) 101.0 (71.4–138.6) * … 114.1 (105.9–122.8) 116.4 (112.5–120.3)
Business and financial operations . . . . . . . . . . 81.2 (64.5–101.0) * … * … 51.5 (41.7–63.0) 65.6 (60.8–70.7)
Community and social services . . . . . . . . . . . . 82.3 (60.9–108.7) * … * … 71.0 (59.3–84.4) 85.5 (77.0–94.7)
Computer and mathematical . . . . . . . . . . . . . . . 83.5 (58.5–115.6) * … * … 58.5 (43.8–76.5) 58.6 (53.0–64.5)
Construction and extraction . . . . . . . . . . . . . . . 120.7 (116.4–125.0) 117.3 (96.8–140.8) 208.4 (151.4–279.8) 154.0 (147.6–160.3) 143.2 (141.2–145.1)
Education, training, and library . . . . . . . . . . . . . 31.8 (22.0–44.5) * … * … 29.2 (22.6–37.3) 44.6 (40.5–49.1)
Farming, fishing, and forestry . . . . . . . . . . . . . 55.5 (45.3–67.3) 129.1 (78.8–199.4) * … 64.1 (41.9–93.9) 98.1 (88.4–108.6)
Food preparation and serving-related . . . . . . . . 111.4 (103.4–119.8) 104.8 (78.3–137.5) 159.5 (126.9–198.0) 139.6 (133.3–146.0) 132.6 (129.9–135.4)
Healthcare practitioners and technical . . . . . . . 78.7 (63.6–96.3) * … 70.5 (46.8–101.9) 58.7 (50.1–68.4) 87.8 (83.4–92.2)
Healthcare support . . . . . . . . . . . . . . . . . . . . . . 104.8 (89.0–122.6) * … * … 90.0 (81.7–98.9) 104.0 (98.7–109.4)
Installation, maintenance, and repair . . . . . . . . 117.2 (106.1–129.1) * … 108.7 (67.3–166.1) 112.6 (100.5–125.8) 97.2 (93.9–100.5)
Legal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . * … * … * … 71.0 (43.9–108.5) 81.0 (70.6–92.4)
Life, physical, and social science . . . . . . . . . . . 98.7 (61.1–150.9) * … * … * … 68.7 (59.4–79.1)
Management . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.6 (69.7–88.2) * … 93.4 (71.3–120.2) 61.6 (54.6–69.2) 68.4 (65.4–71.3)
Office and administrative support . . . . . . . . . . . 84.1 (75.9–93.1) 86.9 (59.4–122.7) 69.3 (47.1–98.4) 68.3 (62.6–74.5) 76.4 (73.3–79.5)
Personal care and service . . . . . . . . . . . . . . . . . 122.2 (108.6–137.1) 121.6 (87.6–164.4) 136.9 (100.9–181.5) 109.8 (100.4–119.8) 110.1 (105.6–114.6)
Production . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87.8 (79.7–96.6) 112.9 (78.7–157.1) 55.6 (35.3–83.4) 100.3 (92.7–108.3) 89.4 (86.3–92.4)
Protective service . . . . . . . . . . . . . . . . . . . . . . . 73.3 (60.0–88.7) * … * … 59.1 (51.4–67.6) 50.9 (46.0–56.1)
Sales and related . . . . . . . . . . . . . . . . . . . . . . . 93.3 (85.1–102.1) 72.0 (46.6–106.3) 127.0 (100.7–158.1) 90.2 (82.8–98.1) 97.3 (94.7–100.0)
Transportation and material moving . . . . . . . . . 106.3 (99.8–113.1) 113.5 (88.0–144.2) 119.1 (91.1–153.0) 117.2 (113.3–121.2) 101.5 (98.9–104.1)
… Category not applicable.
* Estimate does not meet National Center for Health Statistics standards of reliability or precision.
1
People of Hispanic origin may be of any race.
NOTES: Proportionate mortality ratios are internally adjusted to the separate age distributions of U.S. resident decedents in each race and Hispanic-origin group aged 15–64 with paid civilian
usual occupations using 10-year age categories. Proportionate mortality ratio 95% confidence intervals are estimated using separate formulas for populations with 1,000 or fewer and over
1,000 total observed deaths from drug overdoses. Proportionate mortality ratios based on fewer than 20 deaths across all age groups are suppressed. Death counts for Asian, American Indian
and Alaska Native, and Hispanic people might be affected by misclassification of race and Hispanic origin on death certificates. See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
24 National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023
Table 10. Drug overdose proportionate mortality ratios among U.S. decedents aged 15–64, by race and Hispanic origin and usual
industry group: 46 states and New York City, 2020
Usual industry group
Age-adjusted drug overdose proportionate mortality ratio (95% confidence interval)
Hispanic
1
Non-Hispanic, single race
American Indian and
Alaska Native Asian Black White
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 … 100.0 … 100.0 … 100.0 … 100.0 …
Accommodation and food services . . . . . . . . . 104.9 (98.1–112.2) 107.1 (82.7–136.5) 149.9 (123.6–180.0) 142.4 (136.8–148.1) 125.5 (123.1–127.9)
Administrative, support, and
waste services . . . . . . . . . . . . . . . . . . . . . . . . 103.6 (94.8–112.9) 114.0 (75.8–164.8) * … 116.8 (108.2–125.9) 117.2 (113.5–120.9)
Agriculture, forestry, fishing, and hunting . . . . 55.6 (46.6–65.7) 91.1 (56.4–139.3) * … 64.8 (46.5–88.0) 74.4 (68.4–80.8)
Arts, entertainment, and recreation . . . . . . . . . 124.0 (105.9–144.2) 102.8 (73.4–140.0) 144.5 (90.6–218.8) 102.9 (90.1–117.0) 100.3 (95.1–105.5)
Construction . . . . . . . . . . . . . . . . . . . . . . . . . . . 121.7 (117.5–125.9) 120.2 (99.4–144.1) 195.1 (144.3–257.9) 160.4 (154.2–166.6) 141.2 (139.4–143.0)
Education services . . . . . . . . . . . . . . . . . . . . . . 42.0 (32.8–52.9) * … * … 35.3 (29.7–41.8) 44.1 (40.7–47.8)
Finance and insurance . . . . . . . . . . . . . . . . . . . 67.9 (52.9–85.8) * … * … 47.6 (37.9–59.0) 71.5 (66.5–76.8)
Healthcare and social assistance . . . . . . . . . . . 91.3 (82.9–100.3) 89.8 (66.9–118.1) 78.3 (59.4–101.2) 79.9 (75.2–84.6) 89.8 (87.2–92.5)
Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112.5 (88.8–140.6) * … * … 73.8 (59.7–90.3) 82.6 (75.8–89.9)
Management of companies and
enterprises . . . . . . . . . . . . . . . . . . . . . . . . . . . * … * … * … * … * …
