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The Economic Costs of Alcohol and Drug Abuse in the United States - 1992
Mortality

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Synopsis

Alcohol and drug abuse caused more than 132,000 deaths in 1992. The estimated loss of productivity resulting from these deaths was $45.9 billion using a 6-percent discount rate - 107,000 alcohol-attributable deaths cost an estimated $31.3 billion, and 25,000 deaths due to drug abuse cost an estimated $14.6 billion. This study, using 1992 mortality and cost data, found that the number of deaths attributed to alcohol had increased 13 percent since the previous study conducted by Rice et al. (1990) using 1985 data. Alcohol-attributable deaths increased from 94,768 in 1985 to 107,360 in 1992. The number of deaths attributed to drug abuse alone increased by 20 percent, and when other drug abuse-related conditions (tuberculosis, AIDS, and hepatitis) were added, the number of drug abuse deaths tripled from 7,454 to 25,493. The number of deaths during 1985 estimated by Rice et al. (1990) was 50 percent higher than the estimate of Harwood et al. (1984) for 1980. Table 5.2 summarizes the number of deaths and cost effects for alcohol and drug abuse.

Economic costs were estimated using the "human capital" approach to valuation of loss of expected years of life and productivity that would been undertaken over the course of life. These values are dependent on the age and gender of the decedent to reflect both the life expectancy as well as expected value of market and nonmarket/household productivity. This approach is in contrast to the "willingness-to-pay" approach, which attempts to reflect both expected loss of productivity (the essence of the human capital approach) as well as the "value" of pain and suffering. Studies performed for the U.S. Department of Health and Human Services and the Public Health Service have predominantly used the human capital approach, although cost-benefit studies (for example, studies of highway safety and pollution control) often use the willingness-to-pay approach (Miller et al. 1991). Human capital values are materially lower than "typical" willingness-to-pay values and, thus, will yield "conservative" estimates for economic costs relative to estimates based on the willingness-to-pay approach. Most of the prior studies on the economic costs of alcohol and drug abuse have used the human capital approach (an exception is Miller et al. 1997a,b). It has never been addressed whether special willingness-to-pay estimates would be needed for alcohol and drug abuse.

The following sections report the numbers of deaths attributed to alcohol and drugs and the estimated economic costs of those deaths using the human capital approach.

Methodology for Estimating Deaths

This study uses the same approach employed in the studies by Rice et al. (1990) and Cruze et al. (1981). The approach entails:

  • Identifying the causes of death (ICD-9 diagnoses) that can be entirely or partially attributed to alcohol and drugs,
  • Obtaining estimates of appropriate "attribution factors" by diagnosis,
  • Accessing data on the number of deaths for each diagnosis by age and gender group, and
  • Applying economic values by age and gender group for the present discounted value of expected lifetime productivity.

Mortality data are from 1992, the year for which detailed estimates have been developed. This study estimates values using discount rates of 3 percent, 4 percent, and 6 percent and primarily uses the 6-percent values in order to remain consistent with Rice et al. (1990) and previous studies. The concepts of expected lifetime productivity and discounting are discussed earlier, in section 3.3.3, as well as following, in section 5.2.3.

Deaths Attributable to Alcohol Abuse

This study first identified the ICD-9 codes - listed as the primary cause of death - that, according to the most recent research, are attributable entirely or partially to alcohol abuse. As a first step in this analysis, a list of applicable diagnoses, the proportion of deaths attributable to alcohol for each diagnosis (as designated by the attribution factor, or AF), and the corresponding age ranges were drawn from The Eighth Special Report to the U.S. Congress on Alcohol and Health (National Institute on Alcohol Abuse and Alcoholism [NIAAA] 1993). This list was supplemented with data from a report published by NIAAA in 1993 (Stinson et al. 1993). The final list of diagnoses, along with respective AF values, was reviewed and supplemented slightly by NIAAA staff.

The number of alcohol-related deaths for each ICD-9 code was calculated by multiplying the AF for each diagnosis by the total number of deaths in the relevant age range indicating the particular ICD-9 code as the primary cause of death. Mortality data with detailed age and gender distributions by diagnostic code for 1991 were initially obtained from the most recent public-use National Center for Health Statistics (NCHS) ICD-9 mortality data series (see table 5.3). Subsequently, this study gained access to NCHS mortality estimates for 1992, which have been used to adjust the 1991 values (NCHS 1996b).

