Paulozzi Leonard J, Xi Yongli
Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
Pharmacoepidemiol Drug Saf. 2008 Oct;17(10):997-1005. doi: 10.1002/pds.1626.
This study was conducted to determine how the recently reported increase in drug poisoning mortality rates in the United States varied by degree of urbanization. Although drug poisoning is traditionally seen as an urban problem, evidence suggested that at least one component of the recent increase, deaths involving opioid analgesics, was increasing more rapidly in rural areas.
The study compared age-adjusted unintentional and undetermined drug poisoning mortality rates between 1999 and 2004 from the National Vital Statistics System (NVSS) in each of six urban-rural categories.
Unintentional and undetermined drug poisoning mortality rates rose 62% from 1999 to 2004. Metropolitan county rates rose 51%, an increase of 2.66/100,000, while nonmetropolitan county rates rose 159%, an increase of 4.81/100,000. By 2004, metropolitan and nonmetropolitan drug poisoning rates had roughly equalized. In the narcotic drug category, which included heroin, cocaine, and opioid analgesics, the most urban ("large central metro") counties increased only 16% while the most rural ("noncore, nonmetropolitan") counties increased 248%. Heroin rates did not increase significantly for any urban-rural category. Cocaine rate increases were largest in nonmetropolitan counties. Opioid analgesic rate increases ranged from a low of 52% in large central metro counties to an increase of 371% in nonmetropolitan, noncore counties.
Prescription drugs have replaced heroin and cocaine as the leading drugs involved in fatal drug overdoses in all urban-rural categories. Fatal drug overdoses are no longer a predominantly urban phenomenon. National prevention efforts will have to shift to address nontraditional populations using nontraditional drugs.
本研究旨在确定美国近期报告的药物中毒死亡率上升情况如何因城市化程度而异。尽管药物中毒传统上被视为城市问题，但有证据表明，近期死亡率上升的至少一个因素，即涉及阿片类镇痛药的死亡，在农村地区上升得更快。
该研究比较了1999年至2004年期间国家生命统计系统（NVSS）在六个城乡类别中每个类别的年龄调整后的非故意和不明药物中毒死亡率。
1999年至2004年，非故意和不明药物中毒死亡率上升了62%。大都市县的死亡率上升了51%，即每10万人增加2.66例，而非大都市县的死亡率上升了159%，即每10万人增加4.81例。到2004年，大都市和非大都市的药物中毒率大致持平。在包括海洛因、可卡因和阿片类镇痛药的麻醉药品类别中，城市化程度最高的（“大型中心大都市”）县仅增加了16%，而农村程度最高的（“非核心、非大都市”）县增加了248%。海洛因死亡率在任何城乡类别中均未显著增加。非大都市县的可卡因死亡率增幅最大。阿片类镇痛药死亡率增幅从大型中心大都市县的低至52%到非大都市、非核心县的371%不等。
处方药已取代海洛因和可卡因，成为所有城乡类别中致命药物过量的主要药物。致命药物过量不再主要是城市现象。国家预防工作将不得不转向针对使用非传统药物的非传统人群。
