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

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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.

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Acknowledgments

Research reported in this publication was supported by the National Center for Advancing Translational Sciences (KL2 TR002346; PI: Reeds) to Devin Banks. This content is solely the responsibility of the authors and does not necessarily represent the views of the funder(s).

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Authors and Affiliations

  1. Department of Psychological Sciences, University of Missouri—St. Louis, One University Blvd., 325 Stadler Hall, St. Louis, MO, USA

    Devin E. Banks, Maria E. Paschke, Melissa Nance & Rachel P. Winograd

  2. College for Public Health & Social Justice, Saint Louis University, St. Louis, USA

    Stephen Scroggins & Enbal Shacham

  3. Taylor Geospatial Institute, St. Louis, USA

    Stephen Scroggins & Enbal Shacham

  4. Department of Psychiatry, Washington University School of Medicine, St. Louis, USA

    Patricia Cavazos-Rehg

  5. Missouri Institute of Mental Health, University of Missouri—St. Louis, St. Louis, USA

    Rachel P. Winograd

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Banks, D.E., Scroggins, S., Paschke, M.E. et al. Examining Increasing Racial Inequities in Opioid Overdose Deaths: a Spatiotemporal Analysis of Black and White Decedents in St. Louis, Missouri, 2011–2021. J Urban Health 100, 436–446 (2023). https://doi.org/10.1007/s11524-023-00736-9

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