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. 2023 Jun;100(3):436-446.
doi: 10.1007/s11524-023-00736-9. Epub 2023 May 23.

Examining Increasing Racial Inequities in Opioid Overdose Deaths: a Spatiotemporal Analysis of Black and White Decedents in St. Louis, Missouri, 2011-2021

Devin E Banks  1 , Stephen Scroggins  2   3 , Maria E Paschke  4 , Enbal Shacham  2   3 , Melissa Nance  4 , Patricia Cavazos-Rehg  5 , Rachel P Winograd  4   6
Affiliations

Examining Increasing Racial Inequities in Opioid Overdose Deaths: a Spatiotemporal Analysis of Black and White Decedents in St. Louis, Missouri, 2011-2021

Devin E Banks et al. J Urban Health. 2023 Jun.

Abstract

The third wave of the opioid overdose crisis-defined by the proliferation of illicit fentanyl and its analogs-has not only led to record numbers of overdose deaths but also to unprecedented racial inequities in overdose deaths impacting Black Americans. Despite this racialized shift in opioid availability, little research has examined how the spatial epidemiology of opioid overdose death has also shifted. The current study examines the differential geography of OOD by race and time (i.e., pre-fentanyl versus fentanyl era) in St. Louis, Missouri. Data included decedent records from the local medical examiners suspected to involve opioid overdose (N = 4420). Analyses included calculating spatial descriptive analyses and conducting hotspot analyses (i.e., Gettis-Ord Gi*) stratified by race (Black versus White) and time (2011-2015 versus 2016-2021). Results indicated that fentanyl era overdose deaths were more densely clustered than pre-fentanyl era deaths, particularly those among Black decedents. Although hotspots of overdose death were racially distinct pre-fentanyl, they substantially overlapped in the fentanyl era, with both Black and White deaths clustering in predominantly Black neighborhoods. Racial differences were observed in substances involved in cause of death and other overdose characteristics. The third wave of the opioid crisis appears to involve a geographic shift from areas where White individuals live to those where Black individuals live. Findings demonstrate racial differences in the epidemiology of overdose deaths that point to built environment determinants for future examination. Policy interventions targeting high-deprivation communities are needed to reduce the burden of opioid overdose on Black communities.

Keywords: Fentanyl; Geographic information systems; Opioids; Overdose; Racial disparities.

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Figures

Fig. 1
Fig. 1
Black population and median household income by census tract noting “Delmar Divide,” American community survey 5-year estimates (2017–2021)
Fig. 2
Fig. 2
Hotspots (significantly higher than expected clustering) of opioid overdose death by race of decedent in St. Louis City and County during A T1: 2011–2015 and B T2: 2016–2021
Fig. 3
Fig. 3
Hotspots (significantly higher than expected clustering) and cold spots (significantly lower than expected clustering) of opioid overdose deaths in St. Louis City and County among A Black individuals during T1, B White individuals during T1, C Black individuals during T2, and D White individuals during T2
See this image and copyright information in PMC

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