Drug Consumption and Disease Mortality: Population-level Analyses

描述(由申请人提供)：这一探索性/发展项目的主要目的是在人口层面上审查药物消费和疾病之间的关系。该项目将通过一系列回溯性分析极大地促进我们对这种关系的了解，这些回溯性分析使用最近发现的关于鸦片类药物和大麻类物质消费的独特的、极其丰富和可靠的数据集，结合关于各种传染病和条件(包括但不限于霍乱、天花、鼠疫、腹泻和痢疾)的流行率和强度的同期数据，以及丰富的可能的流行病学相关性。实质性目标包括对以下各项进行单独的测试和/或分析：(1)使用关于毒品消费和死亡率的合法和可靠的人口一级数据，对上述物质的消费量与上述疾病和疾病的死亡率的关系；(2)鸦片、大麻和酒精及其组合之间的差异及其与死亡率变化的关系；(3)不同疾病之间不同的倾向，以不同的方式影响吸毒量大的和非吸毒量大的人群；以及(4)使人群暴露在疾病面前的各种其他流行病学显著因素与毒品消费之间的相互作用。这项研究将涉及应用统计和计量经济学方法来分析英属印度的大麻和鸦片消费、疾病和其他变量的数据。对上述(一)-(四)项的检验将使用经验方法进行，以分析基于计数的因变量(例如死亡率)和空间成分，这就需要使用泊松或负二项模型规范。此外，多变量或条件格兰杰因果检验将被用来确定是否有证据表明一种现象(例如药物消费)相对于另一种现象(例如死亡率)在时间上优先。与公共健康相关：NIDA定义了其在减少药物滥用造成的危害方面的作用。为了实现这一目标，有必要了解药物滥用与个人和人口一级的传染病等负面健康后果联系在一起的机制。这一项目的意义在于，它旨在通过一系列分析大大增进我们对这些关系的了解，利用最近发现的关于阿片剂和大麻类药物在人口一级的消费的独特、极其丰富和可靠的数据集，以及关于各种疾病死亡率的同期数据。这些分析产生的大量知识将首次补充现有的以实验室和临床为基础的药物-疾病关系证据和全人群证据，从而有助于药物滥用的知识库。

DESCRIPTION (provided by applicant): The principal aim of this exploratory/developmental project is to examine the relationship between drug consumption and disease at the population level. This project will significantly advance our knowledge of such a relationship with a series of retrospective analyses using a unique recently-discovered and extraordinarily rich and reliable dataset on the consumption of opiates and cannabinoids, collected at a time when the consumption of these substances was legal, in conjunction with contemporaneous data on the prevalence and intensity of a variety of infectious diseases and conditions (including but not restricted to cholera, smallpox, plague, and diarrhea and dysentery) as well as a rich set of possible epidemiologic correlates. The substantive aims include separate tests for and/or analyses of (i) the relationship of the consumption of the above substances with mortality from the above diseases and conditions using legal and reliable population-level data on drug consumption and mortality, (ii) the differences between opium, marijuana, and alcohol and combinations of them in their association with variations in mortality, (iii) the differences between the diseases in their propensity to differentially affect populations of intense and non-intense drug consuming populations, and (iv) the interactions between various other epidemiologically salient factors and drug consumption in exposing populations to diseases. This study will involve the application of statistical and econometric methods to the analysis of data on marijuana and opium consumption, diseases, and other variables in British India. Tests for (i) - (iv) above will be conducted using empirical methods for the analysis of count-based dependent variables (mortality, for example) with a spatial component, necessitating the use of the Poisson or negative binomial model specifications. In addition, multivariate or conditional Granger causality tests will be used to determine if there is evidence for temporal precedence of one phenomenon (drug consumption, for example) in relation to another phenomenon (mortality, for example). PUBLIC HEALTH RELEVANCE: NIDA defines its role in terms of reducing the harm caused by drug abuse. In order to achieve this goal, it is necessary to understand the mechanisms by which drug abuse is linked to negative health outcomes such as infectious disease at both the individual and population levels. This project is relevant in that it aims to significantly advance our knowledge of these relationships with a series of analyses using a unique recently-discovered and extraordinarily rich and reliable dataset on the consumption, at the population level, of opiates and cannabinoids in conjunction with contemporaneous data on mortality from a variety of diseases. The body of knowledge generated by these analyses will contribute to the knowledge base of drug abuse by complementing, for the first time, the existing laboratory- and clinic-based evidence on the drug-disease relationship with population-wide evidence.