The parameters for the alcohol analysis differ only modestly from the Rice et al. (1990) analysis. This study includes some of the deaths related to diseases in four categories not included in the Rice et al. (1990) study that have been recently studied for their relationship with alcohol abuse. The net effect of these additional categories is an extra 10,900 deaths attributed to alcohol abuse in the current study than would have been counted using the categories employed by Rice et al. (1990). These additional four diagnoses are the following:

  • Hypertension,
  • Cerebrovascular disease,
  • Chronic hepatitis, and
  • Other chronic liver diseases.

In addition, biliary cirrhosis has been dropped.

This study uses specified age breaks (e.g., age 15 and older) for 15 of the disease categories that were used by Rice et al. (1990) without age restrictions. This approach was adopted in accordance with current understanding of disease etiology (Stinson et al. 1993). Despite these restrictions, the number of deaths attributed to those categories for which there were age restrictions and for which there were no other methodological changes was slightly higher for this study than for the Rice et al. (1990) study.

Finally, there were 11 diagnostic codes for which the previous nonzero AF was reduced (e.g., automotive crashes and falls) or was increased (e.g., suicide, homicide, drowning, and fires). The net impact of such attribution changes applied to 1992 mortality in the indicated age groups is to increase attributed deaths for these 11 diagnoses from about 44,800 (using factors applied by Rice et al.) to 46,300 (using factors in this study).

Deaths Attributable to Drug Abuse

A similar process to that used for alcohol-attributable deaths was followed for identifying deaths attributable to drug abuse. The Rice et al. (1990) study (and previously Cruze et al. [1981]) employed a list of drug abuse-related causes (diagnostic codes) originally designated by the National Institute on Drug Abuse for use by the Drug Abuse Warning Network (Gottshalk et al. 1977, 1979). This list includes diagnoses representing abuse of and dependence on psychoactive drugs as well as accidental and intentional (i.e., suicide) poisoning by a broad range of drugs and medicaments - psychoactive and otherwise.

The rationale for using the broad list of drug types had its origin in the difficulty of determining the motivation for drug ingestion. Inappropriate use of prescription or nonprescription drugs constitutes drug abuse, whether a person takes a prescription medication without a prescription or takes a drug for an objective other than that for which it is appropriate.

This study has augmented the basic list of codes by incorporating estimates of deaths from several health problems associated with drug abuse and dependence. Chapter 4 presents the reviews and analyses performed to obtain estimates of attribution factors for tuberculosis, hepatitis B and C, and AIDS for health expenditures. The primary data and references used to calculate the attributable deaths for each of these additional diagnoses are briefly reviewed below. Table 5.4 summarizes data on the number of deaths attributed in this study to drug abuse.

AIDS

In 1992, 33,566 persons died of AIDS (NCHS 1996b). These data are obtained through the national death certificate data. Attribution of AIDS deaths was based on mortality data from national case reports for 1991 submitted to the Centers for Disease Control and Prevention (CDC) surveillance system. This source was chosen because the mortality data provide comprehensive information about AIDS exposure (CDC unpublished data, November 1994). The estimate of 33,566 AIDS deaths incorporates a downward adjustment for the fact that among deaths of AIDS patients, 88 percent were due to AIDS or AIDS-related causes, and the other 12 percent were unrelated (e.g., trauma) (Chu et al. 1993). The most recent year with complete data at the time that these calculations were developed was 1991.

This analysis applied to the reported 33,566 deaths the proportion of deaths within the following exposure categories from the CDC mortality data set (these values were adjusted upward to account for the 5 percent of deaths with no identified exposure category):

  • Adults/adolescents who are injecting drug users (about 24 percent of deaths with identified exposure category);
  • Adults/adolescents who have heterosexual sex with injecting drug users (about two-thirds of the 6 percent exposed through heterosexual contact);
  • Adult/adolescent men who have sex with men and inject drugs (one-half of the 6 percent with dual exposure); and
  • Children (under age 13) with a mother who has an infection or is at risk for infection because she is an injecting drug user or has sex with an injecting drug user (more than one-half of the 1 percent who were pediatric AIDS cases).

