Bronx Community Health Dashboard Drug Use and Opioids

Bronx Community Health Dashboard: Drug Use and Opioids Last Updated: 9/24/2019 See last slide for more information about this project. 1

Drug use is a leading cause of morbidity & mortality in New York State 10% +2. 2% Drug use disorders 8% Chronic kidney disease Alzheimer's/dementia Neck pain 6% COPD Oth. musculoskeletal disord 4. 7% Hearing loss 4% Burden increasing Low back pain Anxiety disorders Headache disorders Burden decreasing Depressive disorders 2% Falls Drug use disorders have experienced the highest annual increase in morbidity + mortality in New York State since 1990 Lung cancer 2 Lower respiratory infections Colon and rectum cancer Chronic kidney disease Road injuries Hearing loss Neonatal disorders Falls Anxiety disorders Neck pain Oth. musculoskeletal disord Alzheimer's/dementia Depressive disorders Stroke Headache disorders Lung cancer Diabetes mellitus COPD Low back pain Drug use disorders Stroke 0% Ischemic heart disease % of total DALYs Diabetes mellitus In the New York State in 2017, drug use was the second leading cause of morbidity + mortality. Lower respiratory infections Colon and rectum cancer Road injuries Neonatal disorders Ischemic heart disease -3% -2% -1% 0% 1% Annual % Change in DALYs Data source: 2017 Global Burden of Disease Project. DALY = Disability Adjusted Life Years and is a measure that captures the impact of a risk factor or condition on total health, including both morbidity (i. e. , disability) and mortality. Analysis limited to top 20 causes. 2% 3%

Youth Behavior 3

After marijuana, Bronx youth most commonly reported using pain, stimulant and benzodiazepine medications without an Rx in 2017 20 Bronx NYC Percent of Youth Reporting Illicit Drug Use 17. 3 Illict drug use 16. 2 Un-prescribed Rx Use 15 10 8. 5 7. 8 6. 4 5. 1 5. 4 5 4. 9 4. 6 4. 7 4. 1 4. 4 5. 8 5. 5 5. 1 3. 9 0 Marijuana 4 Synthetic Marijuana Ecstasy Data source: NYC Youth Risk Behavior Survey, 2017. Cocaine Heroin Pain Meds Stimulants Benzodiazepines

Youth in the Bronx and Brooklyn were more likely to report taking pain medications and stimulants without a doctor’s prescription one or more times in the last year Pain medications Percent of Youth Reporting Unprescribed pain Rx Use 9 8. 5 8. 7 8 7. 4 7. 0 7 6. 6 6 5 4 3 2 1 0 6. 4 6. 3 5. 9 6 5 4. 7 4 3 2 1 0 Bronx 5 Stimulants 7 Percent of Youth Reporting Unprescribed Stimulant Rx Use 10 Brooklyn Manhattan Queens Data source: NYC Youth Risk Behavior Survey, 2017. Staten Island Bronx Brooklyn Manhattan Queens Staten Island

Use of unprescribed Rx pain medication is more common among Bronx youth in 11 th and 12 th grades 13. 4* 14 Percent of youth reporting unprescribed Rx pain medication use 12. 7* 12 10. 1 10. 3 10 8. 4 8 8. 1 7. 9 7. 5 7. 6 5. 6 6 4 2 0 Male 6 Female 9 th 10 th 11 th 12 th Hispanic Data source: NYC Youth Risk Behavior Survey, 2017. * Indicates estimate is statistically imprecise (interpret with caution). Non-Hispanic black white other

The percent of youth reporting using prescription pain medications without an Rx has increased in the Bronx since 2011 Percent of Youth Reporting Rx pain med use without an Rx 10 Bronx NYC 8. 5 8 7. 3 6 4 2 0 2011 7 2013 Data source: NYC Youth Risk Behavior Study, 2011 -2017. Data collected every two years. 2015 2017

The percent of youth reporting ever use of heroin has increased in the Bronx since 2003 Percent of Youth Reporting at Least One Heroin Use 6 Bronx NYC 5 4. 7 4 3. 9 3 2 1. 9 1. 6 1 0 2003 8 2005 2007 Data source: NYC Youth Risk Behavior Study, 2003 -2017. Data collected every two years. 2009 2011 2013 2015 2017

