Background: National data has indicated highest proportions and trends in opioid-related overdose (OD) rates among younger aged non-Hispanic (NH) white populations in non-urban geographic areas. Local state-wide examination among late adolescent and young adults may uncover overlooked disparities.

Objective: To investigate racial-ethnic and geographic differences in opioid-related OD in New York (NY).

Methods: Patient demographics from ED visits involving opioid-related poisoning and behavioral health diagnoses among persons 16-30 years of age were obtained from NY State Department of Health Statewide Planning and Research Cooperative System representing New York City (NYC) as well as the most diverse NY counties outside of NYC (Erie, Onondaga, Monroe, and Kings) from 2010-2015. We used generalized linear mixed models to assess changes in opioid-related ED visits over time and interaction of time trend differences by race-ethnicity and geographic area.

Results: NH whites had higher rates of opioid OD as a proportion of ED visits than blacks and Hispanics, and 21% higher rates of increase in opioid OD visits than blacks, p<0.001. Yet, examination of rates of increase in opioid OD revealed Hispanics having statistically similar rates as NH whites. Geographically, upstate NY had higher opioid OD rates than New York City, p<0.001, but the rate of increase did not differ by region. Race-stratified analyses found that opioid OD among NH whites in upstate regions experiencing a 7% greater increase in opioid OD vs. NYC (p<0.05) with no region differences observed among blacks and Hispanics.

Conclusions: NY statewide ED visit data revealed both NH whites and Hispanics experiencing similar rapid increases in opioid OD with significantly greater increases in non-urban areas for NH white populations. Geographic area did not matter for black and Hispanic populations presented to ED for opioid OD events. These findings can directly inform largescale OD prevention strategies.