Abstract
Racial/ethnic disparities in health and disease have been present in the United States for the past century. Although differences such as individual access to health care and health-related behaviors account for some of these health disparities, it is likely that a combination of individual and contextual-level factors determine the differential rates of disease between racial/ethnic groups. We studied fatal accidental drug overdose in New York City between 1990 and 1998 to describe differences in racial/ethnic patterns over time and to develop hypotheses about factors that might contribute to these differences. During this period, rates of overdose death were consistently higher among blacks and Latinos compared to whites. In addition, cocaine was more common among black decedents, while opiates and alcohol were more common among Latino and white decedents. Differences in situational factors, such as differential likelihood of activating emergency medical response, may in part explain the consistently higher overdose mortality rates observed among minorities. Further study to determine the individual and contextual factors that explain these observed disparities in overdose death may identify effective areas for public health intervention and provide insight into factors underlying racial/ethnic disparities in other health outcomes.
Keywords: Disparities, Drugs, Ethnic, Mortality, Overdose, Race
Full Text
The Full Text of this article is available as a PDF (97.2 KB).
References
- 1.Racial and ethnic disparities in infant mortality rates—60 largest US cities, 1995–1998. MMWR Morb Mortal Wkly Rep. 2002;51:329–332, 343. [PubMed]
- 2.National Institutes of Health. Addressing health disparities: the NIH program of action. US Department of Health and Human Services; 2002. Available at: http://healthdisparities.nih.gov/. Accessed November 18, 2002.
- 3.Williams DR, Jackson JS. Race/ethnicity and the 2000 census: recommendations for African American and other black populations in the United States. Am J Public Health. 2000;90:1728–1730. doi: 10.2105/AJPH.90.11.1728. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Mayberry RM, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Rev. 2000;57(suppl 1):108–145. doi: 10.1177/107755800773743628. [DOI] [PubMed] [Google Scholar]
- 5.Lantz PM, House JS, Lepkowski JM, Williams DR, Mero RP, Chen J. Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. JAMA. 1998;279:1703–1708. doi: 10.1001/jama.279.21.1703. [DOI] [PubMed] [Google Scholar]
- 6.Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116:404–416. doi: 10.1093/phr/116.5.404. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Finch BK, Frank R, Hummer RA. Racial/ethnic disparities in infant mortality: the role of behavioral factors. Soc Biol. 2000;47:244–263. doi: 10.1080/19485565.2000.9989021. [DOI] [PubMed] [Google Scholar]
- 8.Darke S, Ross J, Hall W. Overdose among heroin users in Sydney, Australia: I. prevalence and correlates of non-fatal overdose. Addiction. 1996;91:405–411. doi: 10.1111/j.1360-0443.1996.tb02289.x. [DOI] [PubMed] [Google Scholar]
- 9.Mortality Data from the Drug Abuse Warning Network, 2000. Rockville, MD: Dept of Health and Human Services; 2002. [Google Scholar]
- 10.Summary of Vital Statistics 2000: the City of New York. New York, NY: Office of Vital Statistics; 2002. [Google Scholar]
- 11.Darke S, Zador D. Fatal heroin overdose: a review. Addiction. 1996;91:1765–1772. doi: 10.1111/j.1360-0443.1996.tb03800.x. [DOI] [PubMed] [Google Scholar]
- 12.Perucci CA, Davoli M, Rapiti E, Abeni DD, Forastiere F. Mortality of intravenous drug users in Rome: a cohort study. Am J Public Health. 1991;81:1307–1310. doi: 10.2105/ajph.81.10.1307. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Oppenheimer E, Tobutt C, Taylor C, Andrew T. Death and survival in a cohort of heroin addicts from London clinics: a 22-year follow-up study. Addiction. 1994;89:1299–1308. doi: 10.1111/j.1360-0443.1994.tb03309.x. [DOI] [PubMed] [Google Scholar]
- 14.Frischer M, Goldberg D, Rahman M, Berney L. Mortality and survival among a cohort of drug injectors in Glasgow, 1982–1994. Addiction. 1997;92:419–427. doi: 10.1111/j.1360-0443.1997.tb03373.x. [DOI] [PubMed] [Google Scholar]
- 15.Joe GW, Simpson DD. Mortality rates among opioid addicts in a longitudinal study. Am J Public Health. 1987;77:347–348. doi: 10.2105/ajph.77.3.347. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Zinberg NE. Drug, Set, and Setting: the Basis for Controlled Intoxicant Use. New Haven, CT: Yale University Press; 1986. [Google Scholar]
- 17.Coffin PO, Galea S, Ahern J, Leon AC, Vlahov D, Tardiff K. Opiates, cocaine and alcohol combinations in drug overdose deaths in New York City, 1990–1998. Addiction. In press. [DOI] [PubMed]
- 18.Seymour A, Oliver JS, Black M. Drug-related deaths among recently released prisoners in the Strathclyde region of Scotland. J Forensic Sci. 2000;45:649–654. [PubMed] [Google Scholar]
- 19.Marzuk PM, Tardiff K, Leon AC, et al. Poverty and fatal accidental drug overdoses of cocaine and opiates in New York City: an ecological study. Am J Drug Alcohol Abuse. 1997;23:221–228. doi: 10.3109/00952999709040943. [DOI] [PubMed] [Google Scholar]
- 20.Galea S, Ahern J, Vlahov D, et al. Income distribution and risk of fatal drug overdose in New York City neighborhoods. Drug Alcohol Depend. In press. [DOI] [PubMed]
- 21.Tardiff K, Marzuk PM, Leon AC, et al. Homicide in New York City: cocaine and firearms. JAMA. 1994;272:43–46. doi: 10.1001/jama.272.1.43. [DOI] [PubMed] [Google Scholar]
- 22.Census summary tape, file 3A (STF 3A) Washington, DC: US Dept of Commerce; 1990. [Google Scholar]
- 23.Centers for Disease Control and Prevention. Basic statistics. Division of HIV/AIDS prevention; 2002. Available at: www.cdc.gov/hiv/pubs/facts.htm. Accessed November 18, 2002.
