Journal of Urban Health

, Volume 80, Issue 2, pp 201–211 | Cite as

Racial/ethnic disparities in overdose mortality trends in New York City, 1990–1998

  • Sandro Galea
  • Jennifer Ahern
  • Ken Tardiff
  • Andy Leon
  • Phillip O. Coffin
  • Karen Derr
  • David Vlahov


Racial/ethnic disparities in health and disease have been present in the United States for the past century. Although differences such as individual access to health care and health-related behaviors account for some of these health disparities, it is likely that a combination of individual and contextual-level factors determine the differential rates of disease between racial/ethnic groups. We studied fatal accidental drug overdose in New York City between 1990 and 1998 to describe differences in racial/ethnic patterns over time and to develop hypotheses about factors that might contribute to these differences. During this period, rates of overdose death were consistently higher among blacks and Latinos compared to whites. In addition, cocaine was more common among black decedents, while opiates and alcohol were more common among Latino and white decedents. Differences in situational factors, such as differential likelihood of activating emergency medical response, may in part explain the consistently higher overdose mortality rates observed among minorities. Further study to determine the individual and contextual factors that explain these observed disparities in overdose death may identify effective areas for public health intervention and provide insight into factors underlying racial/ethnic disparities in other health outcomes.


Disparities Drugs Ethnic Mortality Overdose Race 


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  1. 1.
    Racial and ethnic disparities in infant mortality rates—60 largest US cities, 1995–1998. MMWR Morb Mortal Wkly Rep. 2002;51:329–332, 343.Google Scholar
  2. 2.
    National Institutes of Health. Addressing health disparities: the NIH program of action. US Department of Health and Human Services; 2002. Available at: Accessed November 18, 2002.Google Scholar
  3. 3.
    Williams DR, Jackson JS. Race/ethnicity and the 2000 census: recommendations for African American and other black populations in the United States. Am J Public Health. 2000;90:1728–1730.PubMedCrossRefGoogle Scholar
  4. 4.
    Mayberry RM, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Rev. 2000;57 (suppl 1):108–145.CrossRefPubMedGoogle Scholar
  5. 5.
    Lantz PM, House JS, Lepkowski JM, Williams DR, Mero RP, Chen J. Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. JAMA. 1998;279:1703–1708.CrossRefPubMedGoogle Scholar
  6. 6.
    Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001;116:404–416.PubMedGoogle Scholar
  7. 7.
    Finch BK, Frank R, Hummer RA. Racial/ethnic disparities in infant mortality: the role of behavioral factors. Soc Biol. 2000;47:244–263.PubMedGoogle Scholar
  8. 8.
    Darke S, Ross J, Hall W. Overdose among heroin users in Sydney, Australia: I. prevalence and correlates of non-fatal overdose. Addiction 1996;91:405–411.CrossRefPubMedGoogle Scholar
  9. 9.
    Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Mortality Data from the Drug Abuse Warning Network, 2000. DAWN Series D-19, Rockville, MD: Dept of Health and Human Services; 2002. DHHS Publication (SMA) 02-3633.Google Scholar
  10. 10.
    New York City Department of Health. Summary of Vital Statistics 2000: the City of New York. New York, NY: Office of Vital Statistics. Available at: Accessed December 18, 2002.Google Scholar
  11. 11.
    Darke S, Zador D. Fatal heroin overdose: a review. Addiction 1996;91:1765–1772.CrossRefPubMedGoogle Scholar
  12. 12.
    Perucci CA, Davoli M, Rapiti E, Abeni DD, Forastiere F. Mortality of intravenous drug users in Rome: a cohort study. Am J Public Health. 1991;81:1307–1310.PubMedGoogle Scholar
  13. 13.
    Oppenheimer E, Tobutt C, Taylor C, Andrew T. Death and survival in a cohort of heroin addicts from London clinics: a 22-year follow-up study. Addiction. 1994;89: 1299–1308.CrossRefPubMedGoogle Scholar
  14. 14.
    Frischer M, Goldberg D, Rahman M, Berney L. Mortality and survival among a cohort of drug injectors in Glasgow, 1982–1994. Addiction. 1997;92:419–427.CrossRefPubMedGoogle Scholar
  15. 15.
    Joe GW, Simpson DD, Mortality rates among opioid addicts in a longitudinal study. Am J Public Health. 1987;77:347–348.PubMedGoogle Scholar
  16. 16.
    Zinberg NE. Drug, Set, and Setting: the Basis for Controlled Intoxicant Use. New Haven, CT: Yale University Press; 1986.Google Scholar
  17. 17.
