Trends in Black and White Opioid Mortality in the United States, 1979-2015
Trends in Black and White Opioid Mortality in the United States, 1979-2015
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DOI：
10.1097/ede.0000000000000858
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发表时间：
2018-09-01
期刊：
影响因子：
5.4
通讯作者：
Barbieri, Magali
中科院分区：
文献类型：
--
作者：
Alexander, Monica J.;Kiang, Mathew V.;Barbieri, Magali
背景：最近对美国阿片类药物流行的研究主要集中在白人或总人口上，并且主要限于1999年以后的数据。然而，了解阿片类药物长期趋势的种族差异可能有助于改善干预措施。方法：利用多死因数据，按种族和阿片类药物类型计算1979年至2015年美国常住人口的年龄标准化阿片类药物死亡率。我们使用联结点回归分析死亡率趋势。结果：从1979年到2015年，早期数据中阿片类药物相关死亡率的长期趋势不包括种族，因此这是不正确的。美国的居民都是黑人和白人。黑人和白人经历了三个连续的浪潮。在1979年至1990年代中期的第一波浪潮中，这一流行病影响到两国人口，并由海洛因驱动。在第二波浪潮中，从1990年代中期到2010年，白人中阿片类药物死亡率的增加是由天然/半合成阿片类药物（如可待因、吗啡、氢可酮或羟考酮）驱动的，而黑人的死亡率没有增加。在当前的浪潮中，海洛因和合成阿片类药物（例如芬太尼及其类似物）导致了这两个人群中阿片类药物死亡率的增加。目前，白人的海洛因使用率每年增加31%(95%置信区间[CI] = 27,35)，黑人每年增加34%（95%置信区间[CI] = 30,40）。同时，合成阿片类药物的年增长率分别为79% （95% CI = 50, 112）和107% （95% CI = -15, 404）。结论：自1979年以来，阿片类药物流行的性质已经从白人人口的海洛因转向处方阿片类药物，转变为黑人和白人人口的海洛因/合成死亡人数增加。参见视频摘要，http://links.lww.com/EDE/B377。
Background: Recent research on the US opioid epidemic has focused on the white or total population and has largely been limited to data after 1999. However, understanding racial differences in long-term trends by opioid type may contribute to improving interventions.Methods: Using multiple cause of death data, we calculated age-standardized opioid mortality rates, by race and opioid type, for the US resident population from 1979 to 2015. We analyzed trends in mortality rates using joinpoint regression.Results: From 1979 to 2015, the long-term trends in opioid-related mortality for Earlier data did not include ethnicity so this is incorrect. It is all black and all white residents in the US. blacks and whites went through three successive waves. In the first wave, from 1979 to the mid-1990s, the epidemic affected both populations and was driven by heroin. In the second wave, from the mid-1990s to 2010, the increase in opioid mortality was driven by natural/semi-synthetic opioids (e.g., codeine, morphine, hydrocodone, or oxycodone) among whites, while there was no increase in mortality for blacks. In the current wave, increases in opioid mortality for both populations have been driven by heroin and synthetic opioids (e.g., fentanyl and its analogues). Heroin rates are currently increasing at 31% (95% confidence interval [CI] = 27, 35) per year for whites and 34% (95% CI = 30, 40) for blacks. Concurrently, respective synthetic opioids are increasing at 79% (95% CI = 50, 112) and 107% (95% CI = -15, 404) annually.Conclusion: Since 1979, the nature of the opioid epidemic has shifted from heroin to prescription opioids for the white population to increasing of heroin/synthetic deaths for both black and white populations. See video abstract at, http://links.lww.com/EDE/B377.