Death Certificate data are collected by the DSHS Vital Statistics Section during the death registration process. Each death certificate includes literal causes of deaths provided by medical certifiers. Literal causes of deaths are coded by the NCHS coding software which is using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) - Mortality, implemented in 1999. The NCHS coding software identifies a single underlying cause-of-death that is defined as disease or injury that initiated the events resulting in death.
Death Data for this module are derived from the information collected on death certificates for individuals who died in Texas, regardless of the place of residence. Individuals who lived in Texas but died out-of-state are excluded. The demographic, geographic, and medical information included in this module are: county of occurrence, age, race/ethnicity, sex, year of death, and underlying cause of death.
Texas adopted the new U.S. Standard Certificate of Death in 2006. Users are cautioned that some data items might not be directly comparable with previous years.
The type of opioid involved is indicated by the following ICD-10 cause of death codes: heroin (T40.1), commonly prescribed opioids (natural and semisynthetic opioids, T40.2; methadone, T40.3), synthetic opioids other than methadone (T40.4), opium (T40.0), and other and unspecified narcotics (T40.6). The inclusion of ICD-10 code T40.6 is based on guidance from the Centers for Disease Control and Prevention (2017). This code is used in cases where the death certificate does not contain enough information to assign a specific ICD-10 code (e.g., the cause of death is listed as “opioid”). Natural and semisynthetic opioids include natural opioid analgesics (e.g., morphine and codeine) and semisynthetic opioid analgesics (e.g., oxycodone, hydrocodone, hydromorphone, and oxymorphone). Synthetic opioids, other than methadone, include opioids such as tramadol and fentanyl. It is not possible to determine whether an opioid was illegally produced or pharmaceutical, nor how it was obtained; for example, deaths from fentanyl include both legally prescribed and illegally produced fentanyl. Deaths from opioids may involve more than one type of opioid (e.g.,heroin and opioid pain relievers), so users should avoid adding totals by opioid category.
Type of Death
"All Deaths (Natural and Injury) where Opioids Were Involved" are those deaths which include at least one of the following ICD-10 codes: T40.0, T40.1, T40.2, T40.3, T40.4, T40.6. Data include all deaths where opioids contributed to the death, regardless of circumstance.
"Poisoning Deaths, All Intents, where Opioids Were Involved" are those deaths which include one of the following ICD-10 codes among the underlying causes of death: X40-X44 (accidental), X60-X64 (intentional), X85 (homicide), Y10-Y14 (undetermined intent), and at least one of the following ICD-10 codes identifying opioids: T40.0, T40.1, T40.2, T40.3, T40.4, T40.6.
"Accidental Poisoning Deaths where Opioids Were Involved" are those deaths which include at least one of the following ICD-10 codes among the underlying causes of death: X40-X44, and at least one of the following ICD-10 codes identifying opioids: T40.0, T40.1, T40.2, T40.3, T40.4, T40.6.
Benzodiazepines (e.g., diazepam, alprazolam, and clonazepam) are a class of sedatives typically prescribed for the treatment of neurological and psychological conditions. Opioids and benzodiazepines both depress the central nervous system and medical experts strongly caution against concurrent use of the two due to a greater likelihood of adverse events, including death (Dowell, Haegerich, & Chou, 2016; FDA, 2016). “Yes” indicates that a benzodiazepine (ICD-10 code T42.4) was involved in the death.
Centers for Disease Control and Prevention (2017). CDC’s Opioid Overdose Indicator Support Toolkit: Guidance for building and reporting on opioid-related mortality, morbidity, and PDMP indicators (version 2.0).
Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. JAMA. 2016;315(15):1624–1645. doi:10.1001/jama.2016.1464
FDA (2016). Black Box Warning Opioids and Benzodiazepines: Available at https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm518110.htm
For more information about this module, please contact CHS-Info@dshs.texas.gov
For data requests, please email VSTAT@dshs.texas.gov