Racial/Ethnic, Social, and Geographic Trends in Overdose-Associated Cardiac Arrests Observed by US Emergency Medical Services During the COVID-19 Pandemic
Racial/Ethnic, Social, and Geographic Trends in Overdose-Associated Cardiac Arrests Observed by US Emergency Medical Services During the COVID-19 Pandemic
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DOI：
10.1001/jamapsychiatry.2021.0967
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发表时间：
2021-05-26
期刊：
影响因子：
25.8
通讯作者：
Schriger, David L.
中科院分区：
文献类型：
--
作者：
Friedman, Joseph;Mann, N. Clay;Schriger, David L.
重要性 美国疾病控制与预防中心 (CDC) 截至 2020 年 7 月的临时记录表明，在 COVID-19 大流行的最初几个月，用药过量死亡人数激增，但尚无最新趋势，且数据未按发生月份、种族/族裔或其他社会类别进行分类。相比之下，来自紧急医疗服务 (EMS) 的数据提供了几乎实时的信息源，可能有助于快速、更精细地监测用药过量死亡率。 目的 描述截至 2020 年 12 月的 COVID-19 大流行期间 EMS 观察到的用药过量相关心脏骤停的种族/民族、社会和地理趋势，并评估与 CDC 报告的截至 2020 年 5 月的临时总用药过量死亡率的一致性。 设计、设置和参与者 这项队列研究包括美国 49 个州的 11,000 多家参与国家 EMS 信息系统的 EMS 机构，以及与患者接触的 8370 万次 EMS 激活。 暴露 与药物过量相关的心脏骤停发生的年份和月份；患者种族/民族；人口普查地区和分区；县级城市化；主要结果和措施 将 2020 年与患者接触的每 100 000 次 EMS 激活中与药物过量相关的心脏骤停与 2018 年和 2019 年的基线值进行比较。将与药物过量相关的心脏骤停的总数和百分比增加与 CDC 记录中滚动 12 个月窗口的临时总死亡率进行比较。跨度为 2018 年 1 月至 2020 年 7 月。 结果 在 2020 年 3,340 万例 EMS 激活中，1,680 万例 (50.2%) 涉及女性患者，1,630 万例 (48.8%) 涉及非西班牙裔白人。 2020 年，全国范围内与药物过量相关的心脏骤停增加了 42.1%（基线时每 10 万次 EMS 激活有 42.3 例，而 2020 年每 10 万次 EMS 激活有 60.1 例）。增幅最高的是拉丁裔个体（49.7%；基线时每 100 000 次激活 38.8 次，2020 年每 100 000 次激活 58.1 次）和黑人或非裔美国人（50.3%；基线时每 100 000 次激活 21.5 次，2020 年每 100 000 次激活 32.3 次）、居住在较贫困的社区（46.4%；基线时每 10 万次激活 42.0 次，2020 年每 10 万次激活 61.5 次）和太平洋国家（63.8%；基线每 10 万次激活 33.1 次，2020 年每 10 万次激活 54.2 次），尽管这些地区的基线比率较低组。 EMS 记录比 CDC 死亡率数据早 6 至 12 个月提供，并且在两个数据集均可用的月份中显示出高度一致性 (r = 0.98)。如果 EMS 观察到的服药过量死亡率与总服药死亡率之间的历史关联成立，则 CDC 最终可能报告 2020 年服药过量死亡总数约为 90 632 例（95% CI，85 737-95 525）。 结论和相关性 在这项队列研究中，EMS 机构的记录提供了一种有效的方式来快速监测美国服药过量死亡率的变化。大流行期间出现了史无前例的服药过量死亡事件，因此需要对服药过量预防进行投资，以此作为应对 COVID-19 和大流行后恢复的一个重要方面。对于那些承受着不成比例的 COVID-19 死亡率和不断上升的服药过量死亡的复合负担的社会经济弱势群体和种族/族裔少数群体来说，这一点尤为紧迫。
IMPORTANCE Provisional records from the US Centers for Disease Control and Prevention (CDC) through July 2020 indicate that overdose deaths spiked during the early months of the COVID-19 pandemic, yet more recent trends are not available, and the data are not disaggregated by month of occurrence, race/ethnicity, or other social categories. In contrast, data from emergency medical services (EMS) provide a source of information nearly in real time that may be useful for rapid and more granular surveillance of overdose mortality.OBJECTIVE To describe racial/ethnic, social, and geographic trends in EMS-observed overdoseassociated cardiac arrests during the COVID-19 pandemic through December 2020 and assess the concordance with CDC-reported provisional total overdose mortality through May 2020.DESIGN, SETTING, AND PARTICIPANTS This cohort study included more than 11 000 EMS agencies in 49 US states that participate in the National EMS Information System and 83.7 million EMS activations in which patient contact was made.EXPOSURES Year and month of occurrence of overdose-associated cardiac arrest; patient race/ethnicity; census region and division; county-level urbanicity; and zip code-level racial/ethnic composition, poverty, and educational attainment.MAIN OUTCOMES AND MEASURES Overdose-associated cardiac arrests per 100 000 EMS activations with patient contact in 2020 were compared with a baseline of values from 2018 and 2019. Aggregate numbers of overdose-associated cardiac arrests and percentage increases were compared with provisional total mortality in CDC records from rolling 12-month windows with end months spanning January 2018 through July 2020.RESULTS Among 33.4 million EMS activations in 2020, 16.8 million (50.2%) involved female patients and 16.3 million (48.8%) involved non-Hispanic White individuals. Overdoseassociated cardiac arrests were elevated by 42.1% nationally in 2020 (42.3 per 100 000 EMS activations at baseline vs 60.1 per 100 000 EMS activations in 2020). The highest percentage increases were seen among Latinx individuals (49.7%; 38.8 per 100 000 activations at baseline vs 58.1 per 100 000 activations in 2020) and Black or African American individuals (50.3%; 21.5 per 100 000 activations at baseline vs 32.3 per 100 000 activations in 2020), people living in more impoverished neighborhoods (46.4%; 42.0 per 100 000 activations at baseline vs 61.5 per 100 000 activations in 2020), and the Pacific states (63.8%; 33.1 per 100 000 activations at baseline vs 54.2 per 100 000 activations in 2020), despite lower rates at baseline for these groups. The EMS records were available 6 to 12 months ahead of CDC mortality figures and showed a high concordance (r = 0.98) for months in which both data sets were available. If the historical association between EMS-observed and total overdose mortality holds true, an expected total of approximately 90 632 (95% CI, 85 737-95 525) overdose deaths may eventually be reported by the CDC for 2020.CONCLUSIONS AND RELEVANCE In this cohort study, records from EMS agencies provided an effective manner to rapidly surveil shifts in US overdose mortality. Unprecedented overdose deaths during the pandemic necessitate investments in overdose prevention as an essential aspect of the COVID-19 response and postpandemic recovery. This is particularly urgent for more socioeconomically disadvantaged and racial/ethnic minority communities subjected to the compounded burden of disproportionate COVID-19 mortality and rising overdose deaths.