Assessment of Changes in the Geographical Distribution of Opioid-Related Mortality Across the United States by Opioid Type, 1999-2016
Assessment of Changes in the Geographical Distribution of Opioid-Related Mortality Across the United States by Opioid Type, 1999-2016
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DOI：
10.1001/jamanetworkopen.2019.0040
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发表时间：
2019-02-01
影响因子：
13.8
通讯作者：
Alexander, Monica J.
中科院分区：
文献类型：
--
作者：
Kiang, Mathew V.;Basu, Sanjay;Alexander, Monica J.
重要性随着阿片类药物流行的发展，确定阿片类药物相关死亡的地理分布变化以及这些死亡归因于特定阿片类药物至关重要，以确保联邦和州公共卫生干预措施保持适当的针对性。和参与者使用joinpoint建模和生命表分析国家卫生统计中心的个人水平数据的横断面研究，这些数据来自1999年1月1日至2016年12月31日期间死于阿片类药物相关原因的351630名美国居民，适用于美国和哥伦比亚特区。该分析于2018年9月6日至11月23日进行。暴露涉及任何阿片类药物、海洛因、合成阿片类药物以及天然和半合成阿片类药物的死亡。主要结果和指标阿片类药物相关死亡率、阿片类药物相关死亡率的年百分比变化以及按州和阿片类药物类型划分的15岁时预期寿命损失。全美共有231264名男性和120366名女性死于阿片类药物相关原因。由于年龄数据缺失，删除了66个观察结果;因此，本研究纳入了351564名美国居民。男性的平均（SD）死亡年龄为39.8（12.5）岁，女性为43.5（12.9）岁。与类阿片有关的死亡率，特别是合成类阿片的死亡率，在美国东部各地迅速上升。在大多数州，与天然和半合成阿片类药物（即处方止痛药）相关的死亡率保持稳定。相比之下，28个州的合成阿片类药物死亡率每两年增加一倍以上（即，年百分比变化，>= 41%），其中12个州的合成阿片类药物死亡率较高（>10/10万人）。在这28个州中，天然和半合成阿片类药物的死亡率为每10万人2.0至18.7人（平均死亡率为每10万人6.0人）。哥伦比亚特区的阿片类药物死亡率增长最快，自2013年以来每年增加两倍以上（年百分比变化，228.3%; 95% CI，169.7%-299.6%; P
IMPORTANCE As the opioid epidemic evolves, it is vital to identify changes in the geographical distribution of opioid-related deaths, and the specific opioids to which those deaths are attributed, to ensure that federal and state public health interventions remain appropriately targeted.OBJECTIVE To identify changes in the geographical distribution of opioid-related mortality across the United States by opioid type.DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study using joinpoint modeling and life table analysis of individual-level data from the National Center for Health Statistics on 351 630 US residents who died from opioid-related causes from January 1, 1999, to December 31, 2016, for all of the United States and the District of Columbia. The analysis was conducted from September 6 to November 23, 2018.EXPOSURES Deaths involving any opioid, heroin, synthetic opioids, and natural and semisynthetic opioids.MAIN OUTCOMES AND MEASURES Opioid-related mortality rate, annual percent change in the opioid-related mortality rate, and life expectancy lost at age 15 years by state and opioid type.RESULTS From 1999 to 2016, a total of 231 264 men and 120 366 women died from opioid-related causes across the whole United States. Sixty-six observations were removed owing to missing data on age; therefore, 351 564 US residents were included in this study. The mean (SD) age at death was 39.8 (12.5) years for men and was 43.5 (12.9) years from women. Opioid-related mortality rates, especially from synthetic opioids, rapidly increased in all of the eastern United States. In most states, mortality associated with natural and semisynthetic opioids (ie, prescription painkillers) remained stable. In contrast, 28 states had mortality rates from synthetic opioids that more than doubled every 2 years (ie, annual percent change, >= 41%), including 12 with high mortality rates from synthetic opioids (>10 per 100 000 people). Among these 28 states, the mortality rate from natural and semisynthetic opioids ranged from 2.0 to 18.7 per 100 000 people (with a mean mortality rate of 6.0 per 100 000 people). The District of Columbia had the fastest rate of increase in mortality from opioids, more than tripling every year since 2013 (annual percent change, 228.3%; 95% CI, 169.7%-299.6%; P