Identifying Unreported opioid Deaths Through Toxicology Data and Vital Records Linkage: Case Study in Marion County, Indiana, 2011-2016
Identifying Unreported opioid Deaths Through Toxicology Data and Vital Records Linkage: Case Study in Marion County, Indiana, 2011-2016
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DOI：
10.2105/ajph.2018.304683
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发表时间：
2018-12-01
影响因子：
12.7
通讯作者：
Watson, Dennis P.
中科院分区：
文献类型：
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作者：
Lowder, Evan M.;Ray, Bradley R.;Watson, Dennis P.
目标.证明阿片类药物相关死亡的严重性，在当地司法管辖区与高比例的未指明的意外中毒死亡。我们将毒理学数据与2011年1月至2016年12月期间印第安纳州马里恩县所有意外中毒死亡（n = 1238）的生命记录进行了匹配。根据生命记录，我们将病例编码为涉及阿片类药物、指定其他物质或未指定。我们提取了未指明病例的阿片类药物毒理学数据，并在解释毒理学发现后报告了阿片类药物相关死亡的校正估计值。在6年期间，57.7%的意外过量死亡未指明，34.2%涉及阿片类药物。毒理学数据显示，86.8%的未指明病例对阿片类药物检测呈阳性。纳入毒理学结果使阿片类药物相关死亡的比例增加了一倍多，从34.2%增加到86.地方司法管辖区可能在相当大的程度上低估了涉及阿片类药物过量死亡的人数。毒理学数据可以提高确定阿片类药物过量死亡的准确性。需要对当地验尸官进行强制性毒理学测试和加强死亡证明报告标准的培训，以提高当地监测阿片类药物涉及的意外过量死亡的准确性。
Objectives. To demonstrate the severity of undercounting opioid-involved deaths in a local jurisdiction with a high proportion of unspecified accidental poisoning deaths.Methods. We matched toxicology data to vital records for all accidental poisoning deaths (n = 1238) in Marion County, Indiana, from January 2011 to December 2016. From vital records, we coded cases as opioid involved, specified other substance, or unspecified. We extracted toxicology data on opioid substances for unspecified cases, and we have reported corrected estimates of opioid-involved deaths after accounting for toxicology findings.Results. Over a 6-year period, 57.7% of accidental overdose deaths were unspecified and 34.2% involved opioids. Toxicology data showed that 86.8% of unspecified cases tested positive for an opioid. Inclusion of toxicology results more than doubled the proportion of opioid-involved deaths, from 34.2% to 86.0%.Conclusions. Local jurisdictions may be undercounting opioid-involved overdose deaths to a considerable degree. Toxicology data can improve accuracy in identifying opioid-involved overdose deaths.Public Health Implications. Mandatory toxicology testing and enhanced training for local coroners on standards for death certificate reporting are needed to improve the accuracy of local monitoring of opioid-involved accidental overdose deaths.