From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
Division of Epidemiology, School of Public Health, University of California, Berkeley, CA.
Epidemiology. 2020 Jul;31(4):551-558. doi: 10.1097/EDE.0000000000001199.
Overdose deaths increased exponentially in the United States to be the leading cause of adult injury deaths, and declining economic opportunity may contribute. To our knowledge, there has been no quantitative research into the impact of relative economic measures on overdose risk. Prior longitudinal studies on impact of socioeconomic conditions used fixed effects approaches that can result in biased estimates in the presence of time-varying confounders.
We estimated county-level longitudinal associations between drug overdose deaths and unemployment and labor-force nonparticipation rates by gender and racial/ethnic subgroup using longitudinal g-computation and the clustered bootstrap.
We find evidence for associations between both overall and relative aspects of unemployment and labor-force nonparticipation and drug overdose mortality; patterns of associations differed, sometime qualitatively, across subgroups. For males across racial-ethnic groups, greater overall and relative unemployment rates were generally associated with greater overdose mortality in both the short and long terms [e.g., for white males, increasing the overall percentage of unemployed adults by 5% points in 2000, 2009, and 2015 is associated with an increase of 3.2 overdose deaths (95% confidence interval [CI] = -2.8, 14) in 2015, and increasing the ratio by 0.5 in 2000, 2009, and 2015 is associated with an increase of 9.1 overdose deaths (95% CI = 1.6, 24)].
These findings point to important complexity in how the economic and contextual landscape differentially shapes overdose risks, underscoring a need for increased understanding of the mechanisms operating for women and minority groups.
在美国，药物过量致死人数呈指数级增长，成为导致成人受伤死亡的主要原因，而经济机会减少可能是其中的一个因素。据我们所知，还没有针对相对经济指标对药物过量风险影响的定量研究。先前关于社会经济状况影响的纵向研究使用了固定效应方法，而在存在时变混杂因素的情况下，这些方法可能会导致有偏估计。
我们使用纵向 g 计算和聚类自举法，按性别和种族/族裔亚组估计了县一级药物过量死亡与失业和劳动力参与率之间的纵向关联。
我们发现，整体和相对方面的失业和劳动力参与率与药物过量死亡率之间存在关联的证据；关联模式在不同亚组之间存在差异，有时在性质上也存在差异。对于所有种族/族裔男性，总体和相对失业率较高通常与短期和长期的药物过量死亡率增加有关[例如，在 2000 年、2009 年和 2015 年，将失业成年人的总体百分比增加 5%，则与 2015 年增加 3.2 例药物过量死亡（95%置信区间[CI] = -2.8，14）有关，而在 2000 年、2009 年和 2015 年，将该比例增加 0.5 与增加 9.1 例药物过量死亡（95%CI = 1.6，24）有关]。
这些发现表明，经济和背景环境对药物过量风险的影响存在重要的复杂性，这突显了需要进一步了解针对女性和少数族裔群体的运作机制。