The percent of youth reporting ever use of cocaine has increased in the Bronx since 2003 Percent of Youth Reporting at Least One Cocaine Use 6 Bronx NYC 5 4. 7 4. 1 4 3. 5 3 2 1. 9 1 0 2003 9 2005 2007 Data source: NYC Youth Risk Behavior Study, 2003 -2017. Data collected every two years. 2009 2011 2013 2015 2017

Drug Treatment and Opioid Prescribing Behavior 10

The Bronx and Manhattan have the highest naloxone administration rate reported by emergency medical services (EMS) per 100, 000 Bronx Naloxone Administrations by EMS rate per 100, 000 50 Brooklyn Manhattan Queens Staten Island 39. 2 40 37. 6 30 27. 8 22. 3 20 17. 5 15. 4 21. 5 17. 4 12. 0 10. 2 10 0 Q 2 2015 Q 3 2015 Q 4 2015 Q 1 2016 Q 2 2016 Q 3 2016 Q 4 2016 Q 1 2017 Q 2 2017 Q 3 2017 Q 4 2017 Q 1 2018 Q 2 2018 Q 3 2018 11 Data source: New York State: County Opioid Quarterly Report, 2015 -2019. Data are not age-adjusted. Numbers represent naloxone administration events reported electronically, actual number of events may be higher

The Bronx has the highest rate of unique clients admitted for heroin and all opioids per 100, 000 persons All Opioids Heroin Rate of unique clients admitted for heroin per 100, 000 150 146. 3 Brooklyn Manhattan Queens Staten Island 200 146. 6 123. 1 130. 4 112. 2 119. 3 100 80. 7 67. 2 50 37. 7 39. 7 0 Bronx 159. 9 150 154. 7 Brooklyn Manhattan Queens Staten Island 158. 2 136. 4 140. 6 128. 9 100 88. 5 72. 7 50 43. 7 45. 8 0 Q 1 Q 2 Q 3 Q 4 Q 1 Q 2 2015 2016 2017 2018 12 Rate of unique clients admitted for opioid per 100, 000 Bronx 200 Q 1 Q 2 Q 3 Q 4 Q 1 Q 2 2015 2016 2017 2018 Data source: New York State: County Opioid Quarterly Report, 2015 -2019 Data are not age-adjusted. Data reflect admissions to OASAS-certified chemical dependence treatment programs in New York State.

Despite having the highest drug-related mortality rate, the Bronx has only a slightly elevated buprenorphine prescribing rate, significantly lower than Staten Island Age-adjusted buprenorphine prescribing rate for substance use disorder per 1, 000 population 60 Bronx Brooklyn Manhattan Queens Staten Island 52. 4 50 40 39. 0 Buprenorphine is used in medicationassisted treatment (MAT) to help people reduce or stop using heroin or other opiates 30 20 15. 0 12. 5 12. 9 10 10. 2 8. 4 6. 5 0 2012 13 2014 2015 2016 2017 Data source: New York State Prescription Monitoring Program (PMP) data, 2012 -2017; retrieved from New York State Opioid Data Dashboard.

The Bronx has the second highest opioid prescribing rate in NYC, but it has declined slightly since 2012 Age-adjusted opioid analgesics prescription rate per 1, 000 population 600 Bronx Brooklyn Manhattan Queens Staten Island 530. 3 500 397. 7 400 385. 1 315. 7 317. 3 264. 5 245. 0 241. 0 210. 0 193. 0 200 100 0 2012 14 2013 2014 2015 2016 2017 Data source: New York State Prescription Monitoring Program (PMP) data, 2012 -2017; retrieved from New York State Opioid Data Dashboard.

