Medical Informatics Home Area, University of California, Los Angeles, United States of America; Center for Social Medicine and Humanities, University of California, Los Angeles, United States of America.
Center for Social Medicine and Humanities, University of California, Los Angeles, United States of America.
Prev Med. 2021 Dec;153:106845. doi: 10.1016/j.ypmed.2021.106845. Epub 2021 Oct 12.
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.
由于在 COVID-19 大流行期间，药物过量死亡率飙升，因此几乎没有按种族/族裔分层的趋势。这尤其令人担忧，因为在大流行之前，药物过量死亡率在黑人和拉丁裔社区增长最快。我们使用加利福尼亚州的季度、年龄标准化药物过量死亡率来评估随时间推移的种族/族裔和涉及药物的趋势。将 2020 年第 2 季度至第 4 季度的比率与基于 ARIMA 预测模型的预期趋势进行比较，该模型使用 2006 年至 2020 年第 1 季度的数据进行拟合。2020 年第 2 季度至第 4 季度，药物过量死亡率比 2019 年上升了 49.8%，超过了预期的 11.5%（95%CI：0.5%-22.5%）。所有种族/族裔群体的比率均显著超过预测趋势。与白人相比，黑人/非裔美国人的药物过量死亡率从 2019 年增加了 52.4%。2018 年，黑人个体每 10 万人中药物过量死亡率比白人高 0.7，到 2019 年上升到 4.8，在大流行期间进一步上升到 9.9。因此，2020 年第 2 季度至第 4 季度，加利福尼亚州黑人的药物过量死亡率比白人高 34.3%。这反映了黑人群体中与甲基苯丙胺、可卡因和芬太尼有关的死亡人数不断增加。在 COVID-19 大流行期间，必须在社会和经济不平等的背景下理解药物过量的种族差异不断扩大，在此期间，黑人群体承受着 COVID-19 死亡人数不成比例和药物过量死亡率上升的双重负担。需要增加投资，以减轻药物使用治疗、减少伤害以及药物过量的结构性驱动因素方面的种族/族裔差异，这是 COVID-19 应对和大流行后恢复努力的一部分。
