Frank Batten School of Leadership and Public Policy, University of Virginia, Charlottesville, Virginia.
Am J Prev Med. 2017 Dec;53(6):745-753. doi: 10.1016/j.amepre.2017.06.009. Epub 2017 Aug 7.
An important barrier to formulating effective policies to address the rapid rise in U.S. fatal overdoses is that the specific drugs involved are frequently not identified on death certificates. This analysis supplies improved estimates of state opioid and heroin involved drug fatality rates in 2014, and changes from 2008 to 2014.
Reported mortality rates were calculated directly from death certificates and compared to corrected rates that imputed drug involvement when no drug was specified. The analysis took place during 2016-2017.
Nationally, corrected opioid and heroin involved mortality rates were 24% and 22% greater than reported rates. The differences varied across states, with particularly large effects in Pennsylvania, Indiana, and Louisiana. Growth in corrected opioid mortality rates, from 2008 to 2014, were virtually the same as reported increases (2.5 deaths per 100,000 people) whereas changes in corrected heroin death rates exceeded reported increases (2.7 vs 2.3 per 100,000). Without corrections, opioid mortality rate changes were considerably understated in Pennsylvania, Indiana, New Jersey, and Arizona, but dramatically overestimated in South Carolina, New Mexico, Ohio, Connecticut, Florida, and Kentucky. Increases in heroin death rates were understated in most states, and by large amounts in Pennsylvania, Indiana, New Jersey, Louisiana, and Alabama.
The correction procedures developed here supply a more accurate understanding of geographic differences in drug poisonings and supply important information to policymakers attempting to reduce or slow the increase in fatal drug overdoses.
制定有效政策以解决美国致命药物过量的快速上升的一个重要障碍是，涉及的具体药物通常在死亡证明上无法识别。本分析提供了 2014 年及 2008 年至 2014 年期间各州阿片类药物和海洛因相关药物死亡率的改进估计数和变化情况。
直接根据死亡证明计算报告死亡率，并与未指定药物时推断药物参与情况的校正率进行比较。分析于 2016-2017 年进行。
全国范围内，校正后的阿片类药物和海洛因相关死亡率比报告的死亡率分别高出 24%和 22%。各州之间的差异各不相同，宾夕法尼亚州、印第安纳州和路易斯安那州的影响尤其大。2008 年至 2014 年，校正后的阿片类药物死亡率的增长与报告的增长基本相同（每 10 万人中有 2.5 人死亡），而校正后的海洛因死亡率的变化则超过了报告的增长（每 10 万人中有 2.7 人死亡，而报告的增长率为 2.3）。如果不进行校正，宾夕法尼亚州、印第安纳州、新泽西州和亚利桑那州的阿片类药物死亡率变化就会被大大低估，但在南卡罗来纳州、新墨西哥州、俄亥俄州、康涅狄格州、佛罗里达州和肯塔基州则会被大大高估。在大多数州，海洛因死亡率的增长都被低估了，在宾夕法尼亚州、印第安纳州、新泽西州、路易斯安那州和阿拉巴马州，低估幅度非常大。
这里开发的校正程序提供了对药物中毒地理差异的更准确理解，并为试图减少或减缓致命药物过量的政策制定者提供了重要信息。
