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.
Rockett IRH, Connery HS. Variation in Deaths From Intentional Injury and Substance Use. JAMA. 2018;320(6):601. doi:10.1001/jama.2018.7323
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