Wysowski Diane K
Division of Drug Risk Evaluation, Food and Drug Administration, Silver Spring, Maryland 20993, USA.
Drug Saf. 2007;30(6):533-40. doi: 10.2165/00002018-200730060-00007.
The prescription drugs or drug classes that are most frequently associated with death in the US might be identifiable from death certificate data.
To identify the drugs/drug classes associated with the greatest numbers of deaths in the US that might be considered as possible targets for prevention.
US vital statistics data were accessed in order to identify International Classification of Diseases (10th Revision) [ICD-10] codes indicating that prescription drugs had caused or contributed to death and diseases with significant drug-related mortality.
ICD-10 codes for primarily prescription drugs that were listed as the underlying cause or as 'total mentions' on death certificates and were implicated in >or=1000 deaths in any one year were selected. The annual number of deaths by ICD-10 code was obtained from the Division of Vital Statistics, National Center for Health Statistics. Codes for diseases with significant drug-related aetiologies and involvement in >or=1000 deaths in any one year were also identified and analysed separately.
For the selected ICD-10 codes, a total of 25 031 deaths were listed as having a prescription drug as the underlying cause in 2003, compared with 16 135 in 1999, a 55% increase. Total mentions of these codes increased from 46 523 in 1999 to 72 080 in 2003, also a 55% increase. Most codes involved 'poisonings' (overdose or the wrong substance given or taken in error that is accidental, intentional or with undetermined intent). Drugs associated with poisoning deaths had central nervous system effects. Among the codes associated with specified drug classes, poisonings and accidental poisonings involving narcotics, hallucinogens, psychoactive substances and opioids (other than opium and heroin) were associated with the largest numbers of deaths. Drug-related codes associated with the largest percentage increases in deaths between 1999 and 2003 included poisoning due to methadone (275%); poisoning by other and unspecified antidepressants (primarily selective serotonin reuptake inhibitors) [130%]; and poisoning by psychostimulants with potential for abuse (amfetamines and drugs for attention deficit hyperactivity disorder) [117%]. Anticoagulants were associated with the largest numbers of deaths with codes involving "adverse effects in therapeutic use". Among diseases with significant drug-related aetiologies, Clostridium difficile enterocolitis (associated primarily with antibacterials) had the largest percentage increase in total mentions, with a 203% rise between 1999 and 2003.
Deaths due to overdoses are the most prominent cause of drug-related mortality in death certificate data. Certain drugs and drug classes, especially the opioids (e.g. narcotics, methadone), psychoactive drugs (e.g. antidepressants, amfetamines), anticoagulants and antibacterials (which cause or contribute to C. difficile enterocolitis) are associated with large and increasing numbers of deaths and preventive strategies should be considered.
在美国，或许可以从死亡证明数据中识别出与死亡关联最频繁的处方药或药物类别。
识别在美国与最大数量死亡相关的药物/药物类别，这些药物/药物类别可被视为预防的潜在目标。
获取美国生命统计数据，以识别表明处方药已导致死亡或对死亡有促成作用以及与显著药物相关死亡率的疾病的国际疾病分类（第10版）[ICD - 10]编码。
选择在死亡证明上被列为根本死因或“总提及”且在任何一年涉及≥1000例死亡的主要处方药的ICD - 10编码。按ICD - 10编码的年度死亡人数来自国家卫生统计中心生命统计司。还分别识别并分析了具有显著药物相关病因且在任何一年涉及≥1000例死亡的疾病编码。
对于选定的ICD - 10编码，2003年共有25031例死亡被列为以处方药为根本死因，而1999年为16135例，增长了55%。这些编码的总提及次数从1999年的46523次增加到2003年的72080次，同样增长了55%。大多数编码涉及“中毒”（过量用药、给予或误服错误物质，无论是意外、故意还是意图不明）。与中毒死亡相关的药物具有中枢神经系统作用。在与特定药物类别相关的编码中，涉及麻醉药品、致幻剂、精神活性物质和阿片类药物（鸦片和海洛因除外）的中毒及意外中毒与最大数量的死亡相关。1999年至2003年间死亡人数增长百分比最大的与药物相关的编码包括美沙酮中毒（275%）；其他及未特定的抗抑郁药（主要是选择性5 - 羟色胺再摄取抑制剂）中毒（130%）；以及有滥用潜力的精神兴奋药（苯丙胺类和用于注意缺陷多动障碍的药物）中毒（117%）。抗凝血剂在涉及“治疗使用中的不良反应”编码的死亡中数量最多。在具有显著药物相关病因的疾病中，艰难梭菌小肠结肠炎（主要与抗菌药物相关）的总提及次数增长百分比最大，1999年至2003年间增长了203%。
在死亡证明数据中，过量用药导致的死亡是药物相关死亡率最突出的原因。某些药物和药物类别，特别是阿片类药物（如麻醉药品、美沙酮）、精神活性药物（如抗抑郁药、苯丙胺类）、抗凝血剂和抗菌药物（导致或促成艰难梭菌小肠结肠炎）与大量且不断增加的死亡相关，应考虑采取预防策略。