Out of the 33,566 AIDS deaths in 1992, this study attributes 10,737, or about 32 percent, to intravenous drug abuse. This rate is slightly below the 36-percent AF used for health care expenditures. The difference in these values lies in that the proportion of injecting-drug-user HIV cases has steadily increased since the beginning of the epidemic. The proportion of deaths (this section) actually represents AIDS cases reported several years previously.

Hepatitis B and C

The ICD-9 death certificate data undercount the number of deaths due to hepatitis B and C because they do not make the link between hepatitis and chronic liver disease. As an alternative to the ICD-9 data, the CDC Hepatitis Branch has developed annual death estimates, which take into account the toll of chronic liver disease brought on by hepatitis B and C (CDC 1993c, personal communication). The Branch estimates that there are 4,000 to 5,000 deaths a year from hepatitis B and 8,000 to 10,000 from hepatitis C. For the purposes of this analysis, the midpoint of these CDC-produced ranges is used to estimate that there were 4,500 deaths annually from hepatitis B and 9,000 annually from hepatitis C.

To estimate the numbers of these deaths attributable to intravenous drug use, this study relies on a sentinel risk factor study conducted by the CDC in four representative U.S. counties (Alter et al. 1990a). These studies reported the risk factors for acquiring hepatitis B and C, including parenteral (intravenous) drug use as a factor. Although these data do not link case development to death reports, it is thought that these are the most complete data presently available to estimate the number of hepatitis deaths associated with drug use. This study reported that 20 percent of the hepatitis C cases and 30 percent of the hepatitis B cases were linked to drug use for the range of years studied. This analysis uses these percentages as AF's to calculate the number of deaths attributable to drug use.

Tuberculosis

As described in chapter 4 of this report, it is estimated that drug abuse contributes to 4.5 percent of the tuberculosis cases that occur each year. This figure is applied to the deaths identified through the public-use data set from ICD-9 codes for tuberculosis (010 to 018). Co-infection with HIV does not lead to double counting of dually exposed individuals because both the death certificate ICD-9 system and the AIDS surveillance data from the CDC that this study uses impose a hierarchy of classification that assigns dually infected individuals to HIV/AIDS instead of tuberculosis.

Mortality Costs

The death of a person represents a loss of productive potential, whether in the marketplace (employment) or in the household. This productive potential has a clear economic value. For example, many families buy life insurance to protect against the potential loss of future productive contributions by those contributing to the upkeep of the household through jobs, homemaking responsibilities, or both. In instances of wrongful death, court cases make awards to family members of decedents based at least partially on their expected future earnings as well as the cost of replacing their expected contributions to maintaining the household. The "value of life" is recognized to be more than the replacement of future productive contributions. There are two major methods generally used to estimate the costs of premature mortality: the human capital and the willingness-to-pay approaches, both of which were briefly discussed in chapter 3.

This study applies the human capital approach to the estimation of mortality costs. This is the approach that has been used in most previous cost-of-illness studies (Hodgson and Meiners 1982). The approach to estimation of the cost for an individual is to sum the present discounted value of estimated productivity (market as well as nonmarket) over the person's expected remaining lifetime. Using this approach, a dollar value is assigned to production lost because of premature death.

The table of expected lifetime productivity (market plus nonmarket/household) by age and sex for 1992 was obtained in a personal communication from Dorothy Rice (1997). The formula for these calculations appears in Rice et al. (1990). Because Rice estimated lifetime productivity values for discount rates of 2, 4, and 6 percent, but not 3 percent, this value was interpolated from the values for 2 percent and 4 percent, which were provided by Rice. Analysis of the tables provided by Rice indicated that the interpolation should use the geometric mean, which actually provides a lower estimate of the value than use of the arithmetic mean or "average" provides. These estimates appear in appendix B of this report. Recent research suggests that a 3-percent discount value (as well as other, higher values) should be used in performing cost-benefit studies of health services (Gold et al. 1996).

