Department of Psychiatry and Behavioral Sciences, BOX 3903, Duke University School of Medicine, Durham, NC, USA.
Department of Medicine, Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
BMC Public Health. 2019 May 4;19(1):509. doi: 10.1186/s12889-019-6889-8.
Despite a decrease in driving under the influence of alcohol (DUIA) prevalence over the past decades, DUIA prevalence still remains high in the United States. To date, there is limited research examining whether different types of substance users have different trends in DUIA. This study sought to assess trends and variables associated with DUIA by substance use type.
National Survey on Drug Use and Health (NSDUH) is a cross-sectional, nationally representative population-based survey. By using the NSDUH 2008-2014, we performed the Joinpoint analysis to identify time trends of DUIA in each group of substance users (aged ≥18 years). Logistic regression analysis was used to explore association between substance use type and DUIA and to identify variables associated with DUIA.
Adults who reported alcohol or drug use in the past year were classified into different groups based on past-year substance use status: alcohol use only (n = 141,521) and drug use regardless alcohol use. Drug users included prescription opioids only (n = 5337), marijuana only (n = 32,206), other single drug (n = 3789), prescription opioids-marijuana (n = 3921), multiple prescription drugs (n = 1267), and other multiple drugs (n = 18,432). The Joinpoint analysis showed that DUIA prevalence decreased significantly from 2008 to 2014 among alcohol only users (Average Annual Percent Change [AAPC] = - 2.8), prescription opioids only users (AAPC = -5.4), marijuana only users (AAPC = -5.0), prescription opioids-marijuana users (AAPC = -6.5), multiple prescription drug users (AAPC = -7.4), and other multiple drug users (AAPC = -3.2). Although the estimate was not statistically significant, other single drug users showed a decreasing trend (AAPC = -0.9). Substance use type was significantly associated with DUIA in the adjusted logistic regression. All drug use groups, relative to the alcohol only group, had elevated odds of DUIA, and the odds were especially elevated for the multiple drug use groups (prescription opioids-marijuana, adjusted odds ratio [AOR] = 2.71; multiple prescription drugs, AOR = 2.83; and other multiple drugs, AOR = 3.68). Additionally, younger age, male sex, being white, higher income, and alcohol abuse/dependence were positively associated with DUIA.
DUIA prevalence decreased over time and the magnitude of this reduction differed by substance use type. DUIA interventions need to be tailored to substance use type and individual characteristics.
尽管过去几十年来因饮酒而导致的驾车行为（DUIA）的发生率有所下降，但美国的 DUIA 发生率仍然很高。迄今为止，关于不同类型的物质使用者是否具有不同的 DUIA 趋势的研究有限。本研究旨在评估不同物质使用类型与 DUIA 相关的趋势和变量。
国家药物使用与健康调查（NSDUH）是一项基于人群的横断面全国代表性调查。我们使用 NSDUH 2008-2014 年的数据，进行了 Joinpoint 分析，以确定每个物质使用者群体（年龄≥18 岁）中 DUIA 的时间趋势。采用逻辑回归分析探讨物质使用类型与 DUIA 之间的关系，并确定与 DUIA 相关的变量。
报告在过去一年中使用过酒精或药物的成年人根据过去一年的物质使用状况分为不同的组：仅使用酒精（n=141521）和无论是否使用酒精都使用药物。药物使用者包括仅使用阿片类药物（n=5337）、仅使用大麻（n=32206）、其他单一药物（n=3789）、阿片类药物-大麻（n=3921）、多种处方药物（n=1267）和其他多种药物（n=18432）。Joinpoint 分析显示，仅使用酒精的使用者（平均年变化百分比 [AAPC]=-2.8）、仅使用阿片类药物的使用者（AAPC=-5.4）、仅使用大麻的使用者（AAPC=-5.0）、阿片类药物-大麻使用者（AAPC=-6.5）、多种处方药物使用者（AAPC=-7.4）和其他多种药物使用者（AAPC=-3.2）的 DUIA 发生率从 2008 年到 2014 年显著下降。虽然估计没有统计学意义，但其他单一药物使用者显示出下降趋势（AAPC=-0.9）。在调整后的逻辑回归中，物质使用类型与 DUIA 显著相关。与仅使用酒精的组相比，所有药物使用组的 DUIA 发生几率均升高，而多种药物使用组的几率升高尤其明显（阿片类药物-大麻，调整后的优势比 [AOR]=2.71；多种处方药物，AOR=2.83；和其他多种药物，AOR=3.68）。此外，年龄较小、男性、白人、高收入和酒精滥用/依赖与 DUIA 呈正相关。
DUIA 的发生率随时间呈下降趋势，且这种下降幅度因物质使用类型而异。需要针对物质使用类型和个体特征制定 DUIA 干预措施。