Drug-related hospitalizations 15

4000 Age-adjusted drug-related hospitalization rate 9 of 10 NTAs* with highest drug-related hospitalizations are in the Bronx Half (25) of NTAs in NYC with the highest drug-related hospitalization rate are in the Bronx 2000 BX NYC 0 Top 50 NTAs Bronx NTA Drug Hospitalization Rate per 100, 000 Top 5 Bronx Neighborhoods 1. Claremont-Bathgate 3993. 7 2 Melrose South-Mott Haven North 3032. 5 3. East Tremont 3003. 6 4. Morrisania-Melrose 2883. 5 5. Hunts Point 2847. 4 Bottom 5 Bronx Neighborhoods 16 32. Schuylerville-Throgs Neck-Edgewater Park 694. 5 33. Spuyten Duyvil-Kingsbridge 638. 8 34. Co-op City 577. 8 35. Pelham Bay-Country Club-City Island 574. 8 36. North Riverdale-Fieldston-Riverdale 304. 1 Data source: NYC Neighborhood Health Atlas, 2014. Data is age-adjusted and includes those 15 to 84. * NTA stands for Neighborhood Tabulation Area

Staten Island has the highest rate of opioid overdoses occurring in the ED (treat and release) while the Bronx has the highest rate of hospitalization opioid overdoses ED Treat and Release Hospitalizations Rate of ED visits involving an opioid overdose per 100, 000 Brooklyn Manhattan Queens Staten Island 18. 1 15 11. 3 9. 7 10 6. 0 4. 5 4. 3 5 3. 7 3. 2 2. 4 2. 0 Bronx 8 Brooklyn Manhattan Queens Staten Island 9. 1 7. 8 7. 6 6 5. 0 4. 4 4. 0 4 3. 5 2 2. 9 2. 8 1. 2 0 0 Q 3 2015 17 Rate of hospitalization visits involving an opioid overdose per 100, 000 10 Bronx 20 Q 4 2015 Q 1 2016 Q 2 2016 Q 3 2016 Q 4 2016 Q 1 2017 Q 2 2017 Q 3 2017 Q 4 2017 Q 1 2018 Q 2 2018 Q 3 2015 Q 4 2015 Q 1 2016 Q 2 2016 Q 3 2016 Q 4 2016 Q 1 2017 Data source: New York State: County Opioid Quarterly Report, 2015 -2019 Data are not age-adjusted. ED Treat and Release are sometimes called outpatient emergency department visits; and hospitalizations are sometimes referred to as inpatient visits Q 2 2017 Q 3 2017 Q 4 2017 Q 1 2018 Q 2 2018

The Bronx has the highest ED visit rate involving any drug overdose for those ages 45 to 64 Rate of ED visits involving any drug overdose per 100, 000 450 Bronx Staten Island Rest of NYC (Brooklyn, Manhattan, Queens) 393 400 350 320 300 261 250 223 201 200 161 148 150 131 100 50 0 18 to 24 18 25 to 44 Data source: New York State SPARCS data, 2016; retrieved from the New York State Opioid Data Dashboard. 45 to 64

The Bronx has the highest ED visit rate involving an opioid overdose for those ages 45 to 64 200 Bronx Rate of ED visits involving an opioid overdose per 100, 000 185 Staten Island Rest of NYC (Brooklyn, Manhattan, Queens) 180 160 145 140 124 120 100 80 56 60 40 46 36 30 28 20 0 18 to 24 19 25 to 44 Data source: New York State SPARCS data, 2016; retrieved from the New York State Opioid Data Dashboard. 45 to 64 44

Staten Island has the highest rate of ED visits involving a heroin overdose 140 Bronx Staten Island Rest of NYC (Brooklyn, Manhattan, Queens) Rate of ED visits involving a heroin overdose per 100, 000 129 120 100 86 80 60 40 20 30 20 19 17 0 18 to 24 20 Data source: New York State SPARCS data, 2016; retrieved from the New York State Opioid Data Dashboard. 25 to 44

Heroin overdoses are contributing to a growing percentage of all opioid overdoses in NYC Bronx Percent of all opioid overdoses that involve heroin 80 Brooklyn Manhattan Queens Staten Island 60 52. 3 48. 8 48. 6 49. 4 42. 5 40 34. 9 31. 8 31. 1 20 0 Q 3 2015 21 Q 4 2015 Q 1 2016 Q 2 2016 Q 3 2016 Q 4 2016 Data source: New York State: County Opioid Quarterly Report, 2015 -2019. Data are not age-adjusted. Q 1 2017 Q 2 2017 Q 3 2017 Q 4 2017 Q 1 2018 Q 2 2018

