Variation in US Drug Overdose Mortality Within and Between Hispanic/Latine Subgroups: A Disaggregation of National Data

Abstract

This study examined differences across Latine heritage groups (i.e., Mexican, Puerto Rican, Cuban, Dominican, Central American, South American) in rates of US drug overdose mortality. The study utilized 2015-2019 mortality data from the National Center for Health Statistics for 29,137 Hispanic individuals who died of drug overdose. Using population estimates from the American Community Survey, age-standardized drug overdose mortality rates were calculated by specific Latine heritage and sex, nativity, educational attainment, and geographic region. Standardized rate ratios (SRRs), incidence rate ratios (IRRs) from negative binomial regression models, and 95% Confidence Intervals (CIs) were calculated, and multiple imputation was used for missing Latine heritage group in select models. Drug overdose mortality rates in the Puerto Rican heritage population were more than three times as high as in the Mexican heritage population (IRR 3.61 [95% CI 3.02-4.30] in unadjusted model; IRR 3.70 [95% CI 3.31-4.15] in model adjusting for age, sex, nativity, educational attainment, and region; SRR 3.23 [95% CI, 3.15-3.32] in age-standardized model with missing Hispanic heritage imputed). Higher age-standardized rates of drug overdose mortality were observed in males than females across all Latine groups, yet the magnitude of the sex differential varied by Latine heritage. The relationship between drug overdose mortality and nativity differed by Latine heritage; in all groups except Puerto Rican, overdose mortality rates were significantly higher in the US-born than those not US-born. In contrast, overdose mortality rates were significantly lower in US-born Puerto Ricans than in Puerto Ricans who were not US-born (e.g., born in Puerto Rico; SRR, 0.84 [95% CI 0.80-0.88]). The relationship between drug overdose mortality and educational attainment (for ages 25+) also varied between Latine groups. The diverse subgroups comprising the US Latine population vary not only in rates of drug overdose mortality, but also in demographic risk factors for fatal drug overdose.

Similarities and Differences in Alcohol & Other Drug Dependence Among Hispanic/Latino Subgroups: A Disaggregation Approach

“…Although there may be some value gained when all H/L individuals are aggregated into a single group, the practice of categorizing H/L as a homogeneous ethnic group can hinder our understanding of patterns of drug use, with subsequent constraints on research to identify practical prevention and treatment strategies. Examples of research utilizing an ethnicity disaggregation approach have encompassed a variety of health outcomes, including, but not limited to, psychiatric morbidity ( Alegria et al., 2007 ; Alegria, et al., 2008 ), cigarette smoking ( Barnes, et al., 2010 ; Rodriguez et al., 2019 ); alcohol misuse ( Barnes, et al., 2010 ; Caetano et al., 2008 ; Lipsky & Caetano, 2009; Ramisetty-Mikler, et al., 2010 ; Rios-Bedoya & Freile-Salinas, 2014 ), drug misuse ( Lacey, et al., 2016 ; Parker et al., 2018 ), drug overdose (Cano, 2020; Cano & Gelpí-Acosta, 2022 ), and health care utilization ( Barnes, et al., 2010 ; Mancini, et al., 2015 ). Taken together, this research has demonstrated that data aggregation conceals within-group inequities in health-related issues in various populations including countries outside the U.S. ( Lacey, et al., 2016 ).…”