The premature death rate improved in 12 Kentucky counties between 1997 and 2014 but got worse in 44 counties, in part because of increasing drug overdoses, according to a report released Wednesday.
Abuse of prescription drugs such as OxyContin helped drive up the rate of overdose deaths in the state by 296 percent from 2000 to 2010.
By 2010, the total was 979, but rising abuse of heroin and an even more powerful painkiller called fentanyl in recent years has pushed the total even higher.
Kentucky recorded just over 1,300 overdose deaths in 2015, up from 1,070 in 2012, according to Van Ingram, executive director of the Kentucky Office of Drug Control Policy, and a report from the office.
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Kentucky was among four states with the highest age-adjusted overdose death rate in 2015, along with West Virginia, New Hampshire and Ohio, according to the Centers for Disease Control and Prevention.
Ingram said final numbers are not yet available for 2016, but the number of overdose deaths in Kentucky appears to be close to the 2015 total.
It’s good news that the number didn’t continue to rise sharply, he said, but there wasn’t a significant decline either.
“It’s hard to celebrate leveling off,” Ingram said.
Kentucky wasn’t alone in seeing overdoses drive up premature deaths.
From 2014 to 2015, 85 percent of the increase in premature deaths nationwide can be attributed to a spike in deaths among people age 15 to 44, and much of that can be attributed to overdoses, the report said.
The state, legislators, health providers and others have taken a number of steps to deal with substance-abuse problems, including cracking down on unscrupulous prescribing practices, expanding treatment and making a drug called Naloxone, which can reverse heroin overdoses, more widely available.
Dr. Hiram Polk Jr., head of the Kentucky Department for Public Health, said in a news release with the report that the state’s proposed Medicaid waiver would direct more resources to fight substance abuse disorder, which he called “our number one public health crisis.”
But it will take years for the various efforts to make a significant dent in the problem.
“There is no quick fix,” Ingram said.
Dr. Connie White, senior deputy commissioner at the Kentucky Department for Public Health, said health care providers also are seeing people get chronic diseases younger.
There are multiple factors in that, but diabetes is an important one, White said.
Polk said in the news release that the state has increased access to diabetes services and is working on reforms to improve care for people with chronic diseases such as colorectal and lung cancer.
The finding on premature deaths was in a report called County Health Rankings & Roadmaps. The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute produce the report each year.
“The rankings allow local leaders to clearly see and prioritize the challenges they face — whether it’s rising premature death rates or the growing drug overdose epidemic — so they can bring community leaders and residents together to find solutions,” said Risa Lavizzo-Mourey, a physician who heads the Robert Wood Johnson Foundation.
The report shows that some Kentucky counties continue to compare poorly to others — and to the nation — on health measures such as the smoking rate, the percentage of residents with diabetes and access to doctors, and again illustrated the strong link between poverty and health.
The report ranked the five healthiest counties as Oldham, Boone, Spencer, Shelby and Woodford. Scott County ranked 6th and Fayette 7th.
All those counties are in the state’s so-called Golden Triangle — the region roughly bounded by Lexington, Louisville and Northern Kentucky, where jobs, doctors, access to exercise opportunities and adequate housing are more widely available than in most of the rest of the state.
The counties on the bottom end of the rankings were concentrated in Eastern Kentucky, where the rates of smoking, diabetes, obesity and poverty lead the state and there are fewer doctors and places for people to exercise.
Breathitt County ranked as the least healthy in the state in the report, followed by Wolfe, Owsley, Knott and Harlan.
The report measured premature death in terms of the years of potential life lost when someone died before age 75, adjusted for age.
In Oldham County, the combined total for 2012, 2013 and 2014 was 5,300 years. In Breathitt County, the total was 16,900 years.
White said work the state has done the last few years to tackle health problems hasn’t shown up yet in the rankings, since some data sets can lag behind by several years.
For instance, the state has worked to reduce teen pregnancy, and it has gone down.
The County Rankings & Roadmaps website has a variety of suggestions on how communities can try to improve health rankings. The measures can be as simple as building more sidewalks or trails so people can walk.
White said she will arrange for directors of county health departments to talk with people who researched the report about strategies they can consider putting in place to try to improve health.
“There are things they can do,” White said.
Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said the rankings show that there are many factors aside from medical care that influence health.
However, he said barring smoking in public places is the most significant thing communities, employers and schools systems could do to improve the health of residents.
Smoking kills 8,000 Kentuckians a year, Chandler said.
“Reducing smoking and exposure to secondhand smoke is the single most effective thing Kentucky communities can do to improve health,” Chandler said.