Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas - United States.
Illicit Drug Use, Illicit Drug Use Disorders, and Drug Overdose Deaths in Metropolitan and Nonmetropolitan Areas - United States.
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DOI：
10.15585/mmwr.ss6619a1
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发表时间：
2017-10-20
期刊：
影响因子：
--
通讯作者：
Ballesteros MF
中科院分区：
文献类型：
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作者：
Mack KA;Jones CM;Ballesteros MF
药物过量是美国伤害死亡的主要原因，2015年导致约52，000人死亡。了解大都市和非大都市地区非法药物使用，非法药物使用障碍和总体药物过量死亡的差异对于告知公共卫生计划，干预措施和政策非常重要。2003-2014年期间的非法药物使用和药物使用病症，以及1999-2015年期间的药物过量死亡。全国药物使用和健康调查（NSDUH）通过面对面的家庭访谈收集有关美国12岁以上非住院平民人口使用非法药物、酒精和烟草的信息。受访者包括家庭和非机构群体宿舍的居民（例如，难民营（包括临时住所、公寓、宿舍、移徙工人营地和中途宿舍）和居住在军事基地的平民。NSDUH变量包括性别、年龄、种族/民族、居住地（都市/非都市）、家庭年收入、自我报告的药物使用和药物使用障碍。美国居民的国家生命统计系统死亡率（NVSS-M）数据包括来自50个州和哥伦比亚特区提交的死亡证明的信息。根据ICD-10药物过量代码（X40-X44、X60-X64、X85和Y10-Y14），选择有潜在死亡原因的病例。NVSS-M变量包括死者特征（性别、年龄和种族/民族）和意图（非故意、自杀、他杀或未确定）、死亡地点（医疗机构、家中或其他[包括疗养院、临终关怀、未知和其他地点]）和居住县（大都市/非大都市）的信息。在每个数据系统中独立分配城域/非城域状态。NSDUH使用三个类别的系统：基于核心的统计区（CBSA）≥ 100万人; CBSA <100万人;而不是CBSA，为了简单起见，被标记为大都市，小都市和非都市。NVSS-M的死亡按死者居住的县分类，使用CDC的国家卫生统计中心2013年城乡分类方案，分为两类（大都市和非大都市）。尽管大都市和非大都市地区在2003-2005年至2012-2014年期间自我报告的上个月非法药物使用情况显著增加，但在整个研究期间，与小都市或非大都市地区相比，大都市地区的流行率最高。值得注意的是，在研究期间，最年轻的受访者（12-17岁）上个月使用非法药物的情况有所下降。10.在过去一年使用非法药物者中，上一年非法药物使用病症的流行率因都市/非都市状况而异，并随时间而变化。2003-2014年期间，在大都市和非大都市地区，上年非法药物使用病症的流行率均有所下降。2015年，大都市地区发生的药物过量死亡人数是非大都市地区的六倍（大都市：45，059人;非大都市：7，345人）。1999年，大都市地区的药物过量死亡率（每10万人口）高于非大都市地区（6.4比4.0），然而，2004年的死亡率趋于一致，到2015年，非大都市地区的死亡率（17.0）略高于大都市地区（16.2）。吸毒和随后的过量仍然是大都市/非大都市地区的一个关键和复杂的公共卫生挑战。2012-2014年期间，青年非法药物使用减少，农村地区非法药物使用病症流行率降低，这是令人鼓舞的迹象。然而，农村地区吸毒过量死亡率不断上升，超过了城市地区，令人关切。了解大都市和非大都市地区在药物使用，药物使用障碍和药物过量死亡方面的差异可以帮助公共卫生专业人员识别，监测和优先考虑应对措施。考虑到人们居住的地方和他们死于过量的地方可以加强特定的过量预防干预措施，例如纳洛酮管理或救援呼吸的培训。教育开处方者关于CDC的用于开阿片类药物用于慢性疼痛的指南（Dowell D，Haegerich TM，Chou R. CDC慢性疼痛阿片类药物处方指南-美国，2016年。MMWR Recomm Rep 2016;66[No. RR-1]），促进更好地获得美沙酮、丁丙诺啡或纳洛酮的药物辅助治疗，可以使阿片类药物使用障碍率高的社区受益。
Drug overdoses are a leading cause of injury death in the United States, resulting in approximately 52,000 deaths in 2015. Understanding differences in illicit drug use, illicit drug use disorders, and overall drug overdose deaths in metropolitan and nonmetropolitan areas is important for informing public health programs, interventions, and policies. Illicit drug use and drug use disorders during 2003–2014, and drug overdose deaths during 1999–2015. The National Survey of Drug Use and Health (NSDUH) collects information through face-to-face household interviews about the use of illicit drugs, alcohol, and tobacco among the U.S. noninstitutionalized civilian population aged ≥12 years. Respondents include residents of households and noninstitutional group quarters (e.g., shelters, rooming houses, dormitories, migratory workers’ camps, and halfway houses) and civilians living on military bases. NSDUH variables include sex, age, race/ethnicity, residence (metropolitan/nonmetropolitan), annual household income, self-reported drug use, and drug use disorders. National Vital Statistics System Mortality (NVSS-M) data for U.S. residents include information from death certificates filed in the 50 states and the District of Columbia. Cases were selected with an underlying cause of death based on the ICD-10 codes for