The calculation of "present discounted value of expected lifetime earnings" for a person of a given age and gender begins with Bureau of Census "life tables." These tables provide average expected additional years of life (which depends on gender and current age) and use data on the average expected value of market (wages plus the value of fringe benefits) plus nonmarket productivity by age and gender. Expected productivity values are generally assumed to grow by 1 percent annually, reflecting expected growth in real labor productivity over time. Summing these values across the expected lifetime yields total expected lifetime productivity. For economic purposes, values in future years are adjusted down (discounted) by an amount related to the number of years in the future and the selected discount rate (equivalent to an interest rate). This adjustment reflects that a dollar today is worth more next year because it can accrue interest in the interim. Accordingly, a future value is reduced when considered in present discounted value terms. The higher the discount rate and the further in the future, the lower the present discounted value of future productivity.

Discussion is warranted on at least two particular issues in application of human capital estimates to alcohol and drug abusers: the discount rate and the expected future course of productivity. It is possible that a person with an alcohol or drug abuse problem may have lower productivity than a member of the general population - indeed, this is examined and supported in the next section of this report. The question is whether such a factor would justify using values lower than those for the general population in estimating future productivity. The rationale for not making such an adjustment or reduction is that if alcohol or drug abuse has caused the initial/current deficit relative to expected productivity, then future deficits will probably also be caused by those problems. Although it is likely that alcohol and drug abusers would have had lower future productivity, this would be caused by and attributable to alcohol and drug abuse, and making the adjustment would omit a material effect and cost that should be counted.

The appropriate discount rate for human capital estimates is somewhat controversial (Burkhead and Miner 1971). A high discount rate gives a lower present value of expected earnings, and a low discount rate gives a higher present value of expected earnings. There is extensive debate about what rate is appropriate for what kinds of studies. Higher rates (such as 8 to 10 percent) are used when there is more risk or uncertainty associated with a stream of values, while lower discount rates (2 to 4 percent) are used when there is less risk or uncertainty around events. Higher rates give preference to current benefits and consumption, whereas lower discount rates give more emphasis to future consumption and benefits. The major prior alcohol and drug studies have used a value in between - 6 percent - and the primary justification for using this value is to allow comparability with previous estimates. However, lower values, such as 3 percent, are apparently being used in much cost-benefit work for the Office of Management and Budget. This study reports costs using rates of 3, 4, and 6 percent. The more conservative, 6-percent figure (in that it gives lower cost estimates) is used in constructing and reporting the total estimates.

Using a 6-percent discount rate, the costs of alcohol and drug abuse-related deaths in 1992 are estimated to be $45.2 billion. About $30.7 billion of this is attributed to alcohol abuse (see table 5.5), and $14.6 billion is attributed to drug abuse (see table 5.6), or about $290,000 per alcohol-related death and $570,000 per drug-related death. The value per drug death is much higher because much of the alcohol-related mortality occurs at older ages as a result of chronic effects (cirrhosis and neoplasms), whereas virtually all the drug deaths are among young and prime-age adults (drug overdoses, homicide, and AIDS). Estimates are also calculated and reported using 3-percent and 4-percent discount rates. At a 3-percent discount rate, the estimated costs are $45.7 and $21.3 billion, respectively, or $425,000 and $835,000 per death for alcohol and drug abuse.

Much higher costs would result from application of the willingness-to-pay approach. A review of the willingness-to-pay literature found an average value per death across 47 studies of $2.3 million in 1989 dollars (cited in Miller et al. 1995). Adjusted for 3 years of inflation (about 12 percent to $2.55 million per death), this approach would indicate losses of $274 billion for alcohol-related mortality and $65 billion for drug-related deaths. These values are almost 9 and 4.5 times greater, respectively, than the estimates obtained using the human capital approach with a 6-percent discount rate. The application of the willingness-to-pay technique should be given further consideration. It was found that for smoking behaviors, willingness-to-pay values were substantially lower than for other populations and risks. It is worth considering whether the willingness-to-pay to save the lives of alcohol and drug abusers would be different from values for other types of risk and how such values would compare with other willingness-to-pay values.

