How Does Drug Overdose Mortality Vary between US Hispanic Subgroups?

Background and Purpose: Although numerous drug-related outcomes have been well-researched among Latine subpopulations (i.e., Mexican, Puerto Rican, Cuban, Dominican, Central American, South American), comparatively less is known about the most recent patterns of drug overdose mortality in these subgroups, considering that national analyses of drug overdose generally examine the Hispanic population as one uniform group. Therefore, the present study used the LatCrit framework to examine diversity within the Latine population with respect to drug overdose mortality.

Methods: The study utilized 2015-2019 mortality data from the National Center for Health Statistics for 29,137 Hispanic individuals who died of a drug overdose. We used population estimates from the American Community Survey to calculate age-standardized drug overdose mortality rates for subgroups defined by the intersections of specific Latine heritage and sex, nativity, educational attainment, and geographic region. We calculated standardized rate ratios (SRRs), incidence rate ratios (IRRs) from negative binomial regression models, and 95% Confidence Intervals (CIs), using multiple imputation for missing Latine heritage group in select models.

Results: Drug overdose mortality rates in the Puerto Rican heritage group were more than three times as high as in the Mexican heritage group (IRR 3.61 [95% CI 3.02-4.30] in unadjusted model; IRR 3.70 [95% CI 3.31-4.15] in model adjusted for age, gender, 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 men than women across all Latine groups, yet the magnitude of the gender differential varied by Latine heritage (ranging from rates twice as high in men as women of Cuban heritage [SRR, 2.57; 95% CI, 2.22-2.97] to rates five times as high in men as women of Dominican heritage [SRR, 5.14; 95% CI, 4.36-6.07]). 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 for US-born Puerto Ricans than for 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; rates were comparable in the lowest and highest educational strata for Mexican and Central or South American heritage, while rates were six times as high in the lowest relative to the highest educational stratum for the Puerto Rican heritage population (SRR, 6.36; 95% CI, 5.75-7.02).

Conclusions: 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. The present study’s results add to the body of research underscoring the importance of health data disaggregation for the diverse Latine population. Whenever feasible, disaggregating outcomes such as drug overdose mortality by specific Latine heritage can serve as a first step toward more fully addressing health risks for US Latines.