Objective To determine differences in mortality rates and trends according to the occupation of workers who died from the ‘deaths of despair’ (DoD).

Methods Death certificates for deaths due to poisonings (including opioid-related overdoses), suicides, and alcoholic liver disease occurring in Massachusetts from 2000 to 2015 were collected and coded according to the occupation of the decedent. Mortality rates and trends in mortality were calculated for each occupation. We also examined possible underlying causes of differences by occupation in rates of DoD by investigating the relationship between occupational injuries and DoD using data from the U.S. Bureau of Labor Statistics.

Results DoDs increased by more than 50% from 32.5 deaths per 100,000 workers in 2000–2004 to 49.6 in 2011–2015. Deaths increased in all three cause categories, but opioid-related deaths increased most rapidly. There were substantial differences in mortality rates and trends according to occupation. There were particularly elevated risks for blue collar, notably: construction; farming, fishing, and forestry; installation, maintenance, and repair; transportation and material moving; building and grounds cleaning and maintenance; production; and healthcare support workers. Most of these occupations not only had higher than average rates of death, but these rates also increased more rapidly over the 16 year period. As hypothesized, occupations with high injury rates also suffered from high DoD mortality rates. Compared to occupations in the lowest quartile of injuries (< 40 per 10,000 full-time workers), those in the high quartile (> 199 per 10,000 full-time workers) had nearly 4 times higher rates of DoD.

Conclusions These findings suggest that work may be a factor contributing to DoD. Interventions should be targeted to the needs of workers with elevated mortality rates and trends for the deaths of despair. Further work is needed to identify preventable risk factors for these outcomes that may be contributing to these.