Table 5.2: Total Number of Deaths and Economic Costs for Premature Mortalities Attributed to Alcohol and Drug Abuse, 1992

Table 5.2: Total Number of Deaths and Economic Costs for Premature Mortalities Attributed to Alcohol and Drug Abuse, 1992
Category Deaths Economic Cost
(millions of dollars)
Alcohol abuse 107,360 $31,327
Drug abuse 25,493 $14,575
TOTAL 132,853 $45,902

Note: Components may not sum to totals because of rounding. Economic cost is the present discounted value of expected lifetime market plus nonmarket productivity, discounted by 6 percent. Estimates are also presented later in this section for 3-percent and 4-percent discount rates.

Table 5.3: Number of Deaths Attributable to Alcohol Abuse, 1992
Table 5.3: Number of Deaths Attributable to Alcohol Abuse, 1992
Cause ICD-9 Code Percent Attributed This Study Percent Attributed Rice et al. (1990) Estimate This Study, 1992 Data Estimate Rice et al. (1990), 1985 Data
DIRECT PRIMARY CAUSES
Alcoholic psychoses 291.0 100 100 384 368
Alcohol dependence syndrome 303.0 100 100 5,217 4,188
Nondependent abuse of alcohol 305.0 100 100 788 750
Alcoholic polyneuropathy 357.5 100 100 4 2
Alcoholic cardiomyopathy 425.5 100 100 878 767
Alcoholic gastritis 535.3 100 100 90 61
Alcoholic cirrhosis 571.0-571.3 100 100 11,868 11,288
Excessive blood level of alcohol 790.3 100 100 34 12
Accidental poisoning - alcohol E860.0-E860.1 100 100 179 175
Subtotal 19,442 17,611
DIRECT SECONDARY CAUSES
Respiratory tuberculosis 011-012 25 25 329 342
Malignant neoplasm of lip, cavity, and pharynx 140-149 50 (men)
40 (women)		 47 3,741 3,896
Malignant neoplasm - esophagus 150 75 75 7,665 6,460
Malignant neoplasm - stomach 151 20 20 2,700 2,790
Malignant neoplasm of liver and interhepatic bile ducts 155 15 15 1,411 1,021
Malignant neoplasm of larynx 161 50 (men)
40 (women)		 49 1,894 1,716
Diabetes mellitus 250 5 5 2,423 1,848
Essential hypertension 401 8 0 416 0
Cerebrovascular disease 430-438 7 0 9,985 0
Pneumonia and influenza 480-487 5 5 3,693 3,378
Diseases of esophagus, stomach, and duodenum 530-537
(not 535.3)		 10 10 892 943
Chronic hepatitis 571.4 50 0 349 0
Cirrhosis of liver w/out alcohol 571.51 50 50 5,654 6,667
Biliary cirrhosis 571.6 0 50 0 (w/571.5)
Other chronic nonalcoholic liver damage 571.8 50 0 199 0
Unspec. chronic liver disease without mention of alcohol 571.9 50 0 118 0
Portal hypertension 572.3 50 0 67 0
Acute pancreatitis 577.0 42 41 907 917
Chronic pancreatitis 577.1 60 67 126 159
Subtotal 42,569 30,137
INJURIES AND ADVERSE EFFECTS INDIRECTLY ATTRIBUTED TO ALCOHOL
Motor vehicle accidents E810-E825 42 51 17,196 23,190
Pedal cycle, other road accidents E826,
E8292		 20 20 45 76
Water transport accidents E830-E838 20 35 167 388
Air and space transport accidents E840-E845 16 10 175 143
Accidental falls E880-E888 35 41 4,372 4,919
Accidents caused by fire/flames E890-E899 45 42 1,831 2,067
Accidental drowning, submersion E910 38 30 1,339 1,851
Suicide and self-inflicted injury E950-E959 28 13 8,476 3,828
Homicide and injury purposely inflicted by other persons (Rice et al. [1990]: 960-8) E960-E969 46 42 11,609 8,329
Other injuries and adverse effects (Rice et al. [1990] used different coding) E901, E911
E917, E918
E919, E920
E922, E980		 25 11 139 2,229
Subtotal 45,349 47,020
TOTAL 107,360 94,768

Sources: Analysis by The Lewin Group based on data from the National Institute on Alcohol Abuse and Alcoholism (1993), Stinson et al. (1993), National Center for Health Statistics (1996b), and Rice et al. (1990).
Note: Components may not sum to totals because of rounding.
1Rice et al. (1990) included 571.6 in this category. 
2Rice et al. (1990) included E825 in this category.

