The Appalachian Drug Overdose interactive tool was designed and developed by NORC’s Walsh Center for Rural Health Analysis, our Health Media Collaboratory, and our Visualization Laboratory in partnership with the Appalachian Regional Commission (ARC).

The interactive tool was created in JavaScript using the Leaflet library. Data was processed using SAS and converted from shapefile to GeoJSON using the ogr2ogr web client. County-level drug overdose death rates were downloaded from the National Vital Statistics System Multiple Causes of Death File. Employment data come from the U.S. Bureau of Labor Statistics’ Quarterly Census of Employment and Wages. Additional data were derived from the U.S. Census Bureau’s American Community Survey .

The visualizer presents age-adjusted mortality rates for the population aged 15 to 64. Deaths are classified using the International Classification of Diseases, Tenth Revision. Drug overdose deaths are identified using underlying cause-of-death codes X40-X44, X60-X64, X85, and Y10-Y14. The combined population estimates for the time period (either 2006-2010 or 2011-2015) are the denominator for the mortality rates. Five-year average mortality rates were used for this tool in order to maximize the number of counties with a reliable age-adjusted mortality rate. If a county has fewer than 20 deaths over the five-year time period, the mortality rate is considered “unreliable” and we present the crude mortality rate. For counties with fewer than 10 deaths over the five-year time period, the number of deaths is suppressed, and therefore a mortality rate is not provided. However, when possible, we have calculated the maximum crude mortality rate based on the population and the assumption of less than 10 deaths.

Counties were classified as “urban” or “rural” using designations from ARC, which are based on a simplification of the USDA’s Economic Research Services (ERS) 2013 Urban Influence Codes (UIC). Urban counties include large metro counties (counties that include large metropolitan centers of one million population or greater) and small metro counties (counties with metropolitan centers of less than one million population). Rural counties include non-metro counties adjacent to large metros, non-metro counties adjacent to small metros, and non-metro counties not adjacent to a metro.

This tool allows researchers, policymakers, journalists, and the general public to create county-level maps illustrating the relationship between community and population demographics and fatal drug overdoses—including opioids—in the Appalachian Region of the United States. Insights derived from this tool can be used to target resources and interventions, and inform media coverage related to overdose deaths in Appalachia.

The base layer shows the fatal overdose rate by county at two points in time. Darker-colored counties have higher overdose rates. Lighter-colored counties have lower overdose death rates. You can use the List of Counties to link directly to data on a particular county, or click on it on the map.

Click on the dot in the “timeframe” slider in the upper-right section of the screen to change the years represented by the overdose layer.

Use the “urban/rural” drop down to compare data from rural and urban counties.

Choose variables from the left-hand column to layer county-level economic and demographic data on top of the baseline fatal overdose data. By showing the variables as translucent circles of varying sizes, the tool allows users to clearly see how a given measure relates to the baseline fatal overdose rate. For example, choosing “Poverty Rate” will demonstrate the relationship between an individual county’s poverty rate and its overdose mortality rate.