Discrepancies in the reported frequency of cocaine-related deaths, United States, 1983 through 1988
D. A. Pollock, P. Holmgreen, K. J. Lui and M. L. Kirk
Division of Injury Control, Centers for Disease Control, Atlanta, GA 30333.
OBJECTIVE.--To assess the validity of cocaine-related mortality data
available from the principal federal sources of information about the
frequency of drug abuse deaths in the United States: the national vital
statistics system and the Drug Abuse Warning Network (DAWN). DESIGN,
SETTING, AND PARTICIPANTS.--We compared the number of cocaine-related
deaths reported to national vital statistics and DAWN from 25 metropolitan
areas during the years 1983 through 1988. We also compared cocaine-related
mortality data reported to national vital statistics with data from all
published forensic case series of cocaine-related deaths that occurred
during the mid-1980s. RESULTS.--During the 6-year study period, 75% more
cocaine-related deaths were reported to DAWN (6057) than to national vital
statistics (3466) from the 25 metropolitan areas that were studied. For
individual metropolitan areas, the discrepancy between DAWN and vital
statistics counts of cocaine-related deaths was as large as a sixfold
difference. In six of the seven forensic case series identified in our
literature search, the number of cocaine-related deaths exceeded the number
of these deaths reported to vital statistics. The largest discrepancy was
for cocaine-related deaths in New York, NY, during a 10-month period in
1986 for which 151 deaths were reported in a case series and seven deaths
were reported to vital statistics. CONCLUSION.--Improvements in existing
public health surveillance systems are needed for (1) full and accurate
measurements of the lethal impact of drug abuse epidemics and (2) valid and
comprehensive assessments of the effectiveness of national programs
designed to prevent drug-related morbidity and mortality.
