Brady Joanne E, Friedman Samuel R, Cooper Hannah L F, Flom Peter L, Tempalski Barbara, Gostnell Karla
Institute for AIDS Research, National Development and Research Institutes, Inc. (NDRI), 71 West 23rd Street, 8th Floor, New York, NY 10010, USA.
J Urban Health. 2008 May;85(3):323-51. doi: 10.1007/s11524-007-9248-5. Epub 2008 Mar 15.
This paper estimates the prevalence of current injection drug users (IDUs) in 96 large U.S. metropolitan statistical areas (MSAs) annually from 1992 to 2002. Multiplier/allocation methods were used to estimate the prevalence of injectors because confidentiality restrictions precluded the use of other commonly used estimation methods, such as capture-recapture. We first estimated the number of IDUs in the U.S. each year from 1992 to 2002 and then apportioned these estimates to MSAs using multiplier methods. Four different types of data indicating drug injection were used to allocate national annual totals to MSAs, creating four distinct series of estimates of the number of injectors in each MSA. Each series was smoothed over time; and the mean value of the four component estimates was taken as the best estimate of IDUs for that MSA and year (with the range of component estimates indicating the degree of uncertainty in the estimates). Annual cross-sectional correlations of the MSA-level IDU estimates with measures of unemployment, hepatitis C mortality prevalence, and poisoning mortality prevalence were used to validate our estimates. MSA-level IDU estimates correlated moderately well with validators, demonstrating adequate convergence validity. Overall, the number of IDUs per 10,000 persons aged 15-64 years varied from 30 to 348 across MSAs (mean 126.9, standard deviation 65.3, median 106.6, interquartile range 78-162) in 1992 and from 37 to 336 across MSAs (mean 110.6, standard deviation 57.7, median 96.1, interquartile range 67-134) in 2002. A multilevel model showed that overall, across the 96 MSAs, the number of injectors declined each year until 2000, after which the IDU prevalence began to increase. Despite the variation in component estimates and methodological and component data set limitations, these local IDU prevalence estimates may be used to assess: (1) predictors of change in IDU prevalence; (2) differing IDU trends between localities; (3) the adequacy of service delivery to IDUs; and (4) infectious disease dynamics among IDUs across time.
本文估算了1992年至2002年期间美国96个大都市统计区（MSA）中当前注射吸毒者（IDU）的流行率。由于保密限制排除了使用其他常用估算方法（如捕获再捕获法），因此采用乘数/分配方法来估算注射吸毒者的流行率。我们首先估算了1992年至2002年期间美国每年的注射吸毒者人数，然后使用乘数方法将这些估算值分配到各个大都市统计区。利用四种不同类型的表明药物注射的数据将全国年度总数分配到各个大都市统计区，从而得出每个大都市统计区注射吸毒者人数的四个不同系列的估算值。每个系列随时间进行了平滑处理；四个组成估算值的平均值被视为该大都市统计区和该年份注射吸毒者的最佳估算值（组成估算值的范围表明了估算中的不确定程度）。利用大都市统计区层面注射吸毒者估算值与失业率、丙型肝炎死亡率流行率和中毒死亡率流行率指标的年度横断面相关性来验证我们的估算值。大都市统计区层面注射吸毒者估算值与验证指标的相关性中等良好，表明具有足够的收敛效度。总体而言，1992年各大都市统计区每10,000名15 - 64岁人群中注射吸毒者人数在30至348之间（平均126.9，标准差65.3，中位数106.6，四分位距78 - 162），2002年在37至336之间（平均110.6，标准差57.7，中位数96.1，四分位距67 - 134）。一个多层次模型显示，总体而言，在这96个大都市统计区中，注射吸毒者人数在2000年之前逐年下降，之后注射吸毒者流行率开始上升。尽管组成估算值存在差异以及方法和组成数据集存在局限性，但这些局部注射吸毒者流行率估算值可用于评估：（1）注射吸毒者流行率变化的预测因素；（2）不同地区之间注射吸毒者的不同趋势；（3）为注射吸毒者提供服务的充足性；以及（4）不同时间注射吸毒者之间的传染病动态。