Manufacturing . . . . . . . . . . . . . . . . . . . . . . . . . 91.9 (84.5–99.8) 123.9 (90.0–166.3) 65.2 (46.8–88.5) 99.4 (93.2–106.0) 84.8 (82.3–87.2)
Mining . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.9 (54.7–95.1) * … * … 87.4 (57.6–127.2) 85.1 (77.0–93.9)
Other services
(except public administration) . . . . . . . . . . . . 115.2 (105.9–125.1) 122.1 (86.4–167.6) 134.0 (101.0–174.5) 115.6 (107.2–124.5) 105.3 (102.1–108.5)
Professional, scientific, and
technical services . . . . . . . . . . . . . . . . . . . . . . 90.9 (77.2–106.4) * … 49.5 (34.1–69.5) 69.4 (59.1–81.0) 73.1 (69.4–76.9)
Public administration . . . . . . . . . . . . . . . . . . . . 58.6 (46.7–72.6) 79.4 (54.3–112.1) * … 50.0 (43.2–57.7) 49.7 (45.9–53.7)
Real estate, rental, and leasing . . . . . . . . . . . . . 92.0 (70.5–117.9) * … * … 89.0 (70.3–111.1) 95.7 (87.2–104.8)
Retail trade . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94.4 (87.1–102.2) 64.5 (43.2–92.7) 116.8 (92.6–145.3) 94.1 (87.3–101.3) 90.1 (87.7–92.6)
Transportation and warehousing . . . . . . . . . . . 100.5 (92.2–109.4) 121.1 (78.4–178.8) 97.4 (69.9–132.1) 91.6 (85.5–98.0) 89.8 (86.4–93.2)
Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.9 (49.5–103.5) * … * … 76.2 (53.9–104.6) 78.7 (70.1–88.0)
Wholesale trade . . . . . . . . . . . . . . . . . . . . . . . . 86.5 (68.2–108.3) * … * … 82.7 (63.4–106.0) 88.9 (80.6–97.8)
… Category not applicable.
* Estimate does not meet National Center for Health Statistics standards of reliability or precision.
1
People of Hispanic origin may be of any race.
NOTES: Proportionate mortality ratios are internally adjusted to the separate age distributions of U.S. resident decedents in each race and Hispanic-origin group aged 15–64 with paid civilian
usual industries using 10-year age categories. Proportionate mortality ratio 95% confidence intervals are estimated using separate formulas for populations with 1,000 or fewer and over
1,000 total observed deaths from drug overdoses. Proportionate mortality ratios based on fewer than 20 deaths across all age groups are suppressed. Death counts for Asian, American Indian
and Alaska Native, and Hispanic people might be affected by misclassification of race and Hispanic origin on death certificates. See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023 25
Table 11. Drug overdose proportionate mortality ratios among U.S. decedents aged 15–64 for deaths involving specific types of drugs, by usual occupation group:
46 states and New York City, 2020
Usual occupation group
Age-adjusted drug overdose proportionate mortality ratio (95% confidence interval)
Cocaine Heroin Methadone
Natural and
semisynthetic opioids
Psychostimulants with
abuse potential
Synthetic opioids other
than methadone
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 … 100.0 … 100.0 … 100.0 … 100.0 … 100.0 …
Architecture and engineering . . . . . . . . . . . . . . . . . . . . 58.5 (47.6–71.2) 64.2 (50.3–80.7) * … 83.4 (67.7–101.7) 53.5 (43.9–64.7) 61.6 (54.8–69.1)
Arts, design, entertainment, sports, and media . . . . . . 90.2 (79.8–101.6) 89.7 (77.4–103.5) 83.7 (59.5–114.4) 97.8 (84.6–112.3) 103.3 (93.2–114.3) 88.9 (82.9–95.2)
Building and grounds cleaning and maintenance . . . . . 121.5 (113.3–130.1) 112.3 (102.8–122.3) 116.5 (97.0–138.8) 89.0 (80.6–98.1) 116.3 (109.0–124.0) 113.3 (109.3–117.3)
Business and financial operations . . . . . . . . . . . . . . . . 63.7 (54.9–73.4) 50.9 (41.5–61.8) 57.5 (38.2–83.2) 98.9 (85.7–113.5) 53.5 (46.1–61.7) 59.3 (54.2–64.8)
Community and social services . . . . . . . . . . . . . . . . . . 76.8 (63.6–91.9) 90.8 (73.5–111.0) 89.5 (56.7–134.3) 85.2 (68.6–104.6) 60.5 (49.8–72.8) 74.7 (66.8–83.2)
Computer and mathematical . . . . . . . . . . . . . . . . . . . . . 49.0 (39.5–60.1) 53.4 (41.6–67.6) * … 54.4 (42.4–68.8) 50.7 (41.8–60.8) 50.6 (44.8–56.9)
Construction and extraction . . . . . . . . . . . . . . . . . . . . . 144.0 (139.9–148.2) 166.4 (161.4–171.3) 141.3 (128.0–155.5) 129.4 (124.4–134.4) 169.7 (165.9–173.4) 151.5 (149.2–153.7)
Education, training, and library . . . . . . . . . . . . . . . . . . . 31.3 (25.1–38.5) 22.5 (16.3–30.3) * … 57.1 (47.0–68.6) 26.0 (20.8–32.0) 33.2 (29.3–37.4)
Farming, fishing, and forestry . . . . . . . . . . . . . . . . . . . 84.6 (70.0–101.3) 78.9 (62.1–98.7) * … 78.6 (61.8–98.5) 123.0 (106.8–141.0) 76.4 (68.3–85.2)
Food preparation and serving-related . . . . . . . . . . . . . . 144.6 (138.9–150.3) 130.6 (122.5–139.2) 136.3 (118.6–155.9) 114.3 (106.5–122.5) 134.7 (129.6–139.8) 130.9 (127.9–133.9)
Healthcare practitioners and technical . . . . . . . . . . . . . 56.0 (49.1–63.6) 57.5 (49.0–67.0) 86.8 (66.4–111.6) 139.3 (126.1–153.6) 62.3 (55.6–69.6) 67.3 (62.7–72.1)
Healthcare support . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98.4 (88.6–109.0) 80.4 (69.9–92.1) 138.5 (110.3–171.7) 124.3 (111.1–138.8) 85.9 (77.6–94.9) 89.3 (83.8–95.0)
Installation, maintenance, and repair . . . . . . . . . . . . . . 101.1 (93.7–109.0) 108.7 (99.4–118.7) 113.9 (94.6–135.9) 98.2 (89.4–107.7) 119.9 (112.5–127.7) 107.1 (103.1–111.1)
Legal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63.4 (46.1–85.1) 74.9 (52.2–104.1) * … 129.4 (99.2–165.9) 68.7 (52.1–89.0) 72.9 (61.4–86.0)
Life, physical, and social science . . . . . . . . . . . . . . . . . 64.4 (47.0–86.2) 80.6 (57.3–110.2) * … 108.5 (81.0–142.2) 71.3 (54.4–91.8) 71.7 (60.6–84.2)
Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76.8 (71.2–82.8) 60.5 (54.4–67.0) 52.3 (41.3–65.3) 79.7 (72.8–87.1) 61.1 (56.5–65.9) 69.5 (66.0–73.0)
Office and administrative support . . . . . . . . . . . . . . . . . 67.1 (61.9–72.5) 63.4 (57.3–69.8) 80.9 (67.1–96.5) 87.9 (80.8–95.5) 61.6 (57.1–66.4) 71.2 (67.9–74.6)
Personal care and service . . . . . . . . . . . . . . . . . . . . . . . 107.0 (98.1–116.6) 102.6 (92.2–113.9) 138.1 (113.1–166.8) 126.3 (114.5–139.0) 104.7 (96.7–113.3) 101.5 (96.8–106.1)
Production . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84.9 (79.0–91.1) 88.1 (80.9–95.8) 82.8 (68.8–98.9) 87.5 (80.4–95.2) 90.3 (84.7–96.1) 94.7 (91.3–98.1)
Protective service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45.5 (38.3–53.6) 44.4 (35.9–54.3) * … 65.5 (55.1–77.4) 46.4 (39.7–53.9) 50.9 (46.4–55.7)
Sales and related . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92.1 (86.4–98.0) 90.0 (83.3–97.1) 104.5 (89.6–121.2) 109.5 (102.1–117.4) 92.4 (87.3–97.5) 96.8 (93.7–99.9)
Transportation and material moving . . . . . . . . . . . . . . . 115.4 (110.9–120.0) 113.0 (107.5–118.4) 100.6 (88.5–113.8) 81.0 (75.7–86.5) 93.2 (89.1–97.3) 103.8 (101.3–106.2)
… Category not applicable.
* Estimate does not meet National Center for Health Statistics standards of reliability or precision.
NOTES: Proportionate mortality ratios are internally adjusted to the age distribution of all U.S. resident decedents aged 15–64 with paid civilian usual occupations using 10-year age categories. Proportionate mortality ratio 95% confidence intervals are
estimated using separate formulas for populations with 1,000 or fewer and over 1,000 total observed deaths from drug overdoses involving the specified drug type. Proportionate mortality ratios based on fewer than 20 deaths from drug overdoses
involving the specified drug type across all age groups are suppressed. Types of drugs involved in each overdose death were determined using multiple cause-of-death International Classification of Diseases, 10th Revision codes for heroin (T40.1),
natural and semisynthetic opioids (T40.2), methadone (T40.3), synthetic opioids other than methadone (T40.4), cocaine (T40.5), and psychostimulants with abuse potential (T43.6). Types of drugs involved in each overdose death are not mutually
exclusive. See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
26 National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023
Table 12. Drug overdose proportionate mortality ratios among U.S. decedents aged 15–64 for deaths involving specific types of drugs, by usual industry group: 46 states
and New York City, 2020
Usual industry group
Age-adjusted drug overdose proportionate mortality ratio (95% confidence interval)
Cocaine Heroin Methadone
Natural and
semisynthetic opioids
Psychostimulants with
abuse potential
Synthetic opioids other
than methadone
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 … 100.0 … 100.0 … 100.0 … 100.0 … 100.0 …
Accommodation and food services . . . . . . . . . . . . . . . 138.1 (133.1–143.1) 123.1 (117.2–129.0) 130.3 (114.9–147.3) 109.5 (102.8–116.6) 126.2 (121.7–130.6) 123.9 (121.3–126.5)
Administrative, support, and waste services . . . . . . . . 125.2 (117.0–133.9) 122.0 (112.3–132.2) 114.3 (95.0–136.4) 97.0 (88.3–106.2) 116.8 (109.6–124.3) 115.2 (111.4–119.1)
Agriculture, forestry, fishing, and hunting . . . . . . . . . . 64.4 (54.6–75.5) 58.4 (47.2–71.5) * … 64.3 (52.6–77.8) 103.6 (92.1–116.1) 64.8 (59.0–71.0)
Arts, entertainment, and recreation . . . . . . . . . . . . . . . 95.7 (85.2–107.2) 98.2 (85.6–112.2) 88.9 (64.4–119.8) 102.3 (89.3–116.8) 111.5 (101.2–122.5) 96.8 (90.8–103.2)
Construction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147.9 (143.9–151.8) 166.7 (161.9–171.4) 143.3 (130.4–157.2) 127.0 (122.2–131.8) 165.3 (161.7–168.8) 151.4 (149.3–153.6)
Education services . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36.6 (31.1–42.7) 28.9 (23.0–35.8) 44.2 (30.2–62.4) 52.8 (45.0–61.6) 30.0 (25.5–35.1) 36.2 (32.9–39.8)
Finance and insurance . . . . . . . . . . . . . . . . . . . . . . . . . 67.1 (58.0–77.2) 53.4 (43.7–64.7) 61.2 (41.0–87.9) 104.8 (91.2–119.9) 52.1 (44.8–60.1) 63.2 (58.0–68.8)
Healthcare and social assistance . . . . . . . . . . . . . . . . . 76.8 (72.1–81.7) 71.3 (65.8–77.1) 107.0 (93.4–121.9) 114.3 (108.2–120.3) 70.0 (65.5–74.6) 76.5 (73.6–79.3)
Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80.8 (68.4–94.8) 80.9 (66.0–98.1) 97.4 (65.2–139.9) 99.0 (82.6–117.7) 75.4 (64.6–87.6) 80.7 (73.4–88.6)
Management of companies and enterprises . . . . . . . . . * … * … * … * … * … * …
Manufacturing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84.4 (79.4–89.4) 83.3 (77.5–89.5) 74.8 (63.7–87.3) 86.0 (80.2–92.1) 80.6 (76.1–85.1) 92.6 (89.9–95.4)
Mining . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53.3 (41.0–68.2) 78.0 (60.0–99.6) * … 120.1 (97.6–146.3) 141.4 (122.7–162.1) 68.0 (59.8–77.2)
Other services (except public administration) . . . . . . . 112.0 (105.0–119.4) 111.6 (103.1–120.6) 123.9 (105.7–144.3) 102.4 (94.3–111.0) 118.0 (112.2–123.8) 107.4 (103.9–111.0)
Professional, scientific, and technical services . . . . . . . 70.6 (63.6–78.2) 72.9 (64.3–82.3) 62.4 (46.7–81.6) 91.7 (82.1–102.0) 66.0 (59.9–72.6) 69.0 (64.4–73.5)
