Clustering patterns in polysubstance mortality in the United States in 2017: a multiple correspondence analysis of death certificate data

Purpose: The main goal of this analysis was to identify mortality patterns apparent when many drug classes are analyzed together.Methods: The Drug Involved Mortality database is a registry of drug terms mentioned on death certificates of all drug-related deaths in the United States. Means of total number of drugs involved and percentages of specific drug combinations were calculated. Dimensionality reduction using multiple correspondence analysis and hierarchical clustering identified clusters of drugs listed on death certificates. Results: An average of 2.4 specific drugs were listed on death certificates in 2017. For 9 of the top 10 drugs involved, over 80% of deaths involved at least one other drug. As expected, opioid drugs and psychostimulants clustered together, but other psychoactive substances (non-opioid analgesics, sedatives, antidepressants, antipsychotics) clustered together into multi-class groups. Other drugs (e.g., acetaminophen, oxymorphone) were frequently involved in polysubstance death, but did not cluster with any other specific drug. Deaths involving illicit drugs listed fewer drugs than deaths involving prescription drugs.Conclusions: While individual drug substances might contribute to many deaths (e.g., fentanyl), polysubstance mortality is more common than single substance mortality. Multidimensional analyses integrating all drugs involved are useful to identify uncommon patterns of overdose and changing trends.(c) 2022 Elsevier Inc. All rights reserved.

Automated summary

The purpose of this analysis was to identify mortality patterns by analyzing multiple drug classes together. The Drug Involved Mortality database was used to calculate the total number of drugs involved and percentages of specific drug combinations. Clustering techniques were then applied to identify patterns of drug combinations listed on death certificates. The results showed that while individual drug substances contribute to many deaths, polysubstance mortality is more common than single substance mortality. Multidimensional analyses integrating all drugs involved are useful in identifying uncommon overdose patterns and changing trends.