drug overdoses (X40–X44, X60–X64, X85, and Y10–Y14). NVSS-M variables include decedent characteristics (sex, age, and race/ethnicity) and information on intent (unintentional, suicide, homicide, or undetermined), location of death (medical facility, in a home, or other [including nursing homes, hospices, unknown, and other locations]) and county of residence (metropolitan/nonmetropolitan). Metropolitan/nonmetropolitan status is assigned independently in each data system. NSDUH uses a three-category system: Core Based Statistical Area (CBSA) of ≥1 million persons; CBSA of <1 million persons; and not a CBSA, which for simplicity were labeled large metropolitan, small metropolitan, and nonmetropolitan. Deaths from NVSS-M are categorized by the county of residence of the decedent using CDC’s National Center for Health Statistics 2013 Urban-Rural Classification Scheme, collapsed into two categories (metropolitan and nonmetropolitan). Although both metropolitan and nonmetropolitan areas experienced significant increases from 2003–2005 to 2012–2014 in self-reported past-month use of illicit drugs, the prevalence was highest for the large metropolitan areas compared with small metropolitan or nonmetropolitan areas throughout the study period. Notably, past-month use of illicit drugs declined over the study period for the youngest respondents (aged 12–17 years). The prevalence of past-year illicit drug use disorders among persons using illicit drugs in the past year varied by metropolitan/nonmetropolitan status and changed over time. Across both metropolitan and nonmetropolitan areas, the prevalence of past-year illicit drug use disorders declined during 2003–2014. In 2015, approximately six times as many drug overdose deaths occurred in metropolitan areas than occurred in nonmetropolitan areas (metropolitan: 45,059; nonmetropolitan: 7,345). Drug overdose death rates (per 100,000 population) for metropolitan areas were higher than in nonmetropolitan areas in 1999 (6.4 versus 4.0), however, the rates converged in 2004, and by 2015, the nonmetropolitan rate (17.0) was slightly higher than the metropolitan rate (16.2). Drug use and subsequent overdoses continue to be a critical and complicated public health challenge across metropolitan/nonmetropolitan areas. The decline in illicit drug use by youth and the lower prevalence of illicit drug use disorders in rural areas during 2012–2014 are encouraging signs. However, the increasing rate of drug overdose deaths in rural areas, which surpassed rates in urban areas, is cause for concern. Understanding the differences between metropolitan and nonmetropolitan areas in drug use, drug use disorders, and drug overdose deaths can help public health professionals to identify, monitor, and prioritize responses. Consideration of where persons live and where they die from overdose could enhance specific overdose prevention interventions, such as training on naloxone administration or rescue breathing. Educating prescribers on CDC’s guideline for prescribing opioids for chronic pain (Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep 2016;66[No. RR-1]) and facilitating better access to medication-assisted treatment with methadone, buprenorphine, or naltrexone could benefit communities with high opioid use disorder rates.