Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
Lancet Public Health. 2019 Feb;4(2):e97-e106. doi: 10.1016/S2468-2667(18)30208-1. Epub 2019 Jan 15.
Increasing premature mortality among some groups of Americans has been largely driven by increases in drug poisoning deaths. However, to our knowledge, a formal descriptive study by race and ethnicity, socioeconomic status, rurality, and geography has not been done. In this study, we examined US trends in premature all-cause and drug poisoning mortality between 2000 and 2015 at the county level among white, black, and Latino people.
We used US mortality data for the period Jan 1, 2000, to Dec 31, 2015, including underlying cause of death and demographic data, collected from death certificates by the Centers for Disease Control and Prevention National Center for Health Statistics, and ascertained county attributes from the 2011-15 Census American Community Survey. We categorised counties into quintiles on the basis of the percentage of people unemployed, the percentage of people with a bachelor's degree, median income, and rurality. We estimated premature (ie, deaths in those aged 25-64 years) age-standardised mortality for all causes (by race and ethnicity) and drug poisoning, by county, for the periods of 2000-03 and 2012-15. We estimated annual percentage changes in mortality (2000-15) by county-level characteristics.
Premature mortality declined from 2000-03 to 2012-15 among black and Latino people, but increased among white people in many US counties. Drug poisoning mortality increased in counties throughout the country. Significant increases between 2000 and 2015 occurred across low and high socioeconomic status and urban and rural counties among white people aged 25-64 years (annual percentage change range 4·56% per year [95% CI 3·56-5·57] to 11·51% per year [9·41-13·65]), black people aged 50-64 years (2·27% per year [0·42-4·16] to 9·46% per year [7·02-11·96]), Latino women aged 25-49 years (2·43% per year [1·18-3·71] to 5·01% per year [3·80-6·23]), and Latino men aged 50-64 years (2·42% per year [0·53-4·34] to 5·96% per year [3·86-8·11]). Although drug poisoning mortality increased rapidly in counties with the lowest socioeconomic status and in rural counties, most deaths during 2012-15 occurred in the largest metropolitan counties (121 395 [76%] in metropolitan counties with ≥250 000 people vs 2175 [1%] in the most rural counties), reflecting population size.
Premature mortality has declined among black and Latino people in the USA, and increased among white people, particularly in less affluent and rural counties. Increasing drug poisoning mortality was not limited to poor white people in rural areas. Rapid increases have occurred in communities throughout the USA regardless of race and ethnicity, socioeconomic status, or rurality. Widespread public health interventions are needed to addess this public health emergency.
National Institutes of Health.
在美国，一些人群的过早死亡率上升在很大程度上是由于药物中毒死亡人数的增加所致。然而，据我们所知，尚未对种族和民族、社会经济地位、农村地区和地理位置进行正式的描述性研究。在这项研究中，我们在县一级检查了 2000 年至 2015 年期间美国白人、黑人和拉丁裔人群中所有原因和药物中毒导致的过早死亡率的趋势。
我们使用了美国疾病控制与预防中心国家卫生统计中心收集的 2000 年 1 月 1 日至 2015 年 12 月 31 日期间的死亡率数据，包括死亡原因和人口统计数据，并从 2011-15 年美国社区调查的美国社区调查中确定了县属性。我们根据失业人口的百分比、拥有学士学位的人口百分比、中位数收入和农村地区，将各县分为五等份。我们根据种族和民族，按县估算了所有原因（25-64 岁）和药物中毒导致的过早死亡率（2000-03 年和 2012-15 年）。我们根据县一级的特点，估算了死亡率（2000-15 年）的年百分比变化。
黑人和拉丁裔人群的过早死亡率从 2000-03 年下降到 2012-15 年，而美国许多县的白人过早死亡率却有所上升。全国各县的药物中毒死亡率都有所上升。2000 年至 2015 年间，白人群体中 25-64 岁人群的低和高社会经济地位以及城乡县的死亡率显著上升（年百分比变化范围为 4.56%/年[3.56-5.57]至 11.51%/年[9.41-13.65]），50-64 岁黑人（2.27%/年[0.42-4.16]至 9.46%/年[7.02-11.96]），25-49 岁拉丁裔妇女（2.43%/年[1.18-3.71]至 5.01%/年[3.80-6.23]），以及 50-64 岁拉丁裔男性（2.42%/年[0.53-4.34]至 5.96%/年[3.86-8.11]）。尽管在社会经济地位最低和农村县的药物中毒死亡率迅速上升，但 2012-15 年期间的大多数死亡发生在最大的都会县（人口超过 25 万的都会县有 121395 人[76%]，而人口最少的农村县有 2175 人[1%]），反映了人口规模。
美国黑人和拉丁裔人群的过早死亡率有所下降，而白人群体的过早死亡率有所上升，尤其是在不太富裕和农村地区。药物中毒死亡率的增加不仅限于农村地区贫困的白人。无论种族、民族、社会经济地位或农村地区如何，美国各地的社区都出现了快速增长。需要采取广泛的公共卫生干预措施来应对这一公共卫生紧急情况。
美国国立卫生研究院。
