evidence: From 2019 to 2020, overdose death rates increased by 44% and 39% among non-Hispanic Black (Black) and non-Hispanic American Indian or Alaska Native persons, respectively. As county-level income inequality increased, overdose rates increased, particularly among Black persons. Evidence of previous substance use treatment was lowest for Black decedents (8.3%). [...] ¶ Alaska, Connecticut, Delaware, District of Columbia, Georgia, Kentucky, Maine, Massachusetts, Minnesota, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, Ohio, Oklahoma, Rhode Island, Tennessee, Utah, Vermont, Virginia, and West Virginia were funded to report cause of death data on all overdose deaths within the jurisdiction in 2019 and 2020. Illinois, Missouri, Pennsylvania, and Washington were funded to report cause of death data on ≥75% of all overdose deaths within a jurisdiction in 2019 and 2020. Jurisdictions were included in rate calculations if they met data submission deadlines and addressed data entry errors in 2019 and 2020.