An Escalating Crisis: Uncovering Racial and Ethnic Disparities in U.S. Substance Use Deaths

By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada
https://sudrecoverycenters.com/our-team/
Staff Research and Content Writer

Racial and geographic disparities in substance use disorder (SUD) mortality in the United States have widened significantly over the past two decades.

Black and American Indian/Alaska Native (AIAN) populations experience disproportionately higher burdens of substance use disorders and related mortality. These burdens, exacerbated by unequal access to SUD treatment, socioeconomic status, structural racism, and other social determinants of health, paint a concerning picture of the current state of public health. Moreover, SUD deaths continue to increase across the US. Among Black populations, overdose deaths increased by 44% between 2019-2020 alone, in what the Centers for Disease Control labeled a “record-breaking year.”

Given the ongoing opioid crisis in the US, it is unsurprising that substance use deaths have been increasing, particularly given the rise in synthetic opioids such as fentanyl. However, the data on increased substance use disorder (SUD) mortality is typically cross-sectional, which means it only captures the situation at a specific moment in time and cannot be used to illustrate temporal trends. To better appreciate the long-term patterns in SUD mortality among racial and ethnic groups, researchers designed a study to analyze SUD deaths across the US over twenty years.

What did this study do?

In a new study, researchers conducted a comprehensive, long-term analysis of substance use disorder (SUD) mortality from 2000 to 2019. The study sought to illustrate how the burden of SUDs has shifted across racial and ethnic groups over time. Additionally, the researchers analyzed geographic variations to identify states and counties with particularly high SUD mortality rates. This approach allowed them to examine racial and ethnic disparities within specific regions, pinpointing areas where targeted support for affected populations is most needed.

Using mortality data from the Institute of Health Metrics and Evaluation | Global Health Data Exchange, the researchers conducted a statistical analysis comparing SUD mortality rates across racial and ethnic groups over time. Their statistical approach enabled them to identify periods where the rate of change in mortality rate shifted significantly, indicating a statistically significant change in the pattern or trend in the burden of SUD mortality.

What were the results?

The study found that substance use disorder (SUD) mortality has increased nationwide in the past 20 years among all racial and ethnic groups and across geographic regions. In the year 2000, SUD mortality in the US was 8 deaths per 100,000 people. By 2019, this figure had surged to 28.8 deaths per 100,000 people.

However, certain racial/ethnic groups and geographic regions experienced more significant increases than others and continue to deal with higher burdens of SUD mortality.

Racial disparities in SUD Mortality

Black Americans faced the second-highest burden of substance use disorder (SUD) mortality of all racial/ethnic groups. Between 2000-2019, SUD mortality among Black populations rose from 13.9 to 30.1 deaths per 100,000 people. The SUD mortality rate of Black Americans (30.1) is second only to that of American Indians/Alaska Natives (AIAN) at 57.8 deaths per 100,000 people in 2019. Conversely, the SUD mortality rate among Asian and Pacific Islanders (API) was 5.2 deaths per 100,000 people in 2019.

Of note, the average annual percentage change of mortality rates from 2000-2019 increased most significantly among White Americans, followed by APIs, AIANs, Black Americans, and Latinos.

Geographic disparities in SUD Mortality

The authors mapped the burden of substance use disorder (SUD) deaths across US states and counties to understand where the most significant disparities are seen. As with racial and ethnic groups, SUD mortality increased in all geographic regions in the US from 2000-2019. In 2019, the state with the highest SUD mortality rate was West Virginia, followed by the District of Columbia, Delaware, Ohio, and Pennsylvania. However, there was significant variation in mortality rates across racial/ethnic groups and within and between geographic regions.

The US counties with the highest SUD mortality for Black Americans in 2019 were:

San Fransisco, CA
Cabell County, West Virginia
Louis City, MI
Jefferson County, OH
Kanawha County, West Virginia

SUD mortality rates changed over time at different rates, and there was significant variation by racial/ethnic group and by state or county. In general, Northeastern and Midwestern states saw greater increases in SUD mortality between 2000-2019. The analysis revealed that Ohio and West Virginia saw significant increases in SUD mortality among Black and AIAN populations. Conversely, New York State and California saw slight decreases in mortality rates among these populations.

Overall, the states with the greatest upticks in SUD morality for Black Americans were West Virginia, Kentucky, and Ohio.

What is the significance of this study?

The findings of this study underscore the urgent need to address the escalating crisis of substance use disorder (SUD) deaths across the United States. Tackling the pronounced disparities in SUD mortality across racial, ethnic, and geographic lines identified in this study demands a health equity approach that prioritizes the needs of communities most affected by these inequities. Black and Native American populations, in particular, face disproportionately high rates of SUD-related mortality. A health equity approach must include meaningful engagement and collaboration with these populations, ensuring that interventions are responsive to their specific experiences and challenges. Additionally, a more equitable distribution of resources is essential to align with the geographic disparities highlighted by the study, providing a basis for tailored policies and targeted interventions that can meaningfully reduce SUD mortality.

The authors further recommend that future research delve into the root causes of racial and ethnic disparities in SUD mortality to better inform interventions aimed at addressing these gaps comprehensively.

It is important to note that this study was limited by the Institute of Health Metrics and Evaluation data set, which did not provide a category for participants to identify as multi-racial or multi-ethnic. Thus, the analysis did not capture those who identify as belonging to more than one racial group. As of 2020, over 10% of Americans identified as multi-racial. The lack of identification of this population may limit the generalizability of these findings to the entire US population. Similarly, the grouping of Asians and Pacific Islanders into one category in the data set may limit the study’s generalizability.

Key Points

Substance use disorder (SUD) mortality has increased in the US over the past 20 years.
All racial/ethnic groups are facing escalating rates of SUD deaths. American Indian/Alaska Native and Black populations face a disproportionately high burden of SUD deaths.
All geographic regions are facing escalating rates of SUD deaths; however, there is significant variation in these rates for different racial/ethnic groups and between counties.
A health equity approach with meaningful collaboration with racial and ethnic communities is vital to address the growing burden of SUD mortality.

Reference

Bhagavathula, A. S., Daglis, T., & Nishimura, Y. (2024). Trends in racial/ethnic and geographic disparities in substance use disorders mortality in the United States, 2000–2019. American Journal on Addictions. Advance online publication. https://doi.org/10.1111/ajad.13654