Abstract
BACKGROUND: Kentucky has historically experienced a high burden of drug overdose deaths. During the first years of the COVID-19 pandemic, the state saw a 45% increase in overdose deaths in 2020, followed by an additional 15% increase in 2021. However, drug overdose deaths declined in 2023 and 2024. This study used electronic death certificate records from the Kentucky Office of Vital Statistics (2019-2024) to evaluate whether Kentucky's 2024 drug overdose death rates have declined to pre-pandemic levels and if declines were observed across all demographic groups. The results from Poisson regressions are reported as rate ratios (RRs) and their 95% confidence intervals (CIs). FINDINGS: The estimated 2024 crude drug overdose death rate (31.7/100,000) remained significantly higher than the 2019 rate (29.2/100,000; RR [CI] = 1.08 [1.01-1.17]; P = .035). Several demographic groups had sustained increases from 2019 to 2024: male (RR [CI] = 1.10 [1.00-1.21]), Black residents (RR [CI] = 1.56 [1.22-2.00]), residents aged 55-64 (RR [CI] = 1.41 [1.18-1.70]) and 65 or older (RR [CI] = 1.71 [1.25-2.33]), and residents of non-metropolitan counties (RR [CI] = 1.38 [1.22-1.57]). However, adults aged 25-34 experienced a significant decrease from 2019 to 2024 (RR [CI] = 0.77 [0.65-0.92]). The 2024 rate of fentanyl-involved overdose deaths was not statistically different from 2019 level [RR [CI] = 1.10 [1.00-1.22]; P = .051], but the psychostimulant-involved overdose death rate (RR [CI] = 1.45 [1.30-1.62]) was significantly higher. CONCLUSIONS: The recent decline in drug overdose deaths is encouraging, but sustained increases in mortality rates among some demographic groups highlight the need for continued public health initiatives to prevent overdose deaths.