TY - JOUR
T1 - Examining Increasing Racial Inequities in Opioid Overdose Deaths
T2 - a Spatiotemporal Analysis of Black and White Decedents in St. Louis, Missouri, 2011–2021
AU - Banks, Devin E.
AU - Scroggins, Stephen
AU - Paschke, Maria E.
AU - Shacham, Enbal
AU - Nance, Melissa
AU - Cavazos-Rehg, Patricia
AU - Winograd, Rachel P.
N1 - Publisher Copyright:
© 2023, The New York Academy of Medicine.
PY - 2023/6
Y1 - 2023/6
N2 - 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.
AB - 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.
KW - Fentanyl
KW - Geographic information systems
KW - Opioids
KW - Overdose
KW - Racial disparities
UR - http://www.scopus.com/inward/record.url?scp=85160259110&partnerID=8YFLogxK
U2 - 10.1007/s11524-023-00736-9
DO - 10.1007/s11524-023-00736-9
M3 - Article
C2 - 37221300
AN - SCOPUS:85160259110
SN - 1099-3460
VL - 100
SP - 436
EP - 446
JO - Journal of Urban Health
JF - Journal of Urban Health
IS - 3
ER -