Fentanyl-driven acceleration of racial, gender and geographical disparities in drug overdose deaths in the United States.
Fentanyl-driven acceleration of racial, gender and geographical disparities in drug overdose deaths in the United States.
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DOI：
10.1371/journal.pgph.0000769
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发表时间：
2023
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我们研究了2013-2020年期间美国按种族、性别和地理分布的药物过量死亡趋势。种族和性别特定的粗比率是从几个司法管辖区的最终国家生命统计系统多种死因死亡率文件中提取的，并用于计算2013年至2020年期间粗比率的男女比例。我们确定了四种主要药物类型的2013-2019年时间趋势：具有成瘾潜力的精神兴奋剂（T43.6，如甲基苯丙胺）;海洛因（T40.1）;天然和半合成阿片类药物（T40.2，如处方止痛药中所含的物质）;合成阿片类药物（T40. 4，如芬太尼及其衍生物），并确定2020年大流行年的变化是否具有统计学意义。我们还确定了哪些种族、性别和州最受药物过量死亡的影响。在全国范围内，2020年除海洛因外，所有药物类别的过量死亡人数都有统计学显著增加，超过了基于2013-2019年趋势的预测。2018年，黑人和白人使用芬太尼和精神兴奋剂的粗比率超过了白色人，这一差距在2020年有所扩大。在一些地区，白色死亡率下降，而黑人吸毒过量死亡人数不断上升。2020年最大的死亡率统计数据是哥伦比亚特区的黑人男性，每10万人中有134人因芬太尼过量死亡，是白色男性死亡率的9.4倍。2020年，所有药物类别的男性用药过量粗比率仍高于女性，但爱达荷州、犹他州和阿肯色州除外，在这些州，女性天然和半合成阿片类药物用药过量死亡的粗比率超过男性。毒品预防、缓解和无害战略应包括针对种族、地域和性别的努力，以更好地查明风险群体并为他们提供服务。
We examine trends in drug overdose deaths by race, gender, and geography in the United States during the period 2013–2020. Race and gender specific crude rates were extracted from the final National Vital Statistics System multiple cause-of-death mortality files for several jurisdictions and used to calculate the male-to-female ratios of crude rates between 2013 and 2020. We established 2013–2019 temporal trends for four major drug types: psychostimulants with addiction potential (T43.6, such as methamphetamines); heroin (T40.1); natural and semi-synthetic opioids (T40.2, such as those contained in prescription pain-killers); synthetic opioids (T40.4, such as fentanyl and its derivatives) through a quadratic regression and determined whether changes in the pandemic year 2020 were statistically significant. We also identified which race, gender and states were most impacted by drug overdose deaths. Nationwide, the year 2020 saw statistically significant increases in overdose deaths from all drug categories except heroin, surpassing predictions based on 2013–2019 trends. Crude rates for Black individuals of both genders surpassed those for White individuals for fentanyl and psychostimulants in 2018, creating a gap that widened through 2020. In some regions, mortality among White persons decreased while overdose deaths for Black persons kept rising. The largest 2020 mortality statistic is for Black males in the District of Columbia, with a record 134 overdose deaths per 100,000 due to fentanyl, 9.4 times more than the fatality rate among White males. Male overdose crude rates in 2020 remain larger than those of females for all drug categories except in Idaho, Utah and Arkansas where crude rates of overdose deaths by natural and semisynthetic opioids for females exceeded those of males. Drug prevention, mitigation and no-harm strategies should include racial, geographical and gender-specific efforts, to better identify and serve at-risk groups.