They call it “death by despair” — suicide, drug overdose and alcohol abuse.

And Gila County’s apparently suffering an epidemic of such deaths.

That’s one conclusion that emerges from a national Commonwealth Fund study of a dismaying rise in death rates from those three causes between 2005 and 2017.

Arizona remains in the upper third in all three categories, with Gila County scoring well above the already worrisome state average.

A surge in opiate deaths linked to the abuse of prescription painkillers contributed to the trend, researchers concluded. However, the study also drew a connection between access to affordable health care and the rise in deaths from drugs, alcohol and suicide.

Overall, Arizona ranked 32nd nationally when it comes to health system performance despite an overall improvement after expanding its Medicaid (AHCCCS) program.

The steady rise in deaths slowed with the introduction of the Affordable Care Act, which cut the number of people without medical insurance in half while also requiring health plans to cover treatment for mental health and drug addiction issues. However, the impact of those changes lessened after 2015, with mounting restrictions on the Affordable Care Act.

Overall, the states that accepted the federal money to expand their Medicaid programs (AHCCCS in Arizona) did better. But states that refused the expansion offer generally suffered much faster increases in their death rates, the report concluded.

Overall, drug overdose death rates have risen 115 percent, suicides by 28 percent, and alcohol-related deaths by 37 percent, with most of the increase coming between 2015 and 2017, concluded the researchers.

If states with high death rates like Arizona did as well as the low-death states, it would save 90,000 lives annually, the report concluded.

The report didn’t provide county-by-county breakdowns. However, a 2015 Gila County community health survey documented a suicide rate of 33.7 per 100,000 people in Gila County. That compares to a rate of 18 statewide and 14 nationally. The study also found rates of drug use and overdose deaths in Gila County well above the state average — which is well above the national average.

The earlier community study found relatively high rates of drug use by Gila County residents. Among teens, 40 percent have smoked tobacco, 30 percent use alcohol and 19 percent use marijuana. Among adults, 16 percent report engaging in binge drinking — all much higher than the state average in each category.

The Commonwealth study found deaths from all three causes hit all-time highs in 2017.

“The sharp growth in drug overdose death is most alarming. While the overdose rate has somewhat moderated recently, the 10 percent jump between 2016 and 2017 is still among the highest annual increases the nation has seen,” concluded the report.

The rise in alcohol deaths and suicide have also proved dismaying, with a strong link between the two. “Steady increases in suicides and deaths linked to alcohol are also concerning and represent yet another marker of complex socioeconomic and behavioral health problems across the nation.”

Suicide rates jumped more sharply between 2016 and 2017 than any other one-year period on record. Moreover, alcohol-related deaths rose at a 2 percent annual rate between 2005 and 2012, then at a 4 percent rate between 2013 and 2017.

However, death rates and increases differed markedly from one state to another. For suicide, the lowest rate was 6.6 deaths per 100,000 and the highest 28.9. For alcohol, the lowest rate was 5.5 deaths per 100,000 and the highest 31. For drug overdoses, the lowest rate was 8.1 and the highest a staggering 57.8.

Arizona ranked near the top when it came to alcohol-related deaths and in the top third for suicides and drug overdoses.

The state-by-state trends seemed to reflect different levels of access to affordable health care, the report concluded.

“In nearly all states, there were widespread reductions in uninsured rates between 2013 and 2017. As more people gained coverage, fewer cited cost as a barrier to receiving care. But in most states, progress stalled after 2015,” the report concluded.

More than 15 percent of Arizona residents said they skipped medical care because they couldn’t afford it throughout the period, despite the state’s expansion of AHCCCS.

Interestingly, the study also reported that the cost of private medical insurance through workplaces has risen much faster than the cost of care through Medicare or Medicaid. The rise in premiums and out-of-pocket costs may account for the number of people skipping care due to the cost despite the reduction in the ranks of the uninsured in Arizona.

Arizona remains among a handful of states where health care premium contributions exceed 8 percent of the median income, the report concluded.

Congress has eliminated marketing for the Affordable Care Act, cut back on spending on the online portals and limited payments to expanded Medicaid programs. Moreover, 17 states have decided not to expand their Medicaid programs through the Affordable Care Act.

“At the same time, health care costs in employer plans continue to grow at a faster rate than median income, leaving many families paying more for their insurance but getting less. Most alarming, in some states residents now face shorter life expectancies than just a few years ago, in part because of unrelenting increases in deaths linked to suicide, alcohol and drug overdose.”

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