Higher rates of suicide, substance abuse in Nevada

By MARSHALL ALLEN and ALEX RICHARDS
Las Vegas Sun
Tuesday, July 03, 2007

Nevadans and residents of Clark County, which includes Las Vegas, die younger and at higher rates of suicide, substance abuse and certain chronic illnesses compared with the rates nationally and in other large counties.

That is the conclusion of a Las Vegas Sun analysis of mortality data gathered by the U.S. Centers for Disease Control and Prevention. The comprehensive CDC database includes the fate of every American -- a detailed summary of every death certificate in the United States since 1959, documenting about 5,000 possible causes of death from rarities such as leprosy and yellow fever to mass killers such as heart disease.

The Sun compared the death rates in Clark County and Nevada with the same rates nationwide -- analyzing about 14.5 million deaths from 1999 to 2004, the most recent year for which data are available -- to find ways in which death in Nevada differed from national patterns.

The analysis revealed:

-- Nevadans have the 12th-highest rate of death among people younger than 65.

-- Nevada's rate of deadly accidental poisoning and exposure to noxious substances, which includes drug overdose, is almost twice the national rate. Clark County has the nation's third-highest rate of fatal drug overdose for counties with more than 1 million people, behind only Bronx County, N.Y., and Cook County, Ill.

-- The state's rate of death from alcoholic liver disease is 1.7 times that of the national rate, and Clark County is ninth among counties with more than 1 million people.

-- Nevada's suicide rate is about twice the national figure, and Clark County's rate is by far the highest among counties with more than 1 million residents.

"It's always striking to see those kind of elevated rates across a whole range of outcomes," said Matt Wray, a UNLV sociologist who specializes in the study of suicide.

The numbers have their limits. Most strikingly, they can tell what happened, but not why. And there can be variances based on human error and the way states and individual coroners classify causes of death.

Sheniz Moonie, an epidemiologist and biostatistician at UNLV who reviewed the Sun's analysis and methods, said the large amount of data each year -- about 2.5 million Americans die annually -- compensates for reporting variances, although it can be difficult to accurately compare one area with another. Other experts said the CDC numbers provide a starting point for more research, but are not conclusive.

Wray said the strength of the findings is that they provide a scope of death in Nevada.

The findings figure into the debate, for instance, over whether Las Vegas' relatively libertine environment causes behaviors that lead to substance abuse and suicide, or whether people predisposed to such behaviors -- "brighter-burning candles who flame out" -- are drawn here, Wray said.

"My belief is that there are things about this place that are worth looking at closely," Wray said.

Ultimately, whether the higher death rates caused by substance abuse and suicide are attributable to the people or the place, Las Vegas is growing.

Experts need to find out what's behind the death-rate statistics "or things are going to get worse," he said.

There are many theories, but few answers, about why Nevada's suicide rate is so much higher than other states', said Wray, who is on a two-year fellowship at Harvard University.

The contributing factors include problem gambling, social isolation, substance abuse and the state's weak mental-health system, he said.

Las Vegas' preponderance of drinking and drugs may explain the CDC's rates of death from liver disease caused by alcoholism and accidental drug overdose, UNLV addiction specialist Larry Ashley said.

"We're a city based in excesses, in many ways," he said. But Las Vegas and Nevada also are short on treatment options for people with addictions, he said.

"There are probably citizens who need to be in treatment who can't because they can't access them," Ashley said.

Dr. John McDonald, dean of the University of Nevada School of Medicine, said it is particularly interesting that Nevada is the only Western state that's high on the list of places where people die young.

In Nevada, an average of 285 people per 100,000 who were younger than age 65 died annually from 1999 to 2004. That's 9 percent higher than in New Mexico, 15 percent higher than in Arizona and 41 percent higher than in California.

The state's excess mortality, combined with the CDC numbers on chronic disease rates in Nevada, creates a heavy societal burden, he said. Long-term diseases impose a high financial toll on families and health systems.

Moonie said many of the chronic illnesses that cause death at higher rates in Nevada are associated with risk factors and behaviors. Artery hardening is caused by a buildup of fat that's caused by diet. Alcoholic liver disease, which includes fatty liver and cirrhosis, is caused by long-term drinking.

Such chronic conditions raise questions about whether there are particular behaviors among Nevadans that contribute to greater disease and death, Moonie said. She ticked off a few relevant questions: Are Nevadans less active? Do they have high-fat diets? Do they consume more alcohol than in other states?

The CDC shows Nevada ranked eighth in the nation in 2006 for heavy drinking, defined as males who drink at least two alcoholic beverages a day and women who drink at least one a day.

(Marshall Allen can be reached at marshall.allen(at)lasvegassun.com. Alex Richards can be reached at alex.richards(at)lasvegassun.com.)