Opioid-related Mortality in United States Death Certificate Data: A Quantitative Bias Analysis With Expert Elicitation of Bias Parameters.
Opioid-related Mortality in United States Death Certificate Data: A Quantitative Bias Analysis With Expert Elicitation of Bias Parameters.
复制标题
美国死亡证明数据中与阿片类药物相关的死亡率：专家提取偏差参数的定量偏差分析。
DOI：
10.1097/ede.0000000000001600
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
MacLehose,RichardF
中科院分区：
文献类型：
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作者：
Goldsmith,ElizabethS;Krebs,ErinE;Ramirez,MarizenR;MacLehose,RichardF
背景：阿片类药物相关的死亡率是美国一个重要的公共卫生问题。发病率估计依赖于医疗保健提供者和体检人员生成的死亡证明数据。当其他死亡原因似乎合理时，阿片类药物过量的报告可能会被低估。我们将医生得出的死亡证明偏差参数应用于定量偏差分析，评估美国阿片类药物相关死亡率估计中潜在的与年龄相关的差异错误分类。方法：我们从国家卫生统计中心获得了死因数据（美国，2017年），并按年龄类别（25-54、55-64、65+）计算了粗阿片类药物相关门诊死亡人数。我们征求了 10 名初级保健医生对死亡证明中阿片类药物相关死亡分类敏感性的看法。我们总结了得出的敏感性估计值，计算了合理的特异性值，并在概率偏差分析中应用了所得参数。结果：医生根据死亡证明对阿片类药物相关死亡率的分类估计了广泛的敏感性范围，而老年组的估计敏感性较低。调整医生估计的错误分类后的概率偏倚分析表明，阿片类药物相关死亡人数是 65 岁以上年龄组中观察到的死亡人数的 3.1 倍（95% 不确定区间：1.2-23.5）。所有年龄组的偏倚调整死亡人数均大幅增加。结论：
Background:Opioid-related mortality is an important public health problem in the United States. Incidence estimates rely on death certificate data generated by health care providers and medical examiners. Opioid overdoses may be underreported when other causes of death appear plausible. We applied physician-elicited death certificate bias parameters to quantitative bias analyses assessing potential age-related differential misclassification in US opioid-related mortality estimates.Methods:We obtained cause-of-death data (US, 2017) from the National Center for Health Statistics and calculated crude opioid-related outpatient death counts by age category (25–54, 55–64, 65+). We elicited beliefs from 10 primary care physicians on sensitivity of opioid-related death classification from death certificates. We summarized elicited sensitivity estimates, calculated plausible specificity values, and applied resulting parameters in a probabilistic bias analysis.Results:Physicians estimated wide sensitivity ranges for classification of opioid-related mortality by death certificates, with lower estimated sensitivities among older age groups. Probabilistic bias analyses adjusting for physician-estimated misclassification indicated 3.1 times more (95% uncertainty interval: 1.2–23.5) opioid-related deaths than the observed death count in the 65+ age group. All age groups had substantial increases in bias-adjusted death counts.Conclusions: