Racial/Ethnic and Regional Disparities in Opioid-Involved Overdose Deaths among Children and Adolescents in the United States

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BACKGROUND: Despite the opioid crisis being declared a national emergency in 2017, few studies have examined disparities in overdose mortality trends among children and adolescents. This study assessed trends in opioid-involved overdose mortality among U.S. individuals aged 0 to 19 years, categorized by age, sex, race/ethnicity, census region, opioid type (prescription, synthetic, and heroin), and county rural/urban designation, from 1999 to 2019. METHODS: Mortality data were sourced from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research Database. Opioid-related deaths were identified using ICD-10 codes. Crude and age-adjusted mortality rates (AAMR) were assessed by age, sex, race/ethnicity, census region, opioid type, and county rural/urban designation. Temporal trends were analyzed using Joinpoint regression to estimate annual percentage changes (APC) and average APC. 95% confidence intervals were derived using the Empirical Quantile method and the Parametric Method. RESULTS: Between 1999 and 2019, 10,799 children and adolescents died from opioid overdoses (AAMR = 0.6 per 100,000; 95% CI: 0.6-0.6). From 2013-2019, overall mortality increased by 4.5% annually (95% CI: 0.91, 15.54). Mortality trends increased among Non-Hispanic Black (APC = 7.84; 95% CI: 5.12-10.56) and Hispanic individuals (APC = 5.29; 95% CI: 2.84-7.74) from 1999 to 2019, while remaining stable among Non-Hispanic White individuals from 2004 to 2019 (APC = -0.69; 95% CI: -2.09 to 0.58). Mortality rates also increased in the Northeast from 1999 to 2019 (APC = 4.23; 95% CI: 2.70-5.78) and in the West from 2015 to 2019 (APC = 21.96; 95% CI: 13.50-39.67), with a sharp increase in deaths involving synthetic opioids from 2014 to 2019 (APC = 43.37; 95% CI: 21.13-120.46). CONCLUSIONS: Opioid overdose mortality trends among US children and adolescents have increased in recent years. Contemporary rises are most pronounced among Non-Hispanic Black and Hispanic children, in the Northeastern and Western regions, and from synthetic opioids. The disparities in opioid-related deaths underscores the need for targeted interventions and continued research to inform public health strategies.