Extreme vulnerability to overdose mortality: Intersections of detailed race/ethnicity, educational attainment, age, sex, and nativity.

Abstract

This study examined which specific sociodemographic groups are most affected by drug overdose deaths in the United States (US). The study consisted of a cross-sectional analysis of US death certificate data (2018-2023) from 512,198 drug overdose deaths. We calculated drug overdose mortality rates and proportionate mortality for subpopulations formed based on the concurrent intersection of detailed race/ethnicity, sex, age, nativity, and educational attainment. In the US, 2018-2023, of all subpopulations examined, male foreign/territory-born Puerto Rican Americans ages 35-49 with a high school education or lower experienced the highest estimated drug overdose mortality rate (261.9 per 100,000) and highest overdose proportionate mortality (with overdoses accounting for 42.8 % of all deaths in the group). Following this group, the highest overdose mortality rates (per 100,000) were observed in: male US-born Non-Hispanic (NH) American Indian/Alaska Native Americans ages 35-49 with a high school education or lower (235.2); male foreign/territory-born Puerto Rican Americans ages 50-64 with a high school education or lower (218.4); and male US-born NH Black Americans ages 50-64 with a high school education or lower (213.2). Elevated overdose proportionate mortality was observed in female US-born NH White-and-Black Americans ages 21-34 with a high school education or lower and male US-born South Americans ages 21-34 with a high school education or lower (with overdoses accounting for 42.2 % and 42.1 % of all deaths in these groups, respectively). Low educational attainment intersects with risks related to age, sex, nativity, and racial/ethnic identification to shape disparities in US drug overdose deaths.