Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the Mortality Disparities in American Communities Study (MDAC)
Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the Mortality Disparities in American Communities Study (MDAC)
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DOI：
10.1371/journal.pone.0227966
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发表时间：
2020-01-17
期刊：
影响因子：
3.7
通讯作者：
Blanco, Carlos
中科院分区：
文献类型：
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作者：
Altekruse, Sean F.;Cosgrove, Candace M.;Blanco, Carlos
背景 了解个人人口、社会经济地位 (SES) 和美国阿片类药物死亡之间的关系可以为应对这一危机的干预措施提供信息。 方法 美国社区死亡率差异研究 (MDAC) 将 2008 年美国社区调查的近 400 万份回复与 2008-2015 年国家死亡指数联系起来。使用单变量和多变量模型来估计阿片类药物过量死亡风险比 (HR) 和 95% 置信区间 (CI)。 结果 阿片类药物过量是 10 至 59 岁人群中常见的死亡原因。在多变量分析中，与西班牙裔相比，白人和美洲印第安人/阿拉斯加原住民的风险分别较高（HR = 2.52，CI：2.21-2.88）和（HR = 1.88，CI：1.35-2.62）。与女性相比，男性面临风险（HR = 1.61，CI：1.50-1.72）。残疾人比非残疾人面临更高的风险（HR = 2.80，CI：2.59-3.03）。丧偶者的风险高于已婚者（HR = 2.44，CI：2.03-2.95），失业者的风险高于就业者（HR = 2.46，CI：2.17-2.79）。与拥有研究生学位的成年人相比，只有高中学历的人面临风险（HR = 2.48，CI：2.00-3.06）。公民比非公民更有可能死于此原因（HR = 4.62，CI：3.48-6.14）。与拥有抵押贷款房屋的人相比，租房者的 HR 更高（HR = 1.36，CI：1.25-1.48）。非农村居民的风险高于农村居民（HR=1.46，CI：1.34，1.59）。与相应的参考组相比，没有健康保险的人（HR = 1.30，CI：1.20-1.41）和被监禁的人更有可能死于阿片类药物过量（HR = 2.70，CI：1.91-3.81）。与生活在贫困线以上至少五倍的家庭的人们相比，生活在贫困中的人们更有可能死于这种原因（HR = 1.36，CI：1.20-1.54）。与生活在中北部各州的人们相比，南大西洋州（HR = 1.29，CI：1.11，1.50）和山区州（HR = 1.58，CI：1.33，1.88）的 HR 最高。讨论 阿片类药物死亡率与低 SES 指标相关。研究结果可能有助于针对弱势群体开展预防、治疗和康复工作。
Background Understanding relationships between individual-level demographic, socioeconomic status (SES) and U.S. opioid fatalities can inform interventions in response to this crisis.Methods The Mortality Disparities in American Community Study (MDAC) links nearly 4 million 2008 American Community Survey responses to the 2008-2015 National Death Index. Univariate and multivariable models were used to estimate opioid overdose fatality hazard ratios (HR) and 95% confidence intervals (CI).Results Opioid overdose was an overrepresented cause of death among people 10 to 59 years of age. In multivariable analysis, compared to Hispanics, Whites and American Indians/Alaska Natives had elevated risk (HR = 2.52, CI:2.21-2.88) and (HR = 1.88, CI:1.35-2.62), respectively. Compared to women, men were at-risk (HR = 1.61, CI:1.50-1.72). People who were disabled were at higher risk than those who were not (HR = 2.80, CI:2.59-3.03). Risk was higher among widowed than married (HR = 2.44, CI:2.03-2.95) and unemployed than employed individuals (HR = 2.46, CI:2.17-2.79). Compared to adults with graduate degrees, those with high school only were at-risk (HR = 2.48, CI:2.00-3.06). Citizens were more likely than noncitizens to die from this cause (HR = 4.62, CI:3.48-6.14). Compared to people who owned homes with mortgages, those who rented had higher HRs (HR = 1.36, CI:1.25-1.48). Non-rural residents had higher risk than rural residents (HR = 1.46, CI:1.34, 1.59). Compared to respective referent groups, people without health insurance (HR = 1.30, CI:1.20-1.41) and people who were incarcerated were more likely to die from opioid overdoses (HR = 2.70, CI:1.91-3.81). Compared to people living in households at least five-times above the poverty line, people who lived in poverty were more likely to die from this cause (HR = 1.36, CI:1.20-1.54). Compared to people living in West North Central states, HRs were highest among those in South Atlantic (HR = 1.29, CI:1.11, 1.50) and Mountain states (HR = 1.58, CI:1.33, 1.88).Discussion Opioid fatality was associated with indicators of low SES. The findings may help to target prevention, treatment and rehabilitation efforts to vulnerable groups.