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

Greta Muriel Eikermann; Can Martin Ludeke; Annika Eyth; Aline M Grimm; Tina Ramishvili; Felix Borngaesser; Maira Rudolph; Nicole Aber; Corinne M Kyriacou; Giselle D Jaconia; Jerry Chao; Ibraheem M Karaye

doi:10.1007/s40615-025-02554-y

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

J Racial Ethn Health Disparities. 2025 Jul 24. doi: 10.1007/s40615-025-02554-y. Online ahead of print.

Authors

Affiliations

¹ Ethical Culture Fieldston School, New York, New York, NY, USA.
² Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA.
³ Intensive Care, Emergency Medicine, and Pain Therapy, Klinikum Oldenburg AöR, Universitätsmedizin Oldenburg, University Clinic for Anesthesiology, Oldenburg, Germany.
⁴ Department for Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
⁵ Department of Population Health, Hofstra University, Hempstead, NY, USA.
⁶ Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA. ikaraye@montefiore.org.
⁷ Department of Population Health, Hofstra University, Hempstead, NY, USA. ikaraye@montefiore.org.

PMID: 40707842
DOI: 10.1007/s40615-025-02554-y

Abstract

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.

Keywords: Adolescents; Children; Disparities; Epidemic; Mortality; Opioids; Race/ethnicity; United States.