Public administration . . . . . . . . . . . . . . . . . . . . . . . . . . 40.4 (34.5–47.0) 39.0 (32.0–47.2) 48.3 (33.2–67.8) 74.7 (65.1–85.3) 38.8 (33.5–44.7) 45.1 (41.3–49.2)
Real estate, rental, and leasing . . . . . . . . . . . . . . . . . . . 108.7 (92.2–127.2) 87.3 (69.7–108.1) * … 109.0 (89.5–131.5) 75.9 (63.4–90.1) 86.2 (77.5–95.7)
Retail trade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85.9 (80.7–91.1) 82.2 (76.3–88.5) 100.8 (87.2–116.0) 96.6 (90.1–103.4) 84.1 (79.4–88.7) 91.2 (88.4–94.0)
Transportation and warehousing . . . . . . . . . . . . . . . . . 97.0 (90.7–103.6) 92.8 (85.4–100.7) 78.7 (65.0–94.5) 78.5 (71.8–85.7) 81.1 (75.8–86.5) 89.5 (86.1–92.9)
Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61.9 (47.4–79.3) 88.4 (67.5–113.8) * … 88.0 (67.5–112.8) 66.9 (53.1–83.1) 82.7 (72.6–93.8)
Wholesale trade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.3 (67.0–97.8) 78.7 (61.9–98.6) * … 92.0 (73.9–113.2) 82.3 (69.2–97.2) 89.8 (80.9–99.4)
… Category not applicable.
* Estimate does not meet National Center for Health Statistics standards of reliability or precision.
NOTES: Proportionate mortality ratios are internally adjusted to the age distribution of all U.S. resident decedents aged 15–64 with paid civilian usual industries using 10-year age categories. Proportionate mortality ratio 95% confidence intervals are
estimated using separate formulas for populations with 1,000 or fewer and over 1,000 total observed deaths from drug overdoses involving the specified drug type. Proportionate mortality ratios based on fewer than 20 deaths from drug overdoses
involving the specified drug type across all age groups are suppressed. Types of drugs involved in each overdose death were determined using multiple cause-of-death International Classification of Diseases, 10th Revision codes for heroin (T40.1),
natural and semisynthetic opioids (T40.2), methadone (T40.3), synthetic opioids other than methadone (T40.4), cocaine (T40.5), and psychostimulants with abuse potential (T43.6). Types of drugs involved in each overdose death are not mutually
exclusive. See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023 27
Table 13. Drug overdose proportionate mortality ratios among U.S. decedents aged 15–64, by overdose intent and usual
occupation group: 46 states and New York City, 2020
Usual occupation group
Age-adjusted drug overdose proportionate mortality ratio (95% confidence interval)
Unintentional Suicide Undetermined
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 … 100.0 … 100.0 …
Architecture and engineering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63.7 (58.0–69.9) 87.8 (58.3–126.8) 76.0 (49.2–112.2)
Arts, design, entertainment, sports, and media . . . . . . . . . . . . . . . . . . . . . . . . 94.8 (89.9–99.6) 160.6 (127.7–199.3) 88.7 (66.3–116.3)
Building and grounds cleaning and maintenance . . . . . . . . . . . . . . . . . . . . . . . 110.2 (107.0–113.5) 48.4 (36.8–62.6) 122.1 (103.9–142.6)
Business and financial operations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63.1 (58.7–67.7) 159.3 (127.4–196.7) 57.6 (39.6–80.9)
Community and social services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74.2 (67.7–81.1) 164.4 (120.8–218.6) 113.1 (78.4–158.1)
Computer and mathematical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54.9 (49.9–60.3) 189.1 (145.3–241.9) * …
Construction and extraction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148.4 (146.6–150.3) 61.8 (53.5–71.0) 148.9 (136.6–162.0)
Education, training, and library . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35.6 (32.3–39.2) 186.8 (151.8–227.4) 45.3 (29.3–66.9)
Farming, fishing, and forestry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85.2 (78.0–92.9) * … * …
Food preparation and serving-related . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132.2 (129.7–134.7) 98.9 (84.6–115.0) 118.1 (103.6–134.0)
Healthcare practitioners and technical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76.8 (72.6–81.1) 248.6 (215.0–286.1) 99.9 (79.5–124.0)
Healthcare support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94.2 (89.8–98.6) 129.1 (103.1–159.7) 112.6 (89.5–139.7)
Installation, maintenance, and repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107.6 (104.3–110.8) 63.0 (49.6–78.9) 114.3 (96.7–134.1)
Legal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79.3 (69.4–90.3) 241.7 (164.2–343.0) * …
Life, physical, and social science . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70.6 (61.4–80.8) 177.6 (111.3–268.9) * …
Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70.6 (67.8–73.5) 85.7 (72.2–101.0) 66.4 (54.9–79.6)
Office and administrative support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.6 (69.9–75.3) 131.5 (114.8–149.9) 78.1 (65.8–92.0)
Personal care and service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105.2 (101.4–109.0) 148.4 (123.6–176.6) 139.0 (116.4–164.7)
Production . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92.3 (89.5–95.1) 64.2 (52.6–77.5) 79.6 (67.1–93.8)
Protective service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51.1 (47.4–55.2) 64.2 (44.9–88.8) 72.9 (52.9–97.8)
Sales and related . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97.3 (94.8–99.8) 128.7 (112.9–146.1) 93.3 (80.7–107.4)
Transportation and material moving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101.6 (99.6–103.6) 59.1 (50.5–68.8) 85.1 (75.2–96.1)
… Category not applicable.
