Middlesex County ranks ninth on a nationwide list of overdose deaths per 100,000 residents among 44 counties with populations over 1 million.

Middlesex -- whose largest city is Lowell -- is shown as having 24.3 deaths per 100,000 residents for 2016, according to an analysis of government data by the Pew Charitable Trusts. The 44 county median is put at 13 deaths per 100,000.

This is in keeping with the Massachusetts Department of Health release this month listing Number of Opioid-Related Overdose Deaths, All Intents, by County, between 2000-2016.

Middlesex County tops that state list with 2,578 deaths. Suffolk County follows among the top five with 1,814 deaths; Essex, 1,764; Worcester, 1,690, and Bristol, 1,634 deaths.

The state had a total of 13,870 opioid-related deaths, all intents, by residents during those years.

In the Pew listing of drug overdose deaths per 100,000 residents among the 44 counties in the country, Pennsylvania's Allegheny County, which includes the city of Pittsburgh, tops the list at 50.2 deaths per 100,000 residents. Philadelphia is second with 46 per 100,000 residents.

Third was Cuyahoga, Ohio, with 45 deaths per 100,000, followed by Palm Beach, Fla., with 41.5 deaths. Missouri's Wayne County was fifth on the list with 36.9 deaths per 100,00 residents.

Others listed in the top 10 include Florida's Broward County, Suffolk County on Long Island, Franklin County in Ohio and Arizona's Pima County.

The analysis said some jurisdictions with less than one million residents had higher recorded death rates in 2016.

A recent report from Massachusetts Health Department shows an estimated 8.3 percent decline in opioid-related deaths in 2017 from the previous year. It also reports that toxicology screens show a leveling off of opioid-related overdose deaths where prescription drugs were present, and drop in the number of Schedule II opioid prescriptions dispensed.