In the Bronx, the opioid burden is highest in the south and center of the borough 500 465. 7 450 424. 6 Opioid burden per 100, 000 400 350 320. 9 293. 4 300 250 200 150 127. 5 100 50 0 Bronx 22 Brooklyn Manhattan Data Source: New York State Opioid Data Dashboard, 2016. Data presented at the ZIP-code level. The opioid burden includes outpatient ED visits & hospital discharges for non-fatal opioid overdose, abuse, dependence & unspecified use; and opioid overdose deaths. Queens Staten Island

Overall Drug-Related Mortality 23

Bronx and Staten Island have the highest drug-related mortality of the boroughs Age-Adjusted drug-related mortality rate per 100, 000 30 Bronx Brooklyn Manhattan Queens Staten Island 26. 7 25 25. 0 20 16. 0 15 14. 6 13. 3 11. 9 10. 8 10 9. 4 6. 8 5 5. 2 0 2000 24 2001 2002 2003 2004 2005 Data source: Underlying Cause of Death, 2000 -2017. 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

50 44. 5 40 32. 9 28. 7 30 26. 2 24. 3 20. 8 18. 8 20 18. 8 16. 4 13 12 10 YC N am (2 11 sb ) rid ge (2 R iv 12 er ) da le (2 08 ) ) ay illi W lh am Pa rk w ie w (2 Pe U ni on p or t, So un dv ha m Fo rd ec (2 09 07 ) ) (2 10 k 20 N gs ro Th un ts Po in t( (2 ge H 2) ) 04 ) (2 03 hb rid ig H e, C on co ur s /M ty si er U ni v an ia ris or M or ris H ei gh t s (2 05 6) 20 01 on t( (2 Ea st Tr em av en ) 0 t. H M ot 25. 6 21. 9 ) Age-Adjusted drug-related mortality rate per 100, 000 The 3 districts with the highest drug-related mortality rates are in the Bronx Data source: Epi. Query, NYC Death/Mortality Data, 2016. Results are age-adjusted. Data presented at the community district level. 25 Drug-related mortality defined as death due to “mental and behavioral disorders due to use of or accidental poisoning by psychoactive substances excluding alcohol or tobacco”

Males and those 45 -64 have the highest drug-related mortality rates in the Bronx, similar to the rest of NYC 50 80 25 -34 Female 35 -44 43. 5 40 30 20 19. 7 12. 6 10 7. 9 45 -54 55 -64 69. 8 Drug-related mortality rate per 100, 000 Age-adjusted drug-related mortality rate per 100, 000 Male 60 39. 7 40 31. 1 29. 5 28. 6 25. 6 20 13. 9 0 0 20 00 001 002 003 004 005 006 007 008 009 010 011 012 013 014 015 016 017 2 2 2 2 26 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 20 20 20 20 20 Data source: Underlying Cause of Death, 2000 -2017. Age-specific rates are not age-adjusted. 25 -34 year data unstable 2004 -2005, 2009. 55 -64 year data unstable 2000, 2002 -2003.

The increase in drug-related mortality among men is stronger than the rest of NYC Bronx Age-adjusted drug-related mortality rate per 100, 000 Male Female Male 43. 5 40 30 20 19. 7 12. 6 10 NYC (excluding the Bronx) 50 7. 9 0 Age-adjusted drug-related mortality rate per 100, 000 50 Female 40 30 23. 2 20 10 12. 5 6. 5 4 0 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 20 20 20 20 20 27 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 20 20 20 20 20 Data source: Underlying Cause of Death, 2000 -2017. Age-specific rates are not age-adjusted. 25 -34 year data unstable 2004 -2005, 2009. 55 -64 year data unstable 2000, 2002 -2003.