* Estimate does not meet National Center for Health Statistics standards of reliability or precision.
NOTES: Proportionate mortality ratios are internally adjusted to the age distribution of all U.S. resident decedents aged 15–64 with paid civilian usual occupations using 10-year age
categories. Proportionate mortality ratio 95% confidence intervals are estimated using separate formulas for populations with 1,000 or fewer and over 1,000 total observed deaths from drug
overdoses due to each overdose intent. Proportionate mortality ratios based on fewer than 20 deaths from drug overdoses under the specified intent across all age groups are suppressed.
Overdose intent was determined using the underlying cause-of-death International Classification of Diseases, 10th Revision codes for unintentional (X40–X44), suicidal (X60–X64), and
homicidal (X85) overdoses, as well as overdoses of undetermined intent (Y10–Y14). Homicidal overdoses are not presented due to small cell counts. See Technical Notes in this report for
more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
28 National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023
Table 14. Drug overdose proportionate mortality ratios among U.S. decedents aged 15–64, by overdose intent and usual industry
group: 46 states and New York City, 2020
Usual industry group
Age-adjusted drug overdose proportionate mortality ratio (95% confidence interval)
Unintentional Suicide Undetermined
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100.0 … 100.0 … 100.0 …
Accommodation and food services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125.9 (123.7–128.0) 91.7 (79.6–105.2) 106.9 (94.7–120.2)
Administrative, support, and waste services . . . . . . . . . . . . . . . . . . . . . . . . . . 112.6 (109.4–115.7) 68.1 (54.2–84.4) 122.0 (104.2–142.0)
Agriculture, forestry, fishing, and hunting . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72.4 (67.3–77.8) 58.9 (38.4–86.2) 46.9 (29.4–71.1)
Arts, entertainment, and recreation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102.0 (97.3–106.7) 140.5 (110.9–175.6) 96.3 (73.5–123.9)
Construction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147.7 (146.0–149.5) 65.4 (57.2–74.3) 151.1 (139.2–163.7)
Education services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37.6 (34.8–40.5) 139.7 (115.8–167.2) 44.3 (31.4–60.9)
Finance and insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67.3 (62.7–72.0) 156.1 (124.7–193.0) 61.1 (42.6–85.0)
Healthcare and social assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.9 (79.6–84.2) 164.0 (148.3–181.0) 100.3 (88.4–113.3)
Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84.7 (78.4–91.3) 126.4 (91.4–170.2) 59.9 (37.6–90.8)
Management of companies and enterprises . . . . . . . . . . . . . . . . . . . . . . . . . . . 52.1 (32.7–78.9) * … * …
Manufacturing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88.8 (86.6–91.1) 71.8 (61.7–83.1) 77.3 (67.1–88.6)
Mining . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90.8 (82.7–99.4) * … 85.4 (52.2–131.9)
Other services (except public administration) . . . . . . . . . . . . . . . . . . . . . . . . . 108.1 (105.2–110.9) 84.6 (70.6–100.5) 127.9 (111.2–146.3)
Professional, scientific, and technical services . . . . . . . . . . . . . . . . . . . . . . . . . 71.0 (67.3–74.8) 183.5 (157.4–212.6) 83.0 (66.4–102.5)
Public administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47.9 (44.7–51.3) 93.8 (73.9–117.4) 66.6 (50.0–86.8)
Real estate, rental, and leasing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94.3 (86.7–102.4) 129.4 (90.1–180.0) 74.5 (46.1–113.9)
Retail trade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91.0 (88.7–93.2) 117.8 (104.0–133.0) 95.4 (83.6–108.4)
Transportation and warehousing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87.5 (84.8–90.3) 66.2 (54.5–79.5) 76.4 (64.2–90.3)
Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84.5 (76.0–93.6) * … * …
Wholesale trade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87.8 (80.5–95.7) 85.8 (53.8–129.9) 87.1 (55.8–129.6)
… Category not applicable.
* Estimate does not meet National Center for Health Statistics standards of reliability or precision.
NOTES: Proportionate mortality ratios are internally adjusted to the age distribution of all U.S. resident decedents aged 15–64 with paid civilian usual industries using 10-year age categories.
Proportionate mortality ratio 95% confidence intervals are estimated using separate formulas for populations with 1,000 or fewer and over 1,000 total observed deaths from drug overdoses
due to each overdose intent. Proportionate mortality ratios based on fewer than 20 deaths from drug overdoses under the specified intent across all age groups are suppressed. Overdose
intent was determined using the underlying cause-of-death International Classification of Diseases, 10th Revision codes for unintentional (X40–X44), suicidal (X60–X64), and homicidal (X85)
overdoses, as well as overdoses of undetermined intent (Y10–Y14). Homicidal overdoses are not presented due to small cell counts. See Technical Notes in this report for more information.
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality, 2020.
National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023 29
Technical Notes
Nature and sources of data
Data in this report are based on information submitted
by jurisdictions and coded by the National Center for Health
Statistics through the Vital Statistics Cooperative Program. For
the 2020 data year, all states, the District of Columbia, and New
York City submitted mortality medical and demographic data in
electronic data files to the National Center for Health Statistics.
Usual occupation and industry codes are available for decedents
from 46 states and New York City. These data are coded through
an agreement between the National Center for Health Statistics
and the National Institute for Occupational Safety and Health
(13). For more information on the variables that convey the
decedent’s usual occupation and industry for the 2020 data year,
see “Classification of decedent’s usual occupation and industry.”
Death certificates are completed by funeral directors,
attending physicians, medical examiners, coroners, or other
people legally authorized to certify deaths. Data for 2020 are
based on records of deaths that occurred during 2020 and were
received as of July 27, 2021. Data for earlier years, excluding
data on usual occupation and industry, can be obtained via the
Centers for Disease Control and Prevention’s Wide-ranging
Online Data for Epidemiologic Research or WONDER (42).
U.S. Standard Certificate of Death and
how it relates to race and Hispanic-origin
classification
The U.S. Standard Certificate of Death, which states use
as a model, was revised in 2003 (14). Before 2003, the U.S.
