Higher drug overdose mortality among non-hispanic black adults aged 55 and older in the U.S.: Analysis of national death records from CDC's WONDER database (1999-2023).

BACKGROUND

Non-Hispanic Black adults ages 55 and older experienced the sharpest increases in drug overdose mortality from the mid-2010s onwards. We aimed to elucidate longitudinal patterns of rising overdose mortality among this population and identify key substances driving this trend.

METHODS

We analyzed national death records from CDC's WONDER database (1999-2023) to examine unintentional drug overdose death rates across racial/ethnic and age groups, focusing on non-Hispanic Black adults ages 55 and older. We examined trends by substance type and census region (i.e., Northeast, Midwest, South and West), and introduced a metric named contribution ratio (CR)-defined as the ratio of the change in overdose mortality involving a specific substance to the overall change in drug overdose mortality-to quantify the contributions of different substances to the increase in overdose mortality.

RESULTS

Since 2015, drug overdose mortality among non-Hispanic Black adults ages 55 and older increased more than among younger Black adults, older adults of other racial/ethnic groups, and younger adults of all racial/ethnic groups, many of whom experienced more modest increases during this period. By 2019, this group had the highest overdose death rate nationwide. CR analyses showed that cocaine and its co-involvement with fentanyl contributed most to the mortality increases among this population. Regional patterns varied, with methamphetamine-related deaths emerging in the U.S. West. Overdose mortality involving cocaine without opioid co-involvement rose steadily among older non-Hispanic Black adults across all regions, potentially reflecting heightened age-related vulnerability.

CONCLUSIONS

The rapid rise in overdose mortality among non-Hispanic Black adults ages 55 and older-largely associated with cocaine with and without fentanyl-signals an urgent public health crisis requiring targeted interventions.