Drug-related mortality among those 45 -64 y has increased more in the Bronx than the rest of NYC Bronx 80 25 -34 35 -44 45 -54 NYC (excluding the Bronx) 80 55 -64 25 -34 35 -44 45 -54 55 -64 60 39. 7 40 31. 1 29. 5 28. 6 20 13. 9 Drug-related mortality rate per 100, 000 69. 8 60 40 31. 2 26. 6 19. 4 22. 3 20 18. 5 9. 1 18. 1 6. 7 0 0 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 20 20 20 20 20 28 00 001 002 003 004 005 006 007 008 009 010 011 012 013 014 015 016 017 2 2 2 2 20 Data source: Underlying Cause of Death, 2000 -2017. Age-specific rates are not age-adjusted. 25 -34 year data unstable 2004 -2005, 2009. 55 -64 year data unstable 2000, 2002 -2003.

Non-Hispanic white populations have the highest rates of drug-related mortality in the Bronx Hispanic Age-adjusted drug-related mortality rate per 100, 000 70 Non-Hispanic Black Non-Hispanic White 60 57. 3 50 40 32. 9 30 20 31. 7 25. 8 15. 1 10 0 2000 29 2001 2002 2003 2004 2005 Data source: Underlying Cause of Death, 2000 -2017. 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

The relationship between gender and drug-related mortality varies by race/ethnicity Female Male Age-adjusted drug-related mortality per 100, 000 70 59. 3 60 50 41. 7 40 29. 3 30 26. 9 20 12. 1 10. 4 10 0 Hispanic 30 Data source: Underlying Cause of Death, 2015 -2017. Non-Hispanic Black Non-Hispanic White

Mortality Separated by Drug Type Contribution of specific drugs to drug-related mortality 31

The mortality-rate involving heroin or cocaine have increased more in the Bronx than the rest of NYC since 2014 Bronx NYC (excluding the Bronx) Heroin-involved Natural and semisynthetic opioids-involved Drug categories are not mutually exclusive. Rates do not reflect deaths that involved ONLY that drug. The same death will be included in multiple categories if multiple drugs involved. Rates do not sum to overall drug-related mortality rate. 10 12. 8 11. 4 10. 8 Since 2014, percentage increase in deaths involving: Fentanyl: 412. 0% (since 2015) Heroin: 185. 0% Cocaine: 217. 6% 7. 5 5 4. 6 4. 1 3. 5 2. 9 1. 8 0 2007 32 Methadone-involved Fentanyl-involved Benzodiazepine-involved 15 15 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Age-Adjusted drug-related mortality rate per 100, 000 Cocaine-involved Natural and semi-synthetic opioids includes morphine, oxycodone, hydromorphone The term “fentanyl” represents synthetic opioids excluding methadone. This is mostly fentanyl but may also include meperidine 10 Since 2014, percentage increase in deaths involving: Fentanyl: 500. 0% (since 2015) Heroin: 82. 8% Cocaine: 133. 0% 7. 2 5. 6 5. 3 5 3. 8 3. 9 2. 0 2. 9 1. 8 1. 0 1. 4 0 0. 3 2007 2008 2009 2010 2011 2012 Data source: Multiple Cause of Death, 2007 -2017. In the Bronx, natural and semisynthetic opioids unstable 2010 -2011; fentanyl unstable prior to 2015; Benzodiazepine unstable in 2010. In NYC, fentanyl unstable in 2008. The term “fentanyl” represents synthetic opioids excluding methadone. This is mostly fentanyl but may also include meperidine 2013 2014 2015 2016 2017

In 2017 in the Bronx, two-thirds of cocaine-related deaths involved opioids, with an increasing percentage involving fentanyl 14 Cocaine with any opioid Cocaine with fentanyl Cocaine with heroin Cocaine without any opioid Cocaine without any other drug Mortality rate per 100, 000 in the Bronx 12 Drug categories are not mutually exclusive. Rates do not reflect deaths that involved ONLY that drug. The same death will be included in multiple categories if multiple drugs involved. Rates do not sum to overall drug-related mortality rate. 11. 1 10 Percent of cocaine-related deaths involving… 8. 4 2015 2017 Any Opioid 59. 6% 66. 7% Fentanyl 38. 1%* 45. 9% Heroin 40. 4% 40. 5% 5. 1 4. 5 Without any opioid 40. 4% 33. 3% 3. 7 Without any other drug* indicated 38. 5% 32. 4% 8 7. 4 6 5. 2 4 3. 1 2 3. 2 *Data is for 2016 *Other drugs include heroin, fentanyl, natural/semi-synthetic opioids, methadone, benzodiazepine 2. 1 0 2015 2016 2017 Data source: Multiple Cause of Death, 2015 -2017. 33 Data is not age-adjusted. The term “fentanyl” represents synthetic opioids excluding methadone. This is mostly fentanyl but may also include meperidine.