Standard Certificate of Death had not been revised since 1989
(21,43,44). The 2003 revision of the U.S. Standard Certificate
of Death allows the reporting of more than one race (14). This
change was implemented to reflect the increasing diversity of the
U.S. population and to be consistent with the decennial census
and the 1997 “Revisions to the Standards for the Classification
of Federal Data on Race and Ethnicity” issued by the Office of
Management and Budget (23). This revision replaced standards
that were issued in 1977 (44). The new standards mandate the
collection of more than one race, where applicable, for federal
data (14) and require the collection of information on a minimum
set of five races. More than the minimum number of race
categories are reported on death certificates (14).
Multiple races in this report includes people with any
combination of White, Black or African American, American
Indian or Alaska Native, Asian, and Native Hawaiian or Other
Pacific Islander races. However, estimates for non-Hispanic
multiple race and non-Hispanic Native Hawaiian or Other Pacific
Islander workers in each occupation and industry group are not
presented due to small counts. Records are classified within a
single category (rather than as multiple races) if two or more
specific selections within a standard category, such as Korean
and Chinese, are reported.
Quality of race and Hispanic-origin data—Estimates for
Hispanic, American Indian and Alaska Native, Asian, and Native
Hawaiian or Other Pacific Islander populations may be affected
by inconsistencies in reporting Hispanic origin and race on
the death certificate compared with censuses, surveys, and
birth certificates. Studies have shown underreporting on death
certificates of Hispanic, American Indian and Alaska Native,
Asian, and Native Hawaiian or Other Pacific Islander decedents,
as well as undercounts of these groups in censuses (45–49).
Cause-of-death classification
The mortality statistics presented in this report were
compiled following World Health Organization regulations, which
specify that member countries classify and code causes of death
under the current revision of the International Classification of
Diseases (ICD). ICD provides the basic guidance used in almost
all countries to code and classify causes of death. Effective with
deaths occurring in 1999, the United States began using the
International Classification of Diseases, 10th Revision (ICD–10)
(50).
The National Center for Health Statistics publishes its own
volumes of ICD–10 to include modifications in use (51). Effective
with data year 2020, ICD–10 code U07.1, COVID-19, was added
as a new underlying cause-of-death code. No other codes were
added to or deleted from the list of valid underlying cause-of-
death codes in 2020. Information on the addition of U07.1, as
well as codes added or deleted in previous years, is available
from NCHS’ “Instruction Manual, Part 9, ICD–10 Cause-of-death
Lists for Tabulating Mortality Statistics” (17).
Quality of reporting and processing cause of
death
The quality of mortality data is largely dependent on proper
and thorough completion of death certificates by certifiers.
Accuracy and completeness of information entered on death
certificates can vary by state and over time.
One index of the quality of reporting causes of death is
the proportion of death certificates coded to Chapter XVIII—
Symptoms, signs and abnormal clinical and laboratory findings,
not elsewhere classified (ICD–10 codes R00–R99). Although
determining which of these deaths actually occurred within each
underlying cause is not possible, the total proportion coded to
R00–R99 indicates the consideration given to the cause-of-death
statement by medical certifiers. This proportion also may be used
as a rough measure of the specificity of medical diagnoses. The
percentage of all reported deaths in the United States assigned to
Symptoms, signs and abnormal clinical and laboratory findings,
not elsewhere classified decreased from 1.14% in 2019 to 1.01%
in 2020.
Details on coding and classification of causes of death can
be found in NCHS' Instruction Manual, Part 2 (51).
Classification of decedent’s usual occupation
and industry
Occupation and industry information provided on death
certificates was processed and coded through a collaboration
with the National Institute for Occupational Safety and Health
30 National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023
(13). Occupation is the type of work that a person performs, or
their job (such as teacher or cashier), while industry is the type
of business in which a person works (such as an elementary
school or grocery store). Some occupation groups primarily
occur within a single industry group (for example, production
workers primarily work in manufacturing industries, and
healthcare support workers primarily work in healthcare and
social assistance industries). Other occupation groups occur
across most or all industry groups (for example, management,
business and financial operations, and office and administrative
support occupations).
Data on usual occupation and industry are available for
91.0% of decedents aged at least 15 years in the 2020 National
Vital Statistics System mortality files. Occupation and industry
narratives were not coded for deaths that occurred in Arizona,
North Carolina, Rhode Island, and the District of Columbia
because these jurisdictions did not participate in the industry and
occupation coding program in 2020. Iowa did participate, but
because of their data collection method, data were inconsistent
with other states’ data and are excluded from the 2020 National
Vital Statistics System mortality files (13). Occupation and
industry data were also missing for large percentages of records
from decedents who resided in Ohio (11.0%) and Texas (5.8%)
(13).
The U.S. Census Bureau categorizes occupations and
industries into standardized codes and titles for analysis of
survey responses. Occupation and industry narratives from
death certificates were coded to the standardized Census
2012 Occupation Codes and the Census 2012 Industry Codes.
Narratives with insufficient information for coding, military
occupations or industries, and narratives that indicated unpaid
work (homemakers, students, and volunteers, among others)
were coded to National Institute for Occupational Safety and
Health and NCHS non-Census codes to capture all available
information (13).
Census 2012 Occupation Codes and Census 2012 Industry
Codes were then collapsed into broad groups using the National
Health Interview Survey simple occupation and industry recodes
(16). Additional information on occupation and industry coding
within the National Vital Statistics System is available in “Industry
and Occupation (I&O) Data as Applicable to Mortality Vital
Statistics, 2020: History, Background, and Control Tables” (13).
Population denominator data from the Current
Population Survey
Population denominator data for estimation of death rates
were drawn from the Current Population Survey, a large monthly
survey by the U.S. Census Bureau that collects data on the U.S.
labor force (18). Each month, a probability sample is applied to
select about 60,000 U.S. households for voluntary participation.
CPS participants must be noninstitutionalized civilians aged
15 and over, although employment data are largely restricted
to those aged 16 and over. U.S. military members and people
in institutions, including prisons, long-term medical care, and
nursing homes, are not eligible. One survey participant in each
household provides all responses for any eligible household
members. Survey data are then weighted to represent the U.S.
civilian noninstitutionalized population (18).
NCHS uses population denominator data from April for
census years and July for all other years (51). All denominator
data applied in this report were estimated using the April 2020
vintage and the CPS Basic Monthly data set in the U.S. Census
Bureau’s Microdata Access Tool (52). Within the microdata
sample, data were restricted to jurisdictions that participated in
the National Occupational Mortality Surveillance Modernization
program in 2020 (excluding Arizona, the District of Columbia,
Iowa, North Carolina, and Rhode Island) and to people aged
16–64. Weighted CPS data applied in this report are representative
of civilian noninstitutionalized populations within this restricted
data universe.
