Zoorob Michael J, Salemi Jason L
Department of Government, Harvard University, 1737 Cambridge St, Cambridge, MA 02138, USA.
Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Dr., Suite 600 (MS: BCM700), Houston, TX 77098, USA.
Drug Alcohol Depend. 2017 Apr 1;173:1-9. doi: 10.1016/j.drugalcdep.2016.12.011. Epub 2017 Jan 25.
Drug overdose deaths have risen precipitously over the last fifteen years. Substantial geographic variation, beyond a simple rural-urban dichotomy, exists in the concentration of overdose deaths, suggesting the existence of as-yet unidentified environmental variables that predict resilience (or vulnerability) to drug overdoses. Motivated by reports highlighting the role of community fragility in the opioid epidemic, we explore whether social capital attenuates overdose death rates.
We conducted an ecologic temporal trends study from 1999 to 2014 to investigate the association between mortality due to drug overdose and social capital. Data from multiple sources were compiled at the county-level to produce an analytic dataset comprising overdose mortality, social capital, and a host of potentially confounding variables indicated by the literature (N=49,664 county-years). Multinomial logistic regression was used to estimate the likelihood that a county falls in low (<4 deaths per 100,000), moderate, or high (>16 deaths per 100,000) categories of annual overdose morality.
We observed a strong and statistically significant inverse association between county-level social capital and age-adjusted mortality due to drug overdose (p<0.01). Compared to the lowest quintile of social capital, counties at the highest quintile were 83% less likely to fall in the "high-overdose" category and 75% less likely to fall in the "moderate-overdose" category.
This study finds large-sample evidence that social capital protects communities against drug overdose. This finding could help guide policymakers in identifying where overdose epidemics are likely to occur and how to ameliorate them.
在过去十五年中，药物过量致死人数急剧上升。除了简单的城乡二分法之外，药物过量致死的集中程度还存在显著的地理差异，这表明存在尚未确定的环境变量，这些变量可以预测对药物过量的抵御能力（或易感性）。受强调社区脆弱性在阿片类药物流行中作用的报告的启发，我们探讨社会资本是否能降低药物过量死亡率。
我们进行了一项从1999年到2014年的生态时间趋势研究，以调查药物过量致死与社会资本之间的关联。在县一级汇总了多个来源的数据，以生成一个分析数据集，其中包括药物过量死亡率、社会资本以及文献中指出的一系列潜在混杂变量（N = 49,664个县年）。使用多项逻辑回归来估计一个县处于年度药物过量死亡率低（每10万人中<4人死亡）、中等或高（每10万人中>16人死亡）类别中的可能性。
我们观察到县级社会资本与经年龄调整的药物过量死亡率之间存在强烈且具有统计学意义的负相关（p<0.01）。与社会资本最低的五分位数相比，社会资本最高的五分位数的县处于“高药物过量”类别的可能性低83%，处于“中等药物过量”类别的可能性低75%。
本研究发现了大样本证据，表明社会资本可保护社区免受药物过量的影响。这一发现有助于指导政策制定者确定药物过量流行可能发生的地点以及如何改善这种情况。
