Abstract
This study evaluates racial differences in opioid overdose deaths in New York City for 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.
Methods
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.
Results
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).
Table. Number and Rate per 100 000 New Yorkers of Unintentional Drug Poisoning (Overdose) Deaths by Drug Type,a Race/Ethnicity, and Age Group, New York City, 2017.
| Age Range, y | Overall | Heroin and/or Fentanyl | Cocaine | Opioid Analgesicsb | ||||
|---|---|---|---|---|---|---|---|---|
| No. | Rate (95% CI) | No. | Rate (95% CI) | No. | Rate (95% CI) | No. | Rate (95% CI) | |
| Black (Non-Latino)c | ||||||||
| 15-34 | 46 | 8.3 (6.1-11.1) | 32 | 5.8 (4.0-8.2) | 19 | 3.4 (2.1-5.4) | NR | NR |
| 35-54 | 183 | 35.9 (30.7-41.1) | 117 | 22.9 (18.8-27.1) | 117 | 22.9 (18.8-27.1) | 20 | 3.9 (2.4-6.1) |
| 55-84 | 192 | 41 (35.2-46.8) | 119 | 25.4 (20.9-30.0) | 119 | 25.4 (20.9-30.0) | 18 | 3.8 (2.3-6.1) |
| White (Non-Latino)c | ||||||||
| 15-34 | 220 | 27.3 (23.7-30.9) | 179 | 22.2 (19.0-25.5) | 84 | 10.4 (8.3-12.9) | 41 | 5.1 (3.7-6.9) |
| 35-54 | 236 | 33.5 (29.2-37.8) | 180 | 25.6 (21.8-29.3) | 100 | 14.2 (11.4-17.0) | 50 | 7.1 (5.3-9.4) |
| 55-84 | 100 | 13.4 (10.8-16.0) | 70 | 9.4 (7.3-11.8) | 38 | 5.1 (3.6-7.0) | 23 | 3.1 (2.0-4.6) |
| Latinoc | ||||||||
| 15-34 | 98 | 12.3 (10.0-15.0) | 77 | 9.7 (7.6-12.1) | 54 | 6.8 (5.1-8.9) | 11 | 1.4 (0.7-2.5) |
| 35-54 | 234 | 35.3 (30.8-39.8) | 185 | 27.9 (23.9-31.9) | 123 | 18.6 (15.3-21.8) | 28 | 4.2 (2.8-6.1) |
| 55-84 | 123 | 26.4 (21.7-31.1) | 88 | 18.9 (15.2-23.3) | 55 | 11.8 (8.9-15.4) | 13 | 2.8 (1.5-4.8) |
| Other/Missing | ||||||||
| 15-34 | 24 | 5.5 (3.5-8.2) | 16 | 3.7 (2.1-5.9) | 6 | 1.4 (0.5-3.0) | NR | NR |
| 35-54 | 24 | 5.9 (3.8-8.8) | 15 | 3.7 (2.1-6.1) | 14 | 3.5 (1.9-5.8) | NR | NR |
| 55-84 | 7 | 2.3 (0.9-4.7) | NR | NR | NR | NR | NR | NR |
Abbreviation: NR indicates not reported owing to small numbers of cases that must remain unreported to meet confidentiality guidelines.
Drug type was not mutually exclusive; ie, multiple substances might be involved in a single overdose case.
For this analysis, opioid analgesics exclude fentanyl and methadone.
Latino includes persons of Hispanic origin based on ancestry reported on the death certificate, regardless of reported race; Latino excludes reported ancestry from non–Spanish-speaking Central or South American countries and non–Spanish-speaking Caribbean islands.
Figure. Rates of Unintentional Drug Poisoning (Overdose) Death for Non-Latino Blacks and Non-Latino Whites, New York City, 2017.
For this analysis, “opioid analgesics” excluded fentanyl and methadone.
Discussion
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.
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