In a recent article by Tilstra et al., the authors characterize mortality rates from suicide, drug use, and alcohol use stratified by sex and race, with the goal of comparing non-Hispanic Black and non-Hispanic White death rates related to these “deaths of despair.” We commend the authors for this important work. The authors used data from the National Vital Statistics System and US Census to assess cause-specific mortality trends stratified by race and sex and found parallels in mortality trends for Black and White adults with respect to the opioid epidemic and the Great Recession. The authors did not observe period or cohort increases in suicide for Black men and women, stating that this finding warrants further study. Measurement error could underlie some of the unexpected trends the authors identified. One potential source of error is differential misclassification of suicide by race in the US National Center for Vital Statistics data. The authors cite a study that found the odds of suicide misclassification as “undetermined intent” was twice as high in Black populations compared with White populations. Additionally, the National Center of Health Statistics found evidence that deaths are overreported differentially in White and Black populations (overestimates of 1% and 5%, respectively), which may be related to historical undercounting of certain populations, including Black and Hispanic populations, in the Census denominator of the mortality rate
