MPH 530 Week 2 Descriptive Epidemiology by Person, Place and Time Example

Time, Place and Person: Describing Drug Overdose Deaths in Colorado and Eight Neighboring States, 2019 to 2026

[Student Name]

University of Phoenix

MPH/530: Epidemiology Concepts and Public Health Diseases

Week 2 Assignment

[Instructor Name]

[Date]

The county health department and its analysis are composites written for a model paper; state counts come from the CDC data set cited, retrieved in September 2026, and population figures are rounded census estimates used for approximate rates.

The county's overdose fatality review team met monthly to review each death. At one meeting, a member asked the epidemiologist a question the team had never answered: beyond this year's total, what do the numbers actually show? The epidemiologist responded with a descriptive epidemiology of overdose deaths in Colorado and its neighbors. This paper presents it.

Descriptive Epidemiology

Descriptive epidemiology organizes health data by time, place and person. It shows when a problem occurs, where it is concentrated and whom it affects, and it generates hypotheses that analytic studies can test. Variation by these three dimensions is the starting point for understanding causes (Bhopal, 2008).

The Data

The analysis uses CDC's provisional drug overdose death counts, which report 12-month-ending totals by state and month, overall and by drug class (Centers for Disease Control and Prevention, 2026). Each value is the number of deaths in the 12 months ending in the stated month.

Time: The Rise

Colorado's 12-month count was 992 in January 2019 and 1,100 by December 2019. It then climbed steeply, reaching 1,512 by December 2020 and 1,917 by December 2021, a 74% increase over two years.

Time: The Plateau, Decline and Rebound

Counts held near 1,900 through 2023, reaching 1,926 in December 2023, dropped by about 290 to 1,640 for 2024, then climbed back by roughly 180 to 1,819 for 2025. The 2024 decline matched national trends; the 2025 rebound did not.

Seasonality

Month-to-month patterns within a year were hard to see in 12-month totals, so the county team examined its own monthly deaths. They found no strong seasonal pattern, but clusters of deaths sometimes followed the arrival of a new, stronger batch of drugs, which surveillance of local deaths and emergency visits could detect faster than annual totals.

Why 12-Month Totals

Twelve-month-ending totals smooth out month-to-month noise and seasonal variation, making trends easier to see. Their drawback is that they react slowly to sudden changes; a sharp increase in one month is spread over a year.

Place: Comparing States

Counts alone mislead, because states differ in size. Using rounded census estimates, the epidemiologist calculated approximate crude rates for 2025. New Mexico, with 961 deaths and about 2.1 million residents, had about 45 per 100,000. Arizona, with 2,978 deaths and about 7.6 million residents, about 39. Colorado, with 1,819 deaths and about 6.0 million, about 30. Oklahoma, about 21; Utah, about 19; Kansas, about 18; Wyoming, about 14; and Nebraska, with 146 deaths and about 2.0 million residents, about 7 (Centers for Disease Control and Prevention, 2026).

Reading the Place Pattern

The highest rates were in the Southwest states along drug trafficking routes from the border, and the lowest in the Plains states. Colorado was in the middle. These are crude rates and could shift with age adjustment, since states differ in age structure.

Place: Change Over Time

Between 2019 and 2025, counts rose in most states: Colorado from 1,100 to 1,819, New Mexico from 609 to 961, Arizona from 1,981 to 2,978. Nebraska was unchanged at 146. The rise was broad across the region but uneven.

Person: Drugs Involved

Drug-specific counts describe what killed people. In Colorado, deaths involving synthetic opioids other than methadone, mainly fentanyl, rose from 251 in 2019 to 1,044 in 2025. Deaths involving psychostimulants such as methamphetamine rose from 367 to 879, and cocaine from 135 to 343. Deaths involving heroin fell from 218 to 27 (Centers for Disease Control and Prevention, 2026). Heroin nearly disappeared from the death data as fentanyl replaced it.

Overlap Among Drugs

Drug categories overlap because many deaths involve more than one substance. In 2025, synthetic opioid and psychostimulant deaths together exceed the total, meaning many people died with both fentanyl and methamphetamine in their systems.

Person: Race and Ethnicity

The provisional data do not describe race and ethnicity, so the epidemiologist turned to national research. An analysis of national data found that overdose mortality rose especially steeply among Black residents and among Native American communities before and during the COVID-19 pandemic, with rates in these groups exceeding those among White people (Friedman & Hansen, 2022). Local death certificate data will be needed to see whether Colorado follows this pattern.

Person: Age and Sex

Local death certificate reviews by the county team showed most overdose deaths among men aged 25 to 54, consistent with national patterns, though deaths among adults over 55 were rising.

What Descriptive Data Cannot Tell Us

Descriptive patterns show associations in time and place, not causes. The rise in 2020 coincided with the pandemic and with fentanyl's spread, but descriptive data cannot separate these influences. Place differences may reflect differences in reporting and testing as well as true risk.

Limits of the Data

The counts are provisional and may be revised. Drug categories overlap. Rates here are approximate crude rates using rounded population estimates, not official age-adjusted rates. Race and ethnicity data for Colorado were not available in this data set.

Sharing the Picture

The epidemiologist presented the analysis to the review team with three charts: Colorado's 12-month trend line, a bar chart of approximate state rates and a chart of drug-specific counts in 2019 and 2025. Team members said the charts changed their sense of the problem, especially the collapse of heroin deaths and the rise of stimulant-involved deaths, which they had not appreciated from individual case reviews.

Local Place Patterns

Within the county, the team mapped overdose deaths by residence. Deaths clustered in three neighborhoods near the city center and along the highway corridor, which pointed naloxone distribution and outreach to specific places.

Hypotheses From Time

The steep rise in 2020 and 2021 coincided with the spread of illicit fentanyl and pandemic disruptions to treatment and social support. Hypothesis: the introduction of fentanyl into the local drug supply accounts for most of the increase.

Hypotheses From Place

Higher rates in the Southwest suggest supply route effects. Hypothesis: proximity to trafficking corridors is associated with higher fentanyl-involved death rates.

Hypotheses From Person

The combination of fentanyl and methamphetamine suggests polysubstance use. Hypothesis: people using stimulants are exposed to fentanyl unknowingly, raising their risk.

Testing the Hypotheses

The hypotheses could be tested with a case-control study comparing people who died of overdose with living people who use drugs, or a cohort following people released from jail or treatment, examining exposures such as fentanyl test results and treatment status.

Implications for the County

Even before analytic studies, the patterns suggest actions: distribute naloxone and fentanyl test strips to people who use stimulants, not only opioids, and prepare for rebounds rather than assuming declines will continue.

Conclusion

Organized by time, place and person, Colorado's overdose data tell a clearer story than a single annual total: a steep rise to 2021, a partial decline and a rebound, rates in the middle of a region with large differences and a shift from heroin to fentanyl and stimulants. Descriptive epidemiology does not prove causes, but it points to the hypotheses and actions the county should pursue next.

References

Bhopal, R. S. (2008). Variation in disease by time, place, and person. In Concepts of epidemiology (2nd ed., pp. 47-82). Oxford University Press. https://doi.org/10.1093/acprof:oso/9780199543144.003.0003

Centers for Disease Control and Prevention. (2026). VSRR provisional drug overdose death counts [Data set]. data.cdc.gov. https://data.cdc.gov/d/xkb8-kh2a

Friedman, J. R., & Hansen, H. (2022). Evaluation of increases in drug overdose mortality rates in the US by race and ethnicity before and during the COVID-19 pandemic. JAMA Psychiatry, 79(4), 379-381. https://doi.org/10.1001/jamapsychiatry.2022.0004