    Coffin PO, Galea S, Ahern J, Leon AC, Vlahov D, Tardiff K. Opiates, cocaine and alcohol combinations in drug overdose deaths in New York City, 1990–1998. Addiction. In press.Google Scholar
  18. 18.
    Seymour A, Oliver JS, Black M. Drug-related deaths among recently released prisoners in the Strathclyde region of Scotland. J Forensic Sci. 2000;45:649–654.PubMedGoogle Scholar
  19. 19.
    Marzuk PM, Tardiff K, Leon AC, et al. Poverty and fatal accidental drug overdoses of cocaine and opiates in New York City: an ecological study. Am J Drug Alcohol Abuse. 1997;23:221–228.PubMedGoogle Scholar
  20. 20.
    Galea S, Ahern J, Vlahov D, et al. Income distribution and risk of fatal drug overdose in New York City neighborhoods. Drug Alcohol Depend. In press.Google Scholar
  21. 21.
    Tardiff K, Marzuk PM, Leon AC, et al. Homicide in New York City: cocaine and firearms. JAMA. 1994;272:43–46.CrossRefPubMedGoogle Scholar
  22. 22.
    US Bureau of the Census, 1990 Census summary tape, file 3A (STF 3A). Washington, DC: US Dept of Commerce. Available at: Accessed May 11, 2002.Google Scholar
  23. 23.
    Centers for Disease Control and Prevention. Basic statistics. Division of HIV/AIDS prevention; 2002. Available at: Accessed November 18, 2002.Google Scholar
  24. 24.
    Wong MD, Shapiro MF, Boscardin WJ, Ettner SL Contribution of major diseases to disparities in mortality. N Engl J Med. 2002;347:1585–1592.CrossRefPubMedGoogle Scholar
  25. 25.
    Bolen JC, Rhodes L, Powell-Griner EE, Bland SD, Holtzman D. State-specific prevalence of selected health behaviors, by race and ethnicity—Behavioral Risk Factor Surveillance System, 1997. MMWR CDC Surveill Summ. 2000;49:1–60.Google Scholar
  26. 26.
    Feldman RH, Fulwood R. The three leading causes of death in African Americans: barriers to reducing excess disparity and to improving health behaviors. J Health Care Poor Underserved. 1999;10:45–71.PubMedGoogle Scholar
  27. 27.
    van Ameijden EJ, Krol A, Vlahov D, Flynn C, van Haastrecht HJ, Coutinho RA. Pre-AIDS mortality and morbidity among injection drug users in Amsterdam and Baltimore: an ecological comparison. Subst Use Misuse. 1999;34:845–865.PubMedCrossRefGoogle Scholar
  28. 28.
    Substance Abuse and Mental Health Service Administration. National Household Survey on Drug Abuse. 1997. Available at: Accessed November 28, 2002.Google Scholar
  29. 29.
    Lillie-Blanton M, Parsons PE, Gayle H, Dievler A. Racial differences in health: not just black and white, but shades of gray. Annu Rev Public Health. 1996;17:411–448.PubMedGoogle Scholar
  30. 30.
    Ensminger ME, Anthony JC, McCord J. The inner city and drug use: initial findings from an epidemiological study. Drug Alcohol Depend. 1997;48:175–184.CrossRefPubMedGoogle Scholar
  31. 31.
    Bourgois P. In Search of Respect: Selling Crak in El Barrio. Cambridge, UK: Cambridge University Press; 1995.Google Scholar
  32. 32.
    Lillie-Blanton M, Anthony JC, Schuster CR. Probing the meaning of racial/ethnic group comparisons in crack cocaine smoking. JAMA. 1993;269:993–997.CrossRefPubMedGoogle Scholar
  33. 33.
    Darke S, Hall W, Weatherburn D, Lind B. Fluctuations in heroin purity and the incidence of fatal heroin overdose. Drug Alcohol Depend. 1999;54:155–161.CrossRefPubMedGoogle Scholar
  34. 34.
    Van Etten ML, Anthony JC. Comparative epidemiology of initial drug opportunities and transitions to first use: marijuana, cocaine, hallucinogens and heroin. Drug Alcohol Depend. 1999;54:117–125.CrossRefPubMedGoogle Scholar
  35. 35.
    Fillmore KM, Golding JM, Kniep S, et al. Gender differences for the risk of alcohol-related problems in multiple national contexts. Recent Dev Alcohol. 1995;12:409–439.CrossRefPubMedGoogle Scholar
  36. 36.
    Lenton SR, Hargreaves KM. Should we conduct a trial of distributing naloxone to heroin users for peer administration to prevent fatal overdose? Med J Aust. 2000;173: 260–263.PubMedGoogle Scholar
  37. 37.
    Oliver P, Rowse G, Keen J, Forrest R. Snoring prior to fatal opiate overdose: an intervention opportunity? Addiction. 2001;96:652.PubMedGoogle Scholar

Copyright information

© The New York Academy of Medicine 2003

Authors and Affiliations

  • Sandro Galea
    • 2
  • Jennifer Ahern
    • 2
  • Ken Tardiff
    • 1
  • Andy Leon
    • 2
  • Phillip O. Coffin
    • 2
  • Karen Derr
    • 2
  • David Vlahov
    • 2
  1. 1.Department of PsychiatryCornell University Medical CollegeNew York
  2. 2.Center for Urban Epidemiologic StudiesNew York Academy of Medicine, 1216 Fifth AvenueNew York

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