Prescription opioids and population cardiovascular mortality in US South female non-Hispanic whites

Recent ecological studies have demonstrated that mid-life mortality rates in US American Indians and non-Hispanic whites (NHW) have been rising for the past 20 years and are correlated with prescription opioid sales. The study hypothesis was that temporal correlations exist between annual hydrocodone and oxycodone sales and female NHW CV mortality rates in the Deep South USA. Six states in the Deep South were studied across the 2000–2017 timeframe: Alabama, Arkansas, Louisiana, Mississippi, Oklahoma, and South Carolina. Female NHW mortality rates in the 35–44-, 45–54-, and 55–64-, and 65–74-year-old groups were obtained from the CDC Wonder Detailed Mortality database. Hydrocodone and oxycodone sales data were obtained from the State Health Access Data Assistance Center database. Time-series datasets were graphed and analyzed using Spearman rank correlation testing, after second differencing to control for trend. A 1-year adjustment was made to accommodate a 1-year temporal lag of mortality behind opioid sales. Annual CV mortality in 35–44-year-old NHW females was not associated with annual opioid sales. Annual CV mortality in 45–54-year-old NHW females was correlated with hydrocodone sales [rs(13) 0.650; P = 0.009], oxycodone [rs(13) 0.454; P = 0.090], and combined hydrocodone–oxycodone [rs(13) 0.764; P = 0.001]. Annual cardiovascular mortality in 55–64-year-old NHW females was associated with hydrocodone sales [rs(13) 0.499; P = 0.059], oxycodone [rs(13) 0.561; P = 0.030], and combined hydrocodone–oxycodone [rs(13) 0.545; P = 0.036]. Annual CV mortality in 65–74-year-old NHW females was associated with oxycodone [rs(13) 0.696; P = 0.004]. At the population level, prescription opioid sales are temporally correlated with cardiovascular mortality rates in NHW females of the Deep South.