In 2017 in the Bronx, almost three-quarters of heroinrelated deaths involved other opioids, an over two-fold increase since 2015 14 Heroin with any other opioid Heroin with fentanyl Heroin with cocaine Heroin without any other opioid Without any other drug 11. 6 Mortality rate per 100, 000 in the Bronx 12 Drug categories are not mutually exclusive. Rates do not reflect deaths that involved ONLY that drug. The same death will be included in multiple categories if multiple drugs involved. Rates do not sum to overall drug-related mortality rate. 10 Percent of heroin-related deaths involving… 7. 8 8 7. 1 6 7. 8 2015 2017 Any Other Opioid 30. 9% 74. 1% Fentanyl 51. 2%* 67. 2% Cocaine 29. 6% 38. 8% Without any other opioid 69. 0% 25. 9% Without any other drug* indicated 39. 4% 12. 9% 4. 9 4 4. 0 2. 8 2 8. 6 4. 5 3. 0 2. 2 2. 1 1. 5 *Data is for 2016 *Other drugs include heroin, fentanyl, natural/semi-synthetic opioids, methadone, benzodiazepine 0 2015 2016 2017 Data source: Multiple Cause of Death, 2015 -2017. 34 Data is not age-adjusted. The term “fentanyl” represents synthetic opioids excluding methadone. This is mostly fentanyl but may also include meperidine.

In the Bronx, the percent of fentanyl-related deaths involving cocaine or heroin increased between 2016 and 2017 14 Fentanyl with any other opioid Fentanyl with heroin Fentanyl wtih cocaine Fentanyl without any other opioid Fentanyl without 13. 1 any other drug Drug categories are not mutually exclusive. Rates do not reflect deaths that involved ONLY that drug. The same death will be included in multiple categories if multiple drugs involved. Rates do not sum to overall drug-related mortality rate. Mortality rate per 100, 000 in the Bronx 12 9. 8 10 9. 2 8 7. 8 Percent of synthetic-opioid related deaths involving… 2016 2017 Any other opioid 68. 0% 70. 2% Heroin 40. 8%* 59. 5% Cocaine 32. 7%* 38. 9% Without any other opioid 32. 0% 29. 8% Without any other drug* indicated 8. 0% 13. 7% 6 4. 0 4 3. 9 2. 5 2 0 5. 1 3. 2 1. 7 0. 8 1. 8 0. 2 2015 2016 *Data is for 2016 *Date is for 2016 *Other drugs include heroin, fentanyl, natural/semi-synthetic opioids, methadone, benzodiazepine 2017 Data source: Multiple Cause of Death, 2015 -2017. 35 Data is not age-adjusted. The term “fentanyl” represents synthetic opioids excluding methadone. This is mostly fentanyl but may also include meperidine.

Opioid-related mortality rates are increasing at a higher rate in the Bronx Age-Adjusted opioid-related mortality rate per 100, 000 25 Bronx Opioid-related mortality includes heroin, natural and semisynthetic opioids, methadone, and fentanyl NYC excluding the Bronx 19. 2 20 15 10. 8 10 8. 3 4. 9 5 0 2000 36 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Data source: Multiple Cause of Death, 2000 -2017. The term “fentanyl” represents synthetic opioids excluding methadone. This is mostly fentanyl but may also include meperidine 2015 2016 2017

