LAUSR

AIMS To estimate racial differences in rates of opioid-involved overdose deaths (OOD) between Whites and African Americans in the U.S. from 1999 to 2018 to (1) identify racial variation in the temporal trends of OOD over the 20-year period and (2) compare trends in OOD rates between Whites and African Americans using the Centers for Disease Control and Prevention's (CDC) three defined OOD epidemic periods. METHODS Data were obtained from the CDC Wide-ranging Online Data for Epidemiologic Research which combines OOD data from the National Vital Statistics System and population data from the U.S. Census Bureau. Joinpoint regression models were used to estimate age-adjusted annual percent change (APC) in OOD by race from 1999 to 2018. RESULTS The temporal trends of OOD varied by race. African Americans had a persistently low rate of OOD and statistically non-significant rate of change in OOD from 1999 to 2012 (APC = 0.47; p > 0.05), with a statistically significant and rapid acceleration in OOD rates in 2012 that persisted through 2018 (APC = 26.16; p < 0.01). Whites had 3 statistically significant periods of acceleration in OOD rate from 1999 to 2006 (APC =12.43; p<0.01), 2006-2013 (APC = 4.34, p<0.01) and the greatest increase from 2013 to 2016 (APC = 18.96; p < 0.01). Whites had a statistically non-significant decrease in OOD from 2016 to 2018 (p = 0.16). The trend for Whites more closely aligned with the CDC-defined epidemic periods than for African Americans. During wave 1 (1999-2010), the average annual percentage change (AAPC) for African Americans was significantly lower than Whites (0.47 versus 9.42, p<0.01); however, by wave 3 (2013-current; defined by the introduction of illicitly-manufactured fentanyl), the AAPC was significantly higher in African Americans (26.16 versus 13.19, p < 0.01). CONCLUSIONS Despite historically lower rates of opioid misuse and opioid-involved overdose deaths among African Americans compared with Whites, the growth in opioid-involved overdose deaths among African Americans now outpaces that of Whites in the United States.