Growing racial/ethnic disparities in overdose mortality before and during the COVID-19 pandemic in California

Abstract

As overdose mortality is spiking during the COVID-19 pandemic, few race/ethnicity-stratified trends are available. This is of particular concern as overdose mortality was increasing most rapidly in Black and Latinx communities prior to the pandemic. We used quarterly, age-standardized overdose mortality rates from California to assess trends by race/ethnicity and drug involved over time. Rates from 2020 Q2-Q4 were compared to expected trends based on ARIMA forecasting models fit using data from 2006 to 2020 Q1. In 2020 Q2-Q4 overdose death rates rose by 49.8% from 2019, exceeding an expected increase of 11.5% (95%CI: 0.5%-22.5%). Rates significantly exceeded forecasted trends for all racial/ethnic groups. Black/African American individuals saw an increase of 52.4% from 2019, compared to 42.6% among their White counterparts. The absolute Black-White overdose mortality gap rose from 0.7 higher per 100,000 for Black individuals in 2018 to 4.8 in 2019, and further increased to 9.9 during the pandemic. Black overdose mortality in California was therefore 34.3% higher than that of White individuals in 2020 Q2-Q4. This reflects growing methamphetamine-, cocaine-, and fentanyl-involved deaths among Black communities. Growing racial disparities in overdose must be understood in the context of the unequal social and economic fallout from the COVID-19 pandemic, during which time Black communities have been subjected to the dual burden of disproportionate COVID-19 deaths and rising overdose mortality. Increased investments are required to ameliorate racial/ethnic disparities in substance use treatment, harm reduction, and the structural drivers of overdose, as part of the COVID-19 response and post-pandemic recovery efforts.

Keywords: COVID-19 pandemic; Fentanyl; Methamphetamine; Overdose; Racial/ethnic disparities; Substance use.

Fig. 1

Observed and Forecasted Quarterly Trends in Overdose Mortality by Race/Ethnicity and Drug Involved, 2015-2020. Quarterly, age-adjusted, annualized overdose mortality rates per 100,000 residents are shown by race/ethnicity and type of drug involved for 2015-2020. Points represent observed data. Lines and shaded bands represent forecasts and 95% prediction intervals for 2020 Q2-Q4 based on ARIMA models fit on data from 2006 to 2020 Q1. Full timeseries beginning in 2006 can be seen in the Supplemental Figure. *Deaths coded as involving ‘psychostimulants with abuse potential’ predominantly refer to methamphetamine and are labeled as such.