Relation between opioid-related harms and socioeconomic inequalities in Ontario: a population-based descriptive study.
Relation between opioid-related harms and socioeconomic inequalities in Ontario: a population-based descriptive study.
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DOI：
10.9778/cmajo.20180084
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发表时间：
2018-10-01
期刊：
影响因子：
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通讯作者：
Hohenadel, Karin
中科院分区：
文献类型：
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作者：
Cairncross, Zoe F;Herring, Jeremy;Hohenadel, Karin
背景：与使用处方和非处方阿片类药物相关的负面健康结果越来越普遍。我们检查了安大略阿片类药物相关危害的长期趋势，包括一组6项指标以及2016年危害与社区收入之间的关系。方法：我们使用基于人口的卫生管理数据库，检查了2003年至2016年安大略新生儿戒断综合征、阿片类药物中毒（致命性和非致命性）和非中毒阿片类药物相关事件的发生率。我们在2016年对社区收入五分位数的危害指标进行了描述性分析（2015年为死亡）。我们在相对（患病率）和绝对（潜在率降低）量表上检查了阿片类药物相关危害的社会不平等。结果：2003年至2016年期间，阿片类药物相关危害的发生率急剧上升。2016年，新生儿戒断综合征和阿片类药物中毒和非中毒事件显示出强烈的社会梯度，高收入社区的伤害率最低，低收入社区最高。最低收入社区与最高收入社区相比，阿片类药物中毒急诊就诊的患病率为2.36（95%置信区间[CI] 2.15-2.58），新生儿戒断综合征为3.70（95% CI 2.62-5.23）。阿片类药物相关伤害的潜在发生率降低范围为34.8%（95% CI 29.1-40.1）至49.9%（95%CI 36.7-60.5），这表明，如果所有社区的社会经济状况都与最高收入社区相同，那么至少三分之一的有害事件是可以预防的。2003年至2016年期间，安大略的阿片类药物相关危害率有所增加，低收入社区的人们经历的阿片类药物相关危害率远远高于高收入社区。这一发现可以为考虑健康公平的阿片类药物相关公共卫生干预措施的规划提供信息。
BACKGROUND: Negative health outcomes associated with the use of both prescribed and nonprescribed opioids are increasingly prevalent. We examined long-term trends in opioid-related harms in Ontario across a set of 6 indicators and the relation between harms and neighbourhood income in 2016.METHODS: We examined rates of neonatal abstinence syndrome, opioid poisoning (fatal and nonfatal) and nonpoisoning opioid-related events from 2003 to 2016 in Ontario using population-based health administrative databases. We conducted descriptive analyses for harm indicators across neighbourhood income quintiles in 2016 (2015 for death). We examined social inequalities in opioid-related harms on both relative (prevalence ratio) and absolute (potential rate reduction) scales.RESULTS: Rates of opioid-related harms increased dramatically between 2003 and 2016. In 2016, neonatal abstinence syndrome and opioid poisoning and nonpoisoning events showed a strong social gradient, with harm rates being lowest in higher-income neighbourhoods and highest in lower-income neighbourhoods. Prevalence ratios for the lowest-income neighbourhoods compared to the highest-income neighbourhoods ranged from 2.36 (95% confidence interval [CI] 2.15-2.58) for emergency department visits for opioid poisoning to 3.70 (95% CI 2.62-5.23) for neonatal abstinence syndrome. Potential rate reductions for opioid-related harms ranged from 34.8% (95% CI 29.1-40.1) to 49.9% (95% CI 36.7-60.5), which suggests that at least one-third of all harmful events could be prevented if all neighbourhoods had the same socioeconomic profile as the highest-income neighbourhoods.INTERPRETATION: Rates of opioid-related harms increased in Ontario between 2003 and 2016, and people in lower-income neighbourhoods experienced substantially higher rates of opioid-related harms than those in higher-income neighbourhoods. This finding can inform planning for opioid-related public health interventions with consideration of health equity.