Origer Alain, Le Bihan Etienne, Baumann Michèle
Drug Coordination Office, Ministry of Health, Luxembourg, Luxembourg; Research Unit INSIDE, Institute Health & Behaviour, University of Luxembourg, Walferdange, Luxembourg.
Research Unit INSIDE, Institute Health & Behaviour, University of Luxembourg, Walferdange, Luxembourg.
PLoS One. 2015 May 4;10(5):e0125568. doi: 10.1371/journal.pone.0125568. eCollection 2015.
To determine the existence of a social gradient in fatal overdose cases related to non-prescribed opioids and cocaine use, recorded in Luxembourg between 1994 and 2011.
Overdose cases were individually matched with four controls in a nested case-control study design, according to sex, year of birth, drug administration route and duration of drug use. The study sample, composed of 272 cases and 1,056 controls, was stratified according to a Social Inequality Accumulation Score (SIAS), based on educational attainment, employment, income, financial situation of subjects and the professional status of their father or legal guardian. Least squares linear regression analysis on overdose mortality rates and ridit scores were applied to determine the Relative Index of Inequality (RII) of the study sample.
A negative linear relationship between the overdose mortality rate and the relative socioeconomic position was observed. We found a difference in mortality of 29.22 overdose deaths per 100 drug users in the lowest socioeconomic group compared to the most advantaged group. In terms of the Relative Inequality Index, the overdose mortality rate of opioid and cocaine users with lowest socioeconomic profiles was 9.88 times as high as that of their peers from the highest socioeconomic group (95% CI 6.49-13.26).
Our findings suggest the existence of a marked social gradient in opioids and cocaine related overdose fatalities. Harm reduction services should integrate socially supportive offers, not only because of their general aim of social (re)integration but crucially in order to meet their most important objective, that is to reduce drug-related mortality.
确定1994年至2011年期间卢森堡记录的与非处方阿片类药物和可卡因使用相关的致命过量用药病例中是否存在社会梯度。
在一项巢式病例对照研究设计中，根据性别、出生年份、药物给药途径和吸毒持续时间，将过量用药病例与四个对照进行个体匹配。研究样本由272例病例和1056例对照组成，根据社会不平等累积得分（SIAS）进行分层，该得分基于受教育程度、就业情况、收入、受试者的财务状况以及其父亲或法定监护人的职业地位。应用过量用药死亡率的最小二乘线性回归分析和ridit评分来确定研究样本的不平等相对指数（RII）。
观察到过量用药死亡率与相对社会经济地位之间呈负线性关系。我们发现，社会经济地位最低的群体与最具优势的群体相比，每100名吸毒者中过量用药死亡人数相差29.22人。就不平等相对指数而言，社会经济状况最差的阿片类药物和可卡因使用者的过量用药死亡率是社会经济状况最高的同龄人9.88倍（95%CI 6.49 - 13.26）。
我们的研究结果表明，在阿片类药物和可卡因相关的过量用药死亡中存在明显的社会梯度。减少伤害服务应纳入社会支持措施，不仅因为其社会（重新）融合的总体目标，更关键的是为了实现其最重要的目标，即降低与毒品相关的死亡率。
