Association Between Automotive Assembly Plant Closures and Opioid Overdose Mortality in the United States A Difference-in-Differences Analysis
Association Between Automotive Assembly Plant Closures and Opioid Overdose Mortality in the United States A Difference-in-Differences Analysis
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DOI：
10.1001/jamainternmed.2019.5686
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发表时间：
2020-02-01
影响因子：
39
通讯作者：
Tsai, Alexander C.
中科院分区：
文献类型：
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作者：
Venkataramani, Atheendar S.;Bair, Elizabeth F.;Tsai, Alexander C.
重要性下降的经济机会被假设为与美国阿片类药物过量危机有关的一个重要因素。汽车装配厂关闭是文化上的重大事件，极大地侵蚀了当地的经济机会。目的评估汽车装配厂关闭与劳动年龄成年人中阿片类药物过量死亡率上升的关系。设计、背景和参与者一项县级差异研究在分布在30个通勤区(主要是美国南部和中西部)的112个制造县的18至65岁的成年人中进行，截至1999年，至少有1家汽车装配厂在运营。这项研究分析了1999年1月1日至2016年12月31日期间，受工厂关闭影响的制造县与未受工厂关闭影响的制造县的年龄调整后的县级阿片类药物过量死亡率。2018年4月1日至2019年7月20日期间进行了数据分析。居民通勤区汽车组装厂关闭的经验。主要结果和衡量指标是县级年龄调整后的阿片类药物过量死亡率。次要结果包括总体药物过量死亡率和处方与非法药物过量死亡率。结果在研究期间，10个通勤区的29个制造县暴露于汽车组装厂关闭，而20个通勤区的83个制造县未暴露。暴露县(0.9[1.4])和未暴露县(1.0[2.1])的平均(SD)基线阿片类药物超标率相似。汽车组装厂的关闭与阿片类药物过量死亡率的统计显着增加有关。在工厂关闭五年后，与未暴露的县相比，暴露县的死亡率每10万人中增加了8.6例阿片类药物过量死亡(95%CI，2.6-14.6；P=0.006)，相对于同一时间点未暴露县的死亡率(每10万人12例死亡)，增加了85%。在按年龄、性别和种族/民族分层的分析中，18至34岁的非西班牙裔白人男性(每10万人20.1例死亡；95%可信区间8.8-31.3；P=.001)和35-65岁的非西班牙裔白人男性(每10万例死亡12.8例；95%可信区间5.7-20.0；P=.001)中阿片类药物过量死亡率的增幅最大。我们观察到处方药与非法药物过量死亡的相似模式。非制造业县阿片类药物过量死亡率的估计在统计学上没有显著意义。结论和相关性从1999年到2016年，汽车组装厂的关闭与阿片类药物过量死亡率的增加有关。这些发现突显了侵蚀经济机会作为美国阿片类药物过量危机的一个因素的潜在重要性。
IMPORTANCE Fading economic opportunity has been hypothesized to be an important factor associated with the US opioid overdose crisis. Automotive assembly plant closures are culturally significant events that substantially erode local economic opportunities.OBJECTIVE To estimate the extent to which automotive assembly plant closures were associated with increasing opioid overdose mortality rates among working-age adults.DESIGN, SETTING, AND PARTICIPANTS A county-level difference-in-differences study was conducted among adults aged 18 to 65 years in 112 manufacturing counties located in 30 commuting zones (primarily in the US South and Midwest) with at least 1 operational automotive assembly plant as of 1999. The study analyzed county-level changes from January 1, 1999, to December 31, 2016, in age-adjusted, county-level opioid overdose mortality rates before vs after automotive assembly plant closures in manufacturing counties affected by plant closures compared with changes in manufacturing counties unaffected by plant closures. Data analyses were performed between April 1, 2018, and July 20, 2019.EXPOSURE Closure of automotive assembly plants in the commuting zone of residence.MAIN OUTCOMES AND MEASURES The primary outcome was the county-level age-adjusted opioid overdose mortality rate. Secondary outcomes included the overall drug overdose mortality rate and prescription vs illicit drug overdose mortality rates.RESULTS During the study period, 29 manufacturing counties in 10 commuting zones were exposed to an automotive assembly plant closure, while 83 manufacturing counties in 20 commuting zones remained unexposed. Mean (SD) baseline opioid overdose rates per 100 000 were similar in exposed (0.9 [1.4]) and unexposed (1.0 [2.1]) counties. Automotive assembly plant closures were associated with statistically significant increases in opioid overdose mortality. Five years after a plant closure, mortality rates had increased by 8.6 opioid overdose deaths per 100 000 individuals (95% CI, 2.6-14.6; P = .006) in exposed counties compared with unexposed counties, an 85% increase relative to the mortality rate of 12 deaths per 100 000 observed in unexposed counties at the same time point. In analyses stratified by age, sex, and race/ethnicity, the largest increases in opioid overdose mortality were observed among non-Hispanic white men aged 18 to 34 years (20.1 deaths per 100 000; 95% CI, 8.8-31.3; P = .001) and aged 35 to 65 years (12.8 deaths per 100 000; 95% CI, 5.7-20.0; P = .001). We observed similar patterns of prescription vs illicit drug overdose mortality. Estimates for opioid overdose mortality in nonmanufacturing counties were not statistically significant.CONCLUSIONS AND RELEVANCE From 1999 to 2016, automotive assembly plant closures were associated with increases in opioid overdose mortality. These findings highlight the potential importance of eroding economic opportunity as a factor in the US opioid overdose crisis.