Gorman D R, Bain M, Inglis J H C, Murphy D, Bateman D N
NHS Lothian, 148 The Pleasance, Edinburgh, EH8 9RS, Scotland, UK.
Public Health. 2007 Jan;121(1):45-50. doi: 10.1016/j.puhe.2006.08.014. Epub 2006 Nov 28.
To describe how changes in legislation to control sales and thus restrict the general availability of paracetamol have affected deprivation-related inequalities in deliberate self-harm associated with the drug in Scotland.
A descriptive analysis of routine death and hospital discharge data for the entire Scottish population between 1995 and 2002.
Patients in Scotland admitted to hospital with a diagnosis of poisoning and deaths in Scotland due to poisoning 1995-2002.
Changes in mortality and overdose rates by deprivation quintile, and case fatality rates due to poisoning involving paracetamol.
Rates of overdose involving paracetamol, while much higher in disadvantaged quintiles, fell in each deprivation quintile following the 1998 legislation. They then returned to levels similar, or above those in the mid 1990s. All quintiles were affected to a similar extent with the relationship between them remaining constant over time. Case fatality rates were significantly higher in more disadvantaged quintiles.
Marked inequalities exist in paracetamol related harm in Scotland. The most disadvantaged groups (both male and female) have higher overdose and death rates, as well as higher case fatality rates. Following the restrictions all social groups saw similar reductions in paracetamol related harm. This effect has been short-lived and rates have returned to pre-legislation levels. Legislation has not permanently affected overall use of paracetamol in overdose in Scotland or reduced the proportion of patients taking paracetamol as a component of the overdose in the longer term. An important public health policy has failed to achieve its objective and it is not clear why. We need a better understanding of why this measure had only short-term benefits if its full potential is to be achieved.
描述旨在控制扑热息痛销售从而限制其总体可获得性的立法变化如何影响了苏格兰与该药物相关的蓄意自我伤害中与贫困相关的不平等现象。
对1995年至2002年间整个苏格兰人口的常规死亡和医院出院数据进行描述性分析。
1995 - 2002年期间在苏格兰因中毒入院的患者以及因中毒死亡的患者。
按贫困五分位数划分的死亡率和过量用药率的变化，以及因扑热息痛中毒导致的病死率。
涉及扑热息痛的过量用药率虽然在贫困程度较高的五分位数中要高得多，但在1998年立法后，每个贫困五分位数中的该比率都有所下降。随后又回升至与20世纪90年代中期相似或更高的水平。所有五分位数受到的影响程度相似，它们之间的关系随时间保持不变。在贫困程度较高的五分位数中，病死率显著更高。
在苏格兰，与扑热息痛相关的伤害存在明显的不平等现象。最贫困的群体（包括男性和女性）过量用药率和死亡率更高，病死率也更高。在实施限制措施后，所有社会群体与扑热息痛相关的伤害都出现了类似程度的下降。但这种效果是短暂的，比率已回升至立法前的水平。立法并未长期永久性地影响苏格兰扑热息痛过量用药的总体情况，也未降低服用扑热息痛作为过量用药一部分的患者比例。一项重要的公共卫生政策未能实现其目标，且原因不明。如果要充分发挥其潜力，我们需要更好地理解为何这项措施仅带来了短期益处。
