Spatial patterns of suicide in Texas: The potential confounding effect of race and ethnicity composition

Abstract

In the United States, suicide rates are much higher among non-Hispanic Whites than any other racial or ethnic group. However, the impact of this pattern for spatial analysis remains unclear. This article explores the relationship among race and ethnicity, suicide mortality, and space in Texas. We compare traditional age-adjusted mortality rates with standardized mortality ratios created using indirect race or ethnicity rate adjustment. Both measurements are compared in three different contexts: choropleth maps, Getis–Ord Gi* hot spot analysis, and location-allocation modeling. Results show dramatic changes across all three methods after race or ethnicity adjustment. Regions of higher-than-expected suicide mortality shift from the non-Hispanic White-dominated north to the majority-Hispanic south. Accordingly, the p-median location-allocation model moves selected service sites closer to minority strongholds in large urban areas and along the Texas–Mexico border. A closer look at individual counties shows that minority-majority counties may have suicide rates two to three times the state average (given the population composition) yet remain hidden by traditional rate calculation methods. Failing to account for race and ethnicity effects will inevitably draw attention and resources to non-Hispanic White communities. At a time when governments are making investments in both mental health and diversity initiatives, this hidden bias must be addressed.