Table 5.4: Number of Deaths Attributable to Drug Abuse, 1992
Table 5.4: Number of Deaths Attributable to Drug Abuse, 1992
Cause ICD-9 Code Estimate This Study, 1992 Data Estimate Rice et al. (1990), 1985 Data
Drug psychoses 292 13 11
Drug dependence 304 309 1,165
Nondependent abuse of drugs 305.2-305.9 777 524
Polyneuropathy due to drugs 357.0 0 0
Newborn affected by maternal transmission of narcotics and hallucinogens via placenta or breast milk 760.72,   760.73 NA 0
Drug withdrawal syndrome in newborn 779.5 6 1
Accidental poisoning by drugs, medicaments, and biologicals E850-858 (Rice et al. [1990] includes 859) 5,951 3,552
Agricultural and horticultural chemical and pharmaceutical preparations other than plant foods and fertilizers E863 18 0
Heroin, methadone, other opiates and related narcotics, and other drugs causing adverse effects in therapeutic use E935.0-E935.2, E937-E940 27 33
Injury undetermined whether accidentally or purposely inflicted from poisoning by drugs, medicaments, and other E980 1,464 832
Homicide and injury purposely inflicted by other persons (age > 15) E960-E969 2,514 0
Tuberculosis 010-018 77 0
Hepatitis C various 900 0
Hepatitis B various 2,700 0
AIDS various 10,737 1,336
TOTAL 25,493 7,454

Sources: Attribution factors: Gottshalk et al. (1977); analysis by The Lewin Group.
Note: The 760.7 diagnosis contains several factors in addition to narcotic and hallucinogen drugs. There were 69 deaths under this diagnosis in 1992, but the five-digit cause of death values were not available. Number of deaths derived from the National Center for Health Statistics (1996b) (mortality by cause for 1992).

