Inequalities in Drug Overdose Mortality in the US Northeast: A Comparison between Non-Hispanic White Men and Hispanic Men

Background and Purpose: At the national level, the Hispanic population experiences lower rates of drug overdose mortality than Non-Hispanic (NH) White or Black populations; nonetheless, disproportionately high rates of drug overdose mortality have been documented specifically in Hispanic men in several subnational areas in the US Northeast. Therefore, the present study aimed to identify individual- and county-level inequalities that may underlie disparities in drug overdose mortality for Hispanic men in Massachusetts and the broader Northeast region.

Methods: The study consisted of cross-sectional analyses of data from two separate sources. The study first used data from the State Unintentional Drug Overdose Reporting System to compare the 635 Hispanic and 3,593 Non-Hispanic (NH) White men who died of unintentional/undetermined opioid-related overdoses in Massachusetts in 2016-2018. Next, the study used 2015-2019 data from the Multiple Cause of Death online platform from the Centers for Disease Control and Prevention to: a) compare rates of drug overdose mortality in Hispanic versus NH White men in 54 counties in the Northeast; and b) examine associations with inequalities in poverty, educational attainment, unemployment, and uninsurance (with data from the 2015-2019 American Community Survey), using ordinary least squares regression and spatial autoregressive models.

Results: At the individual level, in Massachusetts, Hispanic and NH White men who died of opioid-related overdose differed in terms of: educational attainment (18.4% with an 8^th grade education or lower among Hispanic men, compared to 2.0% among NH White men); homelessness (9.1% in Hispanic men versus 6.3% in NH White men); birthplace (39.1% born in the 50 United States or DC and 36.4% born in a US territory, for Hispanic men, compared to 96.5% born in the US for NH White men); urbanicity (92.6% in urban areas for Hispanic men, compared to 60.0% for NH White men); substance use disorder treatment history (18.3% for Hispanic men versus 31.7% for NH White men); and specific drugs involved in death (greater cocaine and lower prescription drug involvement in Hispanic than NH White men). In the study’s analysis of Northeast counties, drug overdose mortality rates were higher for Hispanic than NH White men in 12 counties, and lower for Hispanic than NH White men in the other 42 counties examined, while inequalities in poverty, educational attainment, unemployment, and uninsurance were observed for the Hispanic population across nearly all counties. Each one-standard deviation increase in the ratio of the Hispanic to NH White poverty rate was associated with a 27% increase in the ratio of Hispanic to NH White male overdose mortality; each one-standard deviation increase in the ratio of the Hispanic to NH White unemployment rate was associated with a 43% increase in the ratio of Hispanic to NH White male overdose mortality.

Conclusions: Study findings highlight several individual-level (education, housing, treatment) and county-level (poverty, unemployment) inequalities which may be relevant to drug overdose mortality in Hispanic men in Massachusetts and the broader Northeast United States. Findings underscore the importance of equitable interventions that address inequalities in social determinants of health for Hispanic populations in the Northeast.