Population estimates were generated for the cross-
tabulations of either industry or occupation group and age group,
coded as 16–24, 25–34, 35–44, 45–54, and 55–64. CPS industry
categories durable goods manufacturing and nondurable goods
manufacturing were combined to align with the National Health
Interview Survey’s manufacturing industry category. Private
households and other services were combined to align with the
National Health Interview Survey’s other services (except public
administration) industry category for the estimation of death
rates. Conversely, two National Health Interview Survey industry
categories—administrative, support, and waste services and
management of companies and enterprises—were combined to
align with CPS’ management, administrative, and waste services
industry category.
Computing death rates and 95% confidence
intervals
Drug overdose deaths for estimation of death rates were
restricted to decedents aged 16–64 because deaths from drug
overdoses in 2020 were acute and because usual occupation and
industry may serve as reasonable proxies for current occupation
and industry among those of working age (15). Decedents aged
15 are excluded from estimation of death rates because they
are not represented in CPS workforce population denominator
estimates.
Death rates are estimated as the number of deaths from
drug overdoses in 2020 in workers aged 16–64 in a specified
occupation or industry group residing in participating
jurisdictions per 100,000 estimated population. Age-adjusted
death rates (R
'
) are used to compare mortality risks between
groups and over time. However, they should be viewed as relative
indices rather than as absolute measures of mortality risk (53).
Age-adjusted death rates were computed via direct
standardization—that is, by applying age-specific death rates
(R
i
) to the age distribution of the 2000 U.S. standard population
aged 15–64 (Table I) (53).
si
i
i
s
P
RR
P
′
=
∑
P
si
is the standard population in age group i and P
s
is the
total standard population (all age groups combined). Direct
age standardization was performed using 10-year categories,
National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023 31
excluding age 15 (16–24, 25–34, 35–44, 45–54, and 55–64),
to account for potential bias introduced by differential age
structures in populations of workers.
Sampling variance data are not available from CPS for the
specific study populations. Parameters from a proxy series were
applied to estimate population denominator standard errors that
account for sampling variance under the survey design effect
(21). α and β parameters were drawn from the parameters
for the civilian labor force aged 16 and over (54). A level-to-
level conversion estimated b as
( )
αβ
= +
bN
, where N is the
universe total (civilian noninstitutionalized population aged 16
and over in April 2020) (55). These parameters were then applied
to estimate the approximate standard error of the estimated
population in each age group in each occupation and industry
group [SE (P
i
)] as:
( )
2
new
i new
x
SE P b x
N
= −
where x
new
is the estimated population and N is the universe total
(21).
These approximate population denominator standard errors
were then applied to estimate standard errors for each death
rate, accounting for sampling variability in the denominator (P
i
)
as well as random variability in the numerator (D
i
). Standard
errors for age-standardized death rates (R
'
) were estimated as:
( )
( )
= +
′
∑
2
2
2
P
1
P
i
si
i
i
s ii
SE P
SE R R
DP
R
i
is the age-specific death rate within a single age group–
occupation or industry pair. D
i
is the number of deaths from drug
overdoses in the age group–occupation or industry pair. All other
parameters are defined as above (53).
The 95% confidence interval (CI) is then estimated as:
′′
−
1.96 ( )R SE R
′′
+ 1.96 ( )R SE R
CIs are approximate and should be interpreted with caution
(21). No hypothesis tests were performed to compare death
rates between worker populations, given the large number of
comparisons and the uncertainty in denominator sampling
variance estimates. A higher absolute rate within one worker
population compared with another does not indicate a statistically
significant difference.
Computing proportionate mortality ratios and
95% CIs
A proportionate mortality ratio (PMR) is estimated as the
ratio of two proportions, or the proportion of deaths from the
cause of interest within an exposed (for example, occupation or
industry) group or subgroup divided by the proportion of deaths
from the cause of interest within the full population, multiplied by
100 for ease of interpretation (19). It can also be conceptualized
as the observed number of deaths from the cause of interest
within an exposed population divided by the expected number of
deaths from the cause of interest within the exposed population,
multiplied by 100. A PMR over 100 indicates a higher proportion
of deaths from the cause of interest within the exposed
population than in all decedents combined (that is, deaths from
drug overdoses in decedents in a specific occupation group
comprise a greater proportion of all deaths in that group than in
decedents in all occupation groups combined). PMRs are often
applied to identify potential associations between exposures and
cause(s) of death when inadequate population data are available
for estimation of rates (19).
PMRs in this report were estimated applying deaths from drug
overdoses overall and deaths from drug overdoses associated
with each individual drug type identified using multiple cause-of-
death codes as the cause of interest in separate analyses.
PMRs were internally adjusted for age to account for
potential bias introduced by differential age structures in
populations of workers. Table II shows the data structure applied
to estimate age-adjusted PMRs for single occupation or industry
groups. The subscript i represents the i th age group (10-year
age categories 15–24, 25–34, and so on). A
i
is the observed
number of deaths in workers in an occupation or industry group
from the cause of death of interest (cause X) within the i th age
category, with all other values calculated similarly.
The expected number of deaths from the cause of interest
within a single occupation or industry group and age category is
estimated as:
( )
=
1
1
i
ii
i
M
EA N
T
Table II. Data structure applied to estimate age-adjusted
proportionate mortality ratios for single occupation or
industry groups
Occupation (or industry) group
Cause of death
Cause X
All other
causes All causes
Occupation Y . . . . . . . . . . . . . . . . . . A
i
B
i
N
1i
All other occupations . . . . . . . . . . . . C
i
D
i
N
2i
All occupations . . . . . . . . . . . . . . . . M
1i
M
2i
T
i
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.
Table I. 2000 U.S. standard population aged 15–64
Age group (years)
Population
N (percent)
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180,961,023 (100.0)
15–24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38,076,743 (21.0)
25–34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37,233,437 (20.6)
35–44 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44,659,185 (24.7)
45–54 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37,030,152 (20.5)
55–64 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,961,506 (13.2)
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.