Table 5.5: Economic Cost of Mortalities Due to Alcohol Abuse, for Various Discount Rates, 1992
Table 5.5: Economic Cost of Mortalities Due to Alcohol Abuse, for Various Discount Rates, 1992
Causes of Death, by ICD-9 Code Total Deaths Attributed to Alcohol Abuse Discounted Economic Effects
(millions of dollars)
Cause ICD-9 Code Percent Age Number 3% 4% 6%
Direct Primary Causes
Alcoholic psychoses 291 384 100 > 0 384 113.9 103.8 88.3
Alcohol dependence syndrome 303 5,217 100 > 0 5,217 2,215.9 2,012.3 1,701.1
Nondependent abuse of alcohol 305.0 788 100 > 0 788 504.4 445.8 360.7
Alcoholic polyneuropathy 357.5 4 100 > 0 4 1.0 1.0 0.9
Alcoholic cardiomyopathy 425.5 878 100 > 0 878 329.0 299.7 254.7
Alcoholic gastritis 535.3 90 100 > 0 90 42.1 38.0 31.9
Alcoholic cirrhosis 571.0-571.3 11,868 100 > 0 11,868 4,664.2 4,246.7 3,604.9
Excessive blood level of alcohol 790.3 34 100 > 0 34 31.2 27.0 21.2
Accidental poisoning by alcohol E860.0, E860.1 179 100 > 0 179 128.1 113.0 91.1
Direct Secondary Causes
Tuberculosis 011-012 1,315 25 >35 329 905.8 811.0 670.1
Malignant neoplasm of lip, oral cavity, and pharynx 140-149 8,107 50 (men)
40 (women)		 >35 3,741 632.6 589.1 519.1
Malignant neoplasm of esophagus 150 10,239 75 >35 7,665 1,073.3 1,005.0 893.8
Malignant neoplasm of stomach 151 13,630 20 >35 2,700 316.6 294.6 259.3
Malignant neoplasm of liver and interhepatic bile ducts 155 9,555 15 >35 1,411 178.8 166.4 146.5
Malignant neoplasm of larynx 161 3,114 50 (men)
40 (women)		 >35 1,894 284.8 266.5 236.7
Diabetes mellitus 250 50,067 5 >35 2,423 255.3 237.3 208.6
Essential hypertension 401 5,232 8 >35 416 33.7 31.5 27.8
Cerebrovascular disease 430-438 143,769 7 >35 9,985 586.3 546.4 482.5
Pneumonia and influenza 480-487 75,719 5 >35 3,693 181.8 168.9 148.5
Diseases of esophagus, stomach, and duodenum 530-537
(excl. 535.3)		 9,088 10 >35 892 67.6 62.8 55.2
Chronic hepatitis 571.4 729 50 >35 349 65.9 60.8 52.6
Cirrhosis of liver without mention of alcohol 571.5 11,506 50 >35 5,654 1,145.2 1,058.0 920.0
Other chronic nonalcoholic liver damage 571.8 482 50 >35 199 94.8 86.2 73.0
Unspecified chronic liver disease without mention of alcohol 571.9 244 50 >35 118 23.4 21.5 18.6
Portal hypertension 572.3 144 50 >35 67 12.0 11.2 9.9
Acute pancreatitis 577.0 2,317 42 >35 907 170.5 156.6 134.8
Chronic pancreatitis 577.1 222 60 >35 126 33.9 31.0 26.6
Injuries and adverse effects indirectly attributable to alcohol
Motor vehicle traffic and nontraffic accidents E810-E825 40,982 42 > 0 17,196 12,685.1 10,692.3 8,023.1
Pedal cycle and other road vehicle accidents E826, E829 223 20 > 0 45 28.6 24.1 18.2
Water transport accidents E830-E838 837 20 > 0 167 133.1 113.9 87.6
Air and space transport accidents E840-E845 1,094 16 > 0 175 129.9 113.6 90.3
Accidental falls E880-E888 12,646 35 >15 4,372 664.8 591.6 485.1
Accidents caused by fires and flames E890-E899 3,958 45 > 0 1,831 994.5 806.1 572.4
Accidental drowning and submersion E910 3,524 38 > 0 1,339 1,068.2 869.0 617.1
Suicide and self-inflicted injury E950-E959 30,484 28 >15 8,476 5,533.4 4,801.1 3,771.6
Homicide and injury purposely inflicted by other persons E960-E969 25,144 46 >15 11,609 10,342.2 8,746.8 6,589.3
Other injuries and adverse effects E901, E911,
E917, E918,
E919, E920,
E922, E980		 558 25 >15 139 45.8 40.8 33.5
Total 483,490   107,360 45,717.7 39,691.5 31,326.6

Sources: Alcohol attributable factors: National Institute on Alcohol Abuse and Alcoholism (1993) and Stinson et al. (1993); number of deaths: National Center for Health Statistics (1996b); NCHS Public Use ICD-9 Data Tape (age and gender distribution for deaths by ICD code for 1991); economic costs: Rice (1997), personal communication. Present discounted values for the 3-percent discount rate were estimated by interpolation of values for 2- and 4-percent discount rates.
Note: Components may not sum to totals because of rounding.

