Drug poisoning deaths in the United States, 1999-2012: a statistical adjustment analysis
Drug poisoning deaths in the United States, 1999-2012: a statistical adjustment analysis
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DOI：
10.1186/s12963-016-0071-7
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发表时间：
2016-01-15
影响因子：
3.3
通讯作者：
Ruhm, Christopher J.
中科院分区：
文献类型：
--
作者：
Ruhm, Christopher J.
背景资料：药物中毒死亡率在美国迅速上升，但涉及的药物往往是未指明的death certificate.Methods：报告和调整的比例，涉及致命的药物中毒的特定药物类型的生命统计死亡率数据计算从1999年至2012年。结果：2012年阿片类镇痛药提及率为54.3%（95%可信区间[CI]：53.6%-55%），比报告的38.6%高40.8%。所有麻醉剂、其他麻醉剂、镇静剂或精神药物以及多种药物使用的调整率为81.5%（95% CI：80.9%-82.2%），38.4%（95% CI：37.8%-39%），30%（95% CI：29.4%-30.7%），26%（95%CI：25.4%-26.6%）和42.8%（95%CI：42.1%-43.5%），而报告的比例分别为60.7%、27.9%、18.7%、18%和26.9%。这些调整通常对1999年的估计数产生类似或稍小的影响，对苯二氮卓类和抗精神病药物等药物类型的亚类产生较大的影响。根据调整后的比例，2012年估计有22，534、15，933、12，457、10，798和17，670例药物死亡涉及阿片类镇痛药、其他麻醉剂、镇静剂、精神药物和药物组合，而死亡证明报告分别为16，007、11，567、7，754、7，467和11，176.Conclusions:死亡证明大大低估了阿片类镇痛药、镇静剂、精神药物和药物组合在致命药物中毒中的作用。对死亡证明中只报告未具体说明的药物的情况进行调整的程序提供了更准确的信息。
Background: Drug poisoning mortality in the US has risen rapidly but the drugs involved are frequently unspecified on death certificates.Methods: Reported and adjusted proportions of specific drug types involved in fatal drug poisonings were calculated using vital statistics mortality data from 1999 to 2012. The adjusted proportions were those predicted to occur if at least one specific type of drug had been identified on the death certificates of all poisoning fatalities.Results: Adjusted involvement rates of opioid analgesic mentions in 2012 were 54.3 % (95 % confidence interval [CI]: 53.6 %-55 %), 40.8 % higher than the reported 38.6 % rate. Adjusted rates for all narcotics, other narcotics, sedatives, or psychotropics, and multiple drug use were 81.5 % (95 % CI: 80.9 %-82.2 %), 38.4 % (95 % CI: 37.8 %-39 %), 30 % (95 % CI: 29.4 %-30.7 %), 26 % (95 % CI: 25.4 %-26.6 %) and 42.8 % (95 % CI: 42.1 %-43.5 %) in 2012, compared to reported proportions of 60.7, 27.9, 18.7, 18 and 26.9 %. The adjustments typically had similar or slightly smaller effects on the estimates in 1999, and larger impacts on subcategories of drug types such benzodiazepines and antipsychotic medications. Based on the adjusted proportions, 22,534, 15,933, 12,457, 10,798, and 17,670 drug deaths in 2012 were estimated to involve opioid analgesics, other narcotics, sedatives, psychotropic medications, and drug combinations, compared to death certificate reports of 16,007, 11,567, 7,754, 7,467, and 11,176.Conclusions: Death certificates substantially understate the involvement of opioid analgesics, sedatives, psychotropics, and drug combinations in fatal drug poisonings. Adjustment procedures that account for cases where only unspecified drugs are reported on death certificates provide more accurate information.