32 National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023
Age-adjusted PMR
( )
=
∑
∑
PMR 100
i
i
i
i
A
AE
( ) ( )
+
=
+
PMR 100
BA
BA
A
E
A
EAA
+
= =
+
50
20
0
100
PMR 100 25
40
PMR 95% CIs are estimated using previously published
formulas for populations with 1,000 or fewer and over 1,000
total observed deaths from the cause of interest (56). For PMRs
with
( )
∑
i
i
A
over 1,000 from the cause of interest, the upper and lower
95% CIs were estimated as:
( )
−
= ±
∑
∑
1 212
2
11
1
CI PMR 196
i iii
i
ii
ii
i
i
MMNN
TT
MN
T
For PMRs with
( )
≤
∑
1,000
i
i
A
from the cause of interest, exact 95% CIs are estimated assuming
Poisson distribution of the data (56). As observed deaths from
a cause of death within each occupation or industry group and
age category are distributed approximately as Poisson random
variables, the total numbers of observed deaths from a cause
of death within each occupation or industry group are also
distributed as Poisson random variables. The mean of
( )
∑
i
i
A
is denoted as λ and PMR can be written as
( )
λ
∑
˘
i
i
EA
The 95% CIs are estimated by obtaining exact confidence limits
for λ and dividing the resulting end points by
( )
∑
i
i
EA
The lower limit of λ is denoted as L and the upper limit is denoted
as U. L and U may be estimated in SAS using the gaminv function
or in R using the qgamma function (57).
M
1i
is the observed number of deaths in all occupation or
industry groups with the cause of death of interest (cause X)
within the i th age category.
T
i
is the observed number of deaths in workers in all
occupation or industry groups from all causes of death within
the i th age category.
Observed and expected numbers of deaths from the cause
of interest within a single occupation or industry group are then
summed across all age categories, and PMR is estimated as:
( )
=
∑
∑
PMR 100
i
i
i
i
AE
A
A simplified example of estimation of an age-adjusted PMR
for cause X in occupation Y for a population with two age groups
(A and B) (Table III) is:
Age group A
( )
1
1
A
AA
A
M
EA N
T
=
( )
=
200
100 = 20
1000
A
EA
Age group B
( )
1
1
B
BB
B
M
EA N
T
=
( )
= =
200
400 40
2000
B
EA
Table III. Example data for estimation of an age-adjusted
proportionate mortality ratio for cause X in occupation Y for a
population with two age groups (A and B)
Occupation
Cause of death
Cause X
All other
causes All causes
Age group A
Occupation Y . . . . . . . . . . . . . . . . 50 50 100
All other occupations . . . . . . . . . . 150 750 900
All occupations . . . . . . . . . . . . . . 200 800 1,000
Age group B
Occupation Y . . . . . . . . . . . . . . . . 100 300 400
All other occupations . . . . . . . . . . 100 1,500 1,600
All occupations . . . . . . . . . . . . . . 200 1,800 2,000
SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.
National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023 33
The 95% CI is then estimated as:
( )
∑
100
i
i
L
EA
( )
∑
100
i
i
U
EA
Occupation and industry group-level PMRs are described
in comparison with the total population for overall estimates
or in comparison with the total demographic subpopulation for
stratified estimates against a referent PMR value of 100.0 in each
population. PMRs are considered elevated in this report if the
lower bound of the 95% CI is over 100.0. No hypothesis tests
were performed to compare PMRs between worker populations,
given the large number of comparisons, and a higher absolute
PMR within one worker population compared with another does
not indicate a statistically significant difference.
Suppression of unreliable estimates—An asterisk is shown
in place of a crude or age-specific PMR based on fewer than
20 deaths. The limit of 20 deaths is a convenient, if somewhat
arbitrary, benchmark, below which estimates are considered too
statistically unreliable for presentation. For age-adjusted PMRs,
the estimate is suppressed if the sum of the age-specific deaths
is fewer than 20 (53). NCHS data presentation standards for
proportions were applied to assess the statistical reliability of
percentages (22). An asterisk is shown in place of a percentage
for estimates that did not meet the standards (22).
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National Vital Statistics Reports, Vol. 72, No. 7, August 22, 2023
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Suggested citation
Billock RM, Steege AL, Miniño A. Drug
overdose mortality by usual occupation
and industry: 46 U.S. states and New York
City, 2020. National Vital Statistics Reports;
vol 72 no 7. Hyattsville, MD: National
Center for Health Statistics. 2023. DOI:
https://dx.doi.org/10.15620/cdc:128631.
Copyright information
All material appearing in this report is in
the public domain and may be reproduced
or copied without permission; citation as to
source, however, is appreciated.
National Center for Health Statistics
Brian C. Moyer, Ph.D., Director
Amy M. Branum, Ph.D., Associate Director for
Science
Division of Vital Statistics
Steven Schwartz, Ph.D., Director
Andrés A. Berruti, Ph.D., M.A., Associate
Director for Science
Contents
Abstract .......................................................1
Introduction ....................................................1
Methods .......................................................2
Data sources ..................................................2
Statistical Methods ..............................................2
Mortality measures .............................................2
Death rates ...................................................2
PMRs .......................................................3
Results ........................................................3
Drug overdose death rates by usual occupation and industry group .......3
Drug overdose PMRs by usual occupation and industry ................6
Drug overdose PMRs within construction and extraction occupations. . . . . . 6
Drug overdose PMRs by usual occupation and industry group and sex .....6
Drug overdose PMRs by usual occupation and industry group and
race and Hispanic origin ........................................6
Drug overdose deaths by usual occupation and industry group and
drug type ...................................................8
Drug overdose deaths by usual occupation and industry group and
drug overdose intent ..........................................9
Discussion ....................................................11
References ....................................................13
List of Detailed Tables ...........................................16
List of Internet Tables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Technical Notes ................................................29
Acknowledgments
This report was prepared in the Division of Vital Statistics (DVS) under the
direction of Steven Schwartz, DVS Director; Amy M. Branum, National Center for
Health Statistics (NCHS) Associate Director for Science; Andrés A. Berruti, DVS
Associate Director for Science; Robert N. Anderson, Mortality Statistics Branch
(MSB) Chief; and Elizabeth Arias, MSB Statistical Analysis and Research Team
Leader. Van Parsons and Yulei He consulted on statistical methods. Veronique
Benie prepared the mortality file. Registration Methods staff and Data Acquisition,
Classification, and Evaluation Branch staff provided consultation to state vital
statistics offices regarding collection of the death certificate data on which this
report is based. National Institute for Occupational Safety and Health’s Health
Informatics Branch staff coded and performed quality control of industry and
occupation coding. NCHS Office of Information Services, Information Design and
Publishing Staff edited and produced this report: Jen Hurlburt edited the report,
and Kyung M. Park produced the typesetting and graphics.
