key: cord-0252873-yjt3ghwv
authors: Friedman, J.; Hansen, H.
title: Black and Native Overdose Mortality Overtook that of White Individuals During the COVID-19 Pandemic
date: 2021-11-03
journal: nan
DOI: 10.1101/2021.11.02.21265668
sha: 8b0c146513e13447fad4bf9aa2186d01fa34b4a8
doc_id: 252873
cord_uid: yjt3ghwv

Drug overdose mortality rates have increased sharply during the COVID-19 pandemic. In recent years, overdose death rates were rising most rapidly among racial/ethnic minority communities. The pandemic has disproportionately affected communities of color in a wide swath of health, social, and economic outcomes. Careful attention is therefore warranted to trends in overdose mortality by race/ethnicity during COVID-19. We calculated total drug overdose death rates per 100,000 population by race/ethnicity for the 1999-2020 time period. We find that Black overdose mortality overtook that of White individuals in 2020 for the first time since 1999. Between 2019 and 2020 Black individuals had the largest percent increase in overdose mortality, of 48.8%, compared to 26.3% among White individuals. In 2020, Black overdose death rates rose to 36.8 per 100,000, representing 16.3% higher than the rate for White individuals for the same period. American Indian and Alaska Native (AI/AN) individuals experienced the highest rate of overdose mortality in 2020, of 41.4 per 100,000, representing 30.8% higher than the rate among White individuals. Our findings suggest that drug overdose mortality is increasingly becoming a racial justice issue in the United States and appears to have been exacerbated by the COVID-19 pandemic. Providing individuals with a safer supply of drugs, closing gaps in access to MOUD and harm reductions services, and ending routine incarceration of individuals with substance use disorders represent urgently needed, evidence-based strategies that can be employed to reduce rising inequalities in overdose.

communities. The pandemic has disproportionately affected communities of color in a wide 13 swath of health, social, and economic outcomes. Careful attention is therefore warranted to 14 trends in overdose mortality by race/ethnicity during COVID-19. We calculated total drug 15 overdose death rates per 100,000 population by race/ethnicity for the 1999-2020 time period. 16 We find that Black overdose mortality overtook that of White 

We calculated total drug overdose death rates per 100,000 population by race/ethnicity for the 50 1999-2020 time period, using data obtained from the National Center for Health Statistics 3 . 51 Records from 2020 were provisional and may underestimate the final level of drug overdose 52 related mortality. Drug overdose deaths were classified as those assigned with the underlying 53 cause of death in the ICD-10 categories pertaining to unintentional, suicide, homicide, or 54 undetermined intent drug overdose deaths, (X40-44, X60-64, X85, or Y10-14, respectively). We 55 calculated annual percent change in a race/ethnicity specific fashion for the 2000-2020 period. 56 All analyses were conducted using R version 4.0.3. See appendix for more details.

We find that Black overdose mortality overtook that of White individuals in 2020 for the first 59 time since 1999. In 2020, Black overdose death rates rose to 36.8 per 100,000, representing 60 16.3% higher than the rate for White individuals for the same period. This is a sharp reversal of 61 the Black-White overdose mortality gap noted in 2010, when the rate among White individuals 62 was double (100.1% higher) than that seen among Black individuals. These shifts reflect that 63 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted November 3, 2021. Deep-seated inequalities in living conditions including stable housing and employment, policing 83 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted November 3, 2021. ; https://doi.org/10.1101/2021.11.02.21265668 doi: medRxiv preprint and arrests, preventive care, harm reduction, telehealth, medications for opioid use disorder 84 (MOUD) and naloxone, are likely playing a key role 4,5 . 85 Further, the increasing toxicity of the drug supply has increased the lethality of recent CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted November 3, 2021. ; https://doi.org/10.1101/2021.11.02.21265668 doi: medRxiv preprint Year-to-year percent change in drug overdose mortality by race/ethnicity (top). Drug overdose mortality per 100,000 population by race/ethnicity (bottom). A vertical dashed line separates the COVID-19 pandemic period from prior trends.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted November 3, 2021. ; https://doi.org/10. 1101 /2021 

COVID-19 and the Drug Overdose Crisis: Uncovering the Deadliest Months in the 118 United States

) stratified by race, 162 ethnicity, and year of occurrence. Both population counts, and counts of overdose fatalities 163 were provided, and used as the denominator and numerator, respectively. 164 2. Overdose mortality rates for 2020 were calculated using provisional race/ethnicity stratified 165 drug overdose mortality counts released by the National Center for

Mid-year population estimates by race/ethnicity for the year 2020 were obtained from the CDC 169 Wonder platform

Total drug overdoses were defined by the following ICD-10 codes

X40 (Accidental poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics

X41 (Accidental poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified) X42 (Accidental poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified) X43 (Accidental poisoning by and exposure to other drugs acting on the autonomic nervous system) X44 (Accidental poisoning by and exposure to other and unspecified drugs, medicaments and biological substances) X60 (Intentional self-poisoning by and exposure to nonopioid analgesics

X61 (Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonism and psychotropic drugs, not elsewhere classified) X62 (Intentional self-poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified) X63 (Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system) X64 (Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substances) X85

Y10 (Poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics

not elsewhere classified, undetermined intent) Y12 (Poisoning by and exposure to narcotics and psychodysleptics [hallucinogens], not elsewhere classified, undetermined intent) Y13 (Poisoning by and exposure to other drugs acting on the autonomic nervous system, undetermined intent) Y14 (Poisoning by and exposure to other and unspecified drugs, medicaments and biological substances, undetermined intent) 172 5. 'Latinx' individuals were defined as any persons for

American Indian or Alaska Native, Non-Hispanic

Non-Hispanic" individuals were defined as individuals of 175 each race, who had their ethnicity listed as "non-Hispanic

Year-to-year percent change values were calculated for each year t in a race/ethnicity group-179 specific fashion according to the following formula