Revisiting the Role of the Urban Environment in Substance Use: The Case of Analgesic Overdose Fatalities
Revisiting the Role of the Urban Environment in Substance Use: The Case of Analgesic Overdose Fatalities
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DOI：
10.2105/ajph.2013.301347
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发表时间：
2013-12-01
影响因子：
12.7
通讯作者：
Galea, Sandro
中科院分区：
文献类型：
--
作者：
Cerda, Magdalena;Ransome, Yusuf;Galea, Sandro
目标。我们检查了社区的社会特征(收入分配和家庭分裂)和身体特征(清洁的人行道和破旧的房屋)是否与止痛药过量导致的死亡风险有关。在一项病例对照研究中，我们比较了2000年至2006年发生在纽约市59个社区的447例非故意止痛类阿片类药物过量死亡(病例)和3436例非故意非阿片类药物过量死亡病例和2530例海洛因过量死亡病例(对照)。止痛药过量死亡发生在高收入社区的可能性低于非过量意外死亡(优势比[OR]=0.82；95%可信区间[CI]=0.70，0.96)，而更有可能发生在分散的社区(OR=1.35；95%CI=1.05，1.72)。高收入(OR=1.31；95%CI=1.12，1.54)和分散程度较低(OR=0.71；95%CI=0.55，0.92)的社区发生海洛因过量死亡的可能性较大。止痛药过量死亡呈现出不同于海洛因和非过量意外死亡的空间模式。虽然止痛药死亡通常发生在收入较低、比非过量死亡更分散的社区，但它们往往发生在收入更高、不平等和分散程度更低的社区，而不是海洛因死亡。
Objectives. We examined whether neighborhood social characteristics (income distribution and family fragmentation) and physical characteristics (clean sidewalks and dilapidated housing) were associated with the risk of fatalities caused by analgesic overdose.Methods. In a case-control study, we compared 447 unintentional analgesic opioid overdose fatalities (cases) with 3436 unintentional nonoverdose fatalities and 2530 heroin overdose fatalities (controls) occurring in 59 New York City neighborhoods between 2000 and 2006.Results. Analgesic overdose fatalities were less likely than nonoverdose unintentional fatalities to have occurred in higher-income neighborhoods (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.70, 0.96) and more likely to have occurred in fragmented neighborhoods (OR = 1.35; 95% CI = 1.05, 1.72). They were more likely than heroin overdose fatalities to have occurred in higher-income (OR = 1.31; 95% CI = 1.12, 1.54) and less fragmented (OR = 0.71; 95% CI = 0.55, 0.92) neighborhoods.Conclusions. Analgesic overdose fatalities exhibit spatial patterns that are distinct from those of heroin and nonoverdose unintentional fatalities. Whereas analgesic fatalities typically occur in lower-income, more fragmented neighborhoods than nonoverdose fatalities, they tend to occur in higher-income, less unequal, and less fragmented neighborhoods than heroin fatalities.