Age-specific disparities in fatal drug overdoses highest among older black adults and American Indian/Alaska native individuals of all ages in the United States, 2015-2020

Introduction: Increasing disparities within and between racial/ethnic groups in overdose deaths underscore the need to identify drivers and patterns to optimize overdose prevention strategies. We assess age-specific mortality rates (ASMR) in drug overdose deaths by race/ethnicity in 2015-2019 and 2020.Methods: Data were from the CDC Wonder, and included information for N = 411,451 deceased individuals in the United States (2015-2020) with a drug overdose-attributed cause of death (ICD-10 codes: X40-X44, X60-X64, X85, Y10-Y14). We compiled overdose death counts by age, race/ethnicity, and population estimates to derive ASMRs, mortality rate ratios (MRR), and cohort effects.Results: The ASMRs for Non-Hispanic Black adults (2015-2019) followed a different pattern than other racial/ethnic groups -low ASMRs among young individuals and peaking between 55-64 years -a pattern exacerbated in 2020. Younger Non-Hispanic Black individuals had lower MRRs than young Non-Hispanic White individuals, yet, older Non-Hispanic Black adults had much higher MRRs than older Non-Hispanic White adults (45-54yrs:126%, 55-64yrs:197%; 65-74yrs:314%; 75-84:148%) in 2020. American Indian/Alaska Native adults had higher MRRs than Non-Hispanic White adults in death counts compiled from pre-pandemic years (20152019); however, MRRs increased in 2020 (15-24yrs:134%, 25-34yrs:132%, 35-44yrs:124%, 45-54yrs:134%, 5564yrs:118%). Cohort analyses suggested a bimodal distribution of increasing fatal overdose rates among NonHispanic Black individuals aged 15-24 and 65-74.Conclusions and Relevance: Overdose fatalities unprecedently impact older Non-Hispanic Black adults and American Indian/Alaska Native populations of all ages, deviating from the pattern found for Non-Hispanic White individuals. Findings highlight the need for targeted naloxone and low-threshold buprenorphine programs to reduce racial disparities.