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Comment & Response
August 14, 2018

Variation in Deaths From Intentional Injury and Substance Use

Author Affiliations
  • 1Department of Epidemiology, West Virginia University School of Public Health, Morgantown
  • 2Division of Alcohol and Drug Abuse, McLean Hospital, Boston, Massachusetts
JAMA. 2018;320(6):601. doi:10.1001/jama.2018.7323

To the Editor Dr Dwyer-Lindgren and colleagues highlighted the variation in mortality from substance use and intentional injuries in the United States.1 Although the authors acknowledged study limitations in general terms, absent was consideration of the differential effect of cause and manner of death misclassification on observed rate variability. Although their underlying cause of death category for substance use disorders blended chronic and acute outcomes, it was dominated by poisoning, and more particularly by drug intoxication.