The increase in opioid-related mortality is particularly profound among men Opioid-related mortality includes heroin, natural and semisynthetic opioids, methadone, and fentanyl 17. 0 10 10. 1 37 Data source: Multiple Cause of Death, 2000 -2017. Female data unstable 2003 -2004, 2010. Age-specific rates are not age-adjusted. 25 -34 year data unstable 2001 -2010; 2013 -2014. 55 -64 year data unstable 2000 -2008; 2010. The term “fentanyl” represents synthetic opioids excluding methadone. This is mostly fentanyl but may also include meperidine. 20 17 20 16 20 15 20 14 20 13 20 12 20 11 0 200020012002200320042005200620072008200920102011201220132014201520162017 20 20 10 0 25. 2 20 09 4. 2 23. 5 20 08 7. 8 48. 6 30 20 07 10 55 to 64 41. 2 20 06 15 13. 0 45 to 54 40 20 05 20 35 to 44 Not age-adjusted 50 20 04 25 25 to 34 20 03 30 5 60 32. 5 20 02 Female 0 20 01 Male Opioid-related mortality rate per 100, 000 Age-adjusted opioid-related mortality rate per 100, 000 35

Opioid-related mortality rates remain highest for non. Hispanic white residents, followed by Hispanic residents Age-Adjusted opioid-related mortality rate per 100, 000 40 Hispanic Non-Hispanic Black Opioid-related mortality includes heroin, natural and semisynthetic opioids, methadone, and fentanyl Non-Hispanic White 35 32. 9 30 25 20 19. 9 15. 7 15. 5 15 10 7. 2 5 4. 8 0 2000 38 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Data source: Multiple Cause of Death, 2000 -2017. Non-Hispanic white rates are unstable 2002, 2004 -2005, 2010; non-Hispanic black rates are unstable 2002 -2004, 2007 -2008, 2010. The term “fentanyl” represents synthetic opioids excluding methadone. This is mostly fentanyl but may also include meperidine. 2017

In the Bronx, the heroin-related mortality rate is highest for men and non-Hispanic white, older residents -----------------------Bronx only------------------------ Age-adjusted heroin-related mortality rate per 100, 000 30 28. 0 25 20 18. 7 17. 4 16. 9 15. 4 15 11. 4 11. 1 9. 4 10 6. 5 5. 3 5 3. 4 0 Bronx 39 Rest of NYC Male Data source: Multiple Cause of Death, 2016 -2017. Age data are not age-adjusted. Female Hispanic Non. Hispanic black Non. Hispanic white 25 to 34 35 to 44 45 to 54 55 to 64

Similar to heroin, the mortality rate for fentanyl is highest for males and those who are non-Hispanic white and 45 to 54 year olds in the Bronx -----------------------Bronx only------------------------ Age-adjusted fentanyl-related mortality rate per 100, 000 35 30. 4 30 25 21. 3 19. 8 20 15 18. 1 12. 8 11. 7 11. 4 9. 8 10 7. 2 4. 5 5 0 Bronx 40 NYC excl. Bronx Male Female Hispanic Non. Hispanic black Non. Hispanic white 25 to 34 35 to 44 Data source: Multiple Cause of Death, 2016 -2017. Age data are not age-adjusted. The term “fentanyl” represents synthetic opioids excluding methadone. This is mostly fentanyl but may also include meperidine 45 to 54 55 to 64

Cocaine-related mortality is highest for the non-Hispanic black population in the Bronx -----------------------Bronx only-----------------------Age-adjusted cocaine-related mortality rate per 100, 000 30 28. 0 25 22. 8 20 14. 8 15 11. 9 10. 8 10 9. 5 8. 8 5. 6 11. 9 8. 7 5. 2 5 0 Bronx 41 NYC excl. Bronx Male Data source: Multiple Cause of Death, 2016 -2017. Age data are not age-adjusted. Female Hispanic Non. Hispanic black Non. Hispanic white 25 to 34 35 to 44 45 to 54 55 to 64

About the Community Health Dashboard Project § The goal of the project is to provide Bronx-specific data on risk factors and health outcomes with an emphasis on presenting data on trends, socio-demographic differences (e. g. , by age, sex, race/ethnicity, etc. ) and sub-county/neighborhood level data § Will be periodically updated as new data becomes available. § Produced by Montefiore’s Office of Community & Population Health using publicly-available data sources § For more information please contact us at OCPHDept@montefiore. org 42