Racial Differences in Opioid Overdose Deaths in New York City, 2017

Since the early 2000s, drug overdose death rates have increased in the United States.¹ From 2000 to 2011, opioid analgesic overdose deaths drove these increases, with the highest rates among whites.² Since 2011, opioid analgesic overdose deaths have remained stable or decreased; in 2016, more deaths involved the synthetic opioid fentanyl than all other opioid analgesics.³ Recent national data suggest changing patterns of overdose among specific populations and age cohorts, including increases in opioid and cocaine deaths among blacks.⁴ Although the overall number of opioid analgesic deaths has plateaued, overdose death rates continue to increase among younger and middle-aged whites.⁵ We examined 2017 New York City data on overdose deaths to determine patterns related to age, race, and drug type.

We obtained death certificate data from the New York City Office of Vital Statistics and toxicology files from the New York City Office of the Chief Medical Examiner (OCME). Deaths were defined as overdose if the OCME determined an accidental manner of death and assigned the underlying or multiple cause of death an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) code of X40 through X44, F11 through F16, or F18 or F19 (excluding F-codes with 0.2 or 0.6 third digit, which are not specific to drug overdose). Drug-involvement classifications were based on postmortem toxicology testing. Race and ancestry are collected separately on the death certificate. Following National Century for Health Statistics Guidelines, responses were recoded into 1 of the following 4 race/ethnicity categories: non-Hispanic white, non-Hispanic black, Latino, and undefined/other. We calculated numbers of deaths, age-adjusted rates per 100 000 people, and standard errors, and compared drug-specific overdose death rates by age and race. We adjusted data for age using 2000 United States standard and New York City population estimates, modified from United States Census Bureau intercensal population estimates for 2016, as updated in September 2017. We constructed 95% confidence intervals (CIs) for age-specific rates using the normal distribution when there were 100 or more events; we used the Poisson distribution when there were fewer than 100 events. Nonoverlapping CIs were considered statistically significant.

Note that this report includes only deaths for which the OCME determined the cause of death at the time of data analysis. Because it can take some time for OCME to complete investigations of suspected overdose deaths, some cases for 2017 were still pending final determination, and so those data are provisional. All analysis took place between August 8 and October 24, 2018.

In 2017, there were 1487 overdose deaths in New York City: 556 (37.0%) among whites, 421 (28.0%) among blacks, 455 (31.0%) among Latinos, and 55 (4.0%) among other or undefined racial/ethnic groups (Table). Among younger persons (age 15-34 years), heroin and/or fentanyl overdose death rates per 100 000 New Yorkers were higher among whites (22.2; 95% CI, 19.0-25.5) than blacks (5.8; 95% CI, 4.0-8.2) or Latinos (9.7; 95% CI, 7.6-12.1). Conversely, heroin and/or fentanyl overdose death rates among older persons (age 55-84 years) were higher among blacks (25.4; 95% CI, 20.9-30.0) than whites (9.4; 95% CI, 7.3-11.8) (Figure). Older blacks had significantly higher cocaine overdose death rates (25.4; 95% CI, 20.9-30.0) than whites (5.1; 95% CI, 3.6-7.0) and Latinos (11.8; 95% CI, 8.9-15.4).

Our findings suggest the existence of 2 concurrent opioid overdose epidemics in New York City. Overdose death rates for blacks and Latinos were highest among middle-aged and older persons; overdose death rates for whites were highest among middle-aged and younger persons. Recent research found that older blacks and Latinos at risk of overdose were more likely than whites to have long drug trajectories (spanning the heroin epidemics of the 1970s and 1990s and the human immunodeficiency virus/AIDS epidemic), to be primary heroin users, and to have histories of opioid agonist treatment.⁵ In contrast, middle-aged and younger whites were more likely to have shorter drug trajectories starting after 2000, to be primary opioid analgesic users who transitioned to heroin, and to be less likely to have histories of opioid agonist treatment.^5,6 The distinct age distribution and drug involvement of overdose deaths among New York City blacks, Latinos, and whites, along with complementary evidence about drug use trajectories, highlight the need for heterogeneous approaches to treatment and the equitable allocation of treatment and health care resources to reach diverse populations at risk of overdose.

Accepted for Publication: November 8, 2018.

Corresponding Author: Bennett Allen, MA, Bureau of Alcohol and Drug Use Prevention, Care, and Treatment, New York City Department of Health and Mental Hygiene, 42-09 28th St, 19th Floor, Queens, NY 11101 (ballen1@health.nyc.gov).

Published Online: February 11, 2019. doi:10.1001/jamainternmed.2018.7700

Author Contributions: Ms Nolan had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Allen, Nolan, Paone.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Allen.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Nolan.

Administrative, technical, or material support: Allen, Kunins, Paone.

Study supervision: Kunins, Paone.

Conflict of Interest Disclosures: None reported.