- 24.Wong MD, Shapiro MF, Boscardin WJ, Ettner SL. Contribution of major diseases to disparities in mortality. N Engl J Med. 2002;347:1585–1592. doi: 10.1056/NEJMsa012979. [DOI] [PubMed] [Google Scholar]
- 25.Bolen JC, Rhodes L, Powell-Griner EE, Bland SD, Holtzman D. State-specific prevalence of selected health behaviors, by race and ethnicity—Behavioral Risk Factor Surveillance System, 1997. MMWR CDC Surveill Summ. 2000;49:1–60. [PubMed] [Google Scholar]
- 26.Feldman RH, Fulwood R. The three leading causes of death in African Americans: barriers to reducing excess disparity and to improving health behaviors. J Health Care Poor Underserved. 1999;10:45–71. doi: 10.1353/hpu.2010.0799. [DOI] [PubMed] [Google Scholar]
- 27.Ameijden EJ, Krol A, Vlahov D, Flynn C, Haastrecht HJ, Coutinho RA. Pre-AIDS mortality and morbidity among injection drug users in Amsterdam and Baltimore: an ecological comparison. Subst Use Misuse. 1999;34:845–865. doi: 10.3109/10826089909037245. [DOI] [PubMed] [Google Scholar]
- 28.Substance Abuse and Mental Health Service Administration. National Household Survey on Drug Abuse. 1997. Available at: www.samhsa.gov/oas/NHSDA/1997Main/Table@20of20Contents.htm. Accessed November 28, 2002.
- 29.Lillie-Blanton M, Parsons PE, Gayle H, Dievler A. Racial differences in health: not just black and white, but shades of gray. Annu Rev Public Health. 1996;17:411–448. doi: 10.1146/annurev.pu.17.050196.002211. [DOI] [PubMed] [Google Scholar]
- 30.Ensminger ME, Anthony JC, McCord J. The inner city and drug use: initial findings from an epidemiological study. Drug Alcohol Depend. 1997;48:175–184. doi: 10.1016/S0376-8716(97)00124-5. [DOI] [PubMed] [Google Scholar]
- 31.Bourgois P. Search of Respect: Selling Crak in El Barrio. Cambridge, UK: Cambridge University Press; 1995. [Google Scholar]
- 32.Lillie-Blanton M, Anthony JC, Schuster CR. Probing the meaning of racial/ethnic group comparisons in crack cocaine smoking. JAMA. 1993;269:993–997. doi: 10.1001/jama.269.8.993. [DOI] [PubMed] [Google Scholar]
- 33.Darke S, Hall W, Weatherburn D, Lind B. Fluctuations in heroin purity and the incidence of fatal heroin overdose. Drug Alcohol Depend. 1999;54:155–161. doi: 10.1016/S0376-8716(98)00159-8. [DOI] [PubMed] [Google Scholar]
- 34.Etten ML, Anthony JC. Comparative epidemiology of initial drug opportunities and transitions to first use: marijuana, cocaine, hallucinogens and heroin. Drug Alcohol Depend. 1999;54:117–125. doi: 10.1016/S0376-8716(98)00151-3. [DOI] [PubMed] [Google Scholar]
- 35.Fillmore KM, Golding JM, Kniep S, et al. Gender differences for the risk of alcohol-related problems in multiple national contexts. Recent Dev Alcohol. 1995;12:409–439. doi: 10.1007/0-306-47138-8_25. [DOI] [PubMed] [Google Scholar]
- 36.Lenton SR, Hargreaves KM. Should we conduct a trial of distributing naloxone to heroin users for peer administration to prevent fatal overdose? Med J Aust. 2000;173:260–263. doi: 10.5694/j.1326-5377.2000.tb125633.x. [DOI] [PubMed] [Google Scholar]
- 37.Oliver P, Rowse G, Keen J, Forrest R. Snoring prior to fatal opiate overdose: an intervention opportunity? Addiction. 2001;96:652–652. [PubMed] [Google Scholar]