Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Nat Med. 2020 May;26(5):699-704. doi: 10.1038/s41591-020-0855-y. Epub 2020 May 4.
The ongoing substance misuse epidemic in the United States is complex and dynamic and should be approached as such in the development and evaluation of policy. Drug overdose deaths (largely attributable to opioid misuse) in the United States have grown exponentially for almost four decades, but the mechanisms of this growth are poorly understood. From analysis of 661,565 overdose deaths from 1999 to 2017, we show that the age-specific drug overdose mortality curve for each birth-year cohort rises and falls according to a Gaussian-shaped curve. The ascending portion of each successive birth-year cohort mortality curve is accelerated compared with that of all preceding birth-year cohorts. This acceleration can be attributed to either of two distinct processes: a stable peak age, with an increasing amplitude of mortality rate curves from one birth-year cohort to the next; or a youthward shift in the peak age of the mortality rate curves. The overdose epidemic emerged and increased in amplitude among the 1945-1964 cohort (Baby Boomers), shifted youthward among the 1965-1980 cohort (Generation X), and then resumed the pattern of increasing amplitude in the 1981-1990 Millennials. These shifting age and generational patterns are likely to be driven by socioeconomic factors and drug availability, the understanding of which is important for the development of effective overdose prevention measures.
美国目前正面临着一场复杂且不断变化的药物滥用危机，因此在制定和评估政策时也应该将其作为一个整体来考虑。美国的药物过量死亡人数（主要归因于阿片类药物滥用）在近四十年中呈指数级增长，但人们对这种增长的机制仍知之甚少。通过对 1999 年至 2017 年的 661,565 例药物过量死亡进行分析，我们发现，每个出生年份队列的特定年龄的药物过量死亡率曲线呈高斯形状上升和下降。与所有前出生年份队列相比，每个连续出生年份队列死亡率曲线的上升部分都在加速。这种加速可以归因于两种截然不同的过程：一种是稳定的峰值年龄，即死亡率曲线的幅度从一个出生年份队列到下一个出生年份队列逐渐增加；另一种是死亡率曲线峰值年龄的年轻化。药物过量流行现象出现在 1945-1964 年出生的队列（婴儿潮一代）中，并在 1965-1980 年出生的队列（X 世代）中增加了幅度，然后在 1981-1990 年出生的千禧一代中又恢复了幅度增加的模式。这些年龄和代际模式的变化可能是由社会经济因素和药物供应驱动的，了解这些因素对于制定有效的药物过量预防措施非常重要。