Table 5.6: Economic Cost of Mortalities Due to Drug Abuse, for Various Discount Rates, 1992
Table 5.6: Economic Cost of Mortalities Due to Drug Abuse, for Various Discount Rates, 1992
Causes of Death, by ICD-9 Code ICD-9 Code Total Deaths Attributed to Drug Abuse Discounted Economic Impact
(millions of dollars)
Cause Percent Number 3% 4% 6%
Direct Primary Causes
Drug psychoses 292 13 100 13 6.7 5.9 4.7
Drug dependence 304 309 100 309 255.1 224.8 180.8
Nondependent abuse of drugs 305.2-305.9 777 100 777 618.8 544.6 437.1
Drug withdrawal syndrome in newborn 779.5 6 100 6 4.3 2.9 1.5
Accidental overdose of psychoactive drugs
Opiates and related narcotics E850.0 1,279 100 1,279 1,130.9 992.5 792.4
Aromatic analgesics, not elsewhere classified E850.2 69 100 69 36.7 32.2 25.9
Other non-narcotic analgesics E850.7 0 100 0 0.0 0.0 0.0
Other E850.8 167 100 167 151.7 132.6 105.2
Unspecified analgesics and antipyretics E850.9 2 100 2 1.9 1.7 1.4
Barbiturates E851 21 100 21 13.3 11.6 9.3
Other sedatives and hypnotics E852 11 100 11 7.6 6.6 5.3
Tranquilizers E853 65 100 65 39.6 34.9 28.1
Other psychotropic agents (incl. antidepressants) E854 269 100 269 197.7 171.4 134.6
Other drugs acting on the central and autonomic nervous system E855 1,113 100 1,113 1,009.4 877.3 689.6
Agricultural and horticultural chemical and pharmaceutical preparations other than plant foods and fertilizers E863 18 100 18 9.9 8.4 6.3
Accidental Overdose of Drugs and Medicaments
Salicylates E850.1 56 100 56 23.5 20.5 16.3
Pyrazole derivatives E850.3 2 100 1 0.9 0.9 0.8
Antirheumatics E850.4 3 100 2 1.8 1.5 1.2
Other non-narcotic analgesics E850.5 79 100 79 60.8 53.5 42.9
Accidental poisoning by antibiotics E856 55 100 55 15.3 13.3 10.6
Accidental poisoning by other anti-infectives E857 5 100 5 3.1 2.7 2.2
Hormones and synthetic substitutes E858.0 18 100 18 5.7 5.1 4.2
Primarily systemic agents E858.1 44 100 44 21.3 18.2 14.0
Agents primarily affecting blood constituents E858.2 33 100 33 13.0 9.9 6.4
Agents primarily affecting cardiovascular system E858.3 218 100 218 16.8 14.9 12.2
Agents primarily affecting gastrointestinal system E858.4 3 100 3 1.0 0.9 0.8
Water mineral and uric acid metabolism drugs E858.5 75 100 75 13.6 11.8 9.4
Agents primarily acting on the smooth and skeletal muscles and respiratory system E858.6 8 100 8 3.7 3.1 2.4
Agents primarily affecting skin and mucous membrane, ophthalmological, otorhinolaryngological, dental drugs E858.7 7 100 7 1.0 1.0 0.9
Other specified drugs E858.8 1,328 100 1,328 1,133.0 993.6 792.5
Unspecified drug E858.9 1,021 100 1,021 855.1 749.6 597.3
Heroin, methadone, other opiates and related narcotics, and other drugs causing adverse effects in therapeutic use E935.0-E935.2
E937-E940		 27 100 27 5.4 4.8 3.9
Injury Undetermined Whether Accidental or Purposely Inflicted
Analgesics, antipyretics, and antirheumatics E980.0 491 100 491 404.7 355.0 283.4
Barbiturates E980.1 13 100 13 9.3 8.1 6.5
Other sedatives and hypnotics E980.2 8 100 8 6.0 5.3 4.2
Tranquilizers and other psychotropic agents E980.3 159 100 159 109.9 96.5 77.3
Other specified drugs and medicinal substances E980.4 478 100 478 405.1 352.9 278.6
Unspecified drug or medicinal substance E980.5 252 100 252 201.0 176.6 141.3
Other and unspecified solid and liquid substances E980.9 63 100 63 45.1 39.4 31.3
Homicide and injury purposely inflicted by other persons E960-E969 25,144 10 2,514 2,239.2 1,893.7 1,426.6
Other Causes
Tuberculosis 010-018 1,705 4.5 77 21.2 19.0 15.7
Hepatitis C See discussion 4,500 20 900 819.4 698.2 532.0
Hepatitis B See discussion 9,000 30 2,700 2,438.3 2,077.9 1,583.9
AIDS See discussion 33,566 32 10,737 8,958.2 7,849.1 6,254.3
Total 25,493 21,316.3 18,524.6 14,574.9

Sources: Attribution factors: Gottshalk et al. (1977); analysis by The Lewin Group, Chu et al (1993), Alter et al. (1990a); number of deaths: National Center for Health Statistics (1996b); NCHS Public Use ICD-9 Data Tape (age and gender distribution for deaths by ICD code for 1991); economic costs: Rice (1997), personal communication. Present discounted values for 3 percent were estimated based on values for 2 percent and 4 percent, respectively.
Notes: Components may not sum to totals because of rounding.