Brandenburg Mark A
Department of Medicine, Bristow Medical Center, Bristow, OK, United States.
Front Public Health. 2020 Apr 29;8:139. doi: 10.3389/fpubh.2020.00139. eCollection 2020.
A one third reduction of premature deaths from non-communicable diseases by 2030 is a target of the United Nations Sustainable Development Goal for Health. Unlike in other developed nations, premature mortality in the United States (US) is increasing. The state of Oklahoma suffers some of the greatest rates in the US of both all-cause mortality and overdose deaths. Medicaid opioids are associated with overdose death at the patient level, but the impact of this exposure on population all-cause mortality is unknown. The objective of this study was to look for an association between Medicaid spending, as proxy measure for Medicaid opioid exposure, and all-cause mortality rates in the 45-54-year-old American Indian/Alaska Native (AI/AN45-54) and non-Hispanic white (NHW45-54) populations. All-cause mortality rates were collected from the US Centers for Disease Control & Prevention Wonder Detailed Mortality database. Annual per capita (APC) Medicaid spending, and APC Medicare opioid claims, smoking, obesity, and poverty data were also collected from existing databases. County-level multiple linear regression (MLR) analyses were performed. American Indian mortality misclassification at death is known to be common, and sparse populations are present in certain counties; therefore, the two populations were examined as a combined population (AI/NHW45-54), with results being compared to NHW45-54 alone. State-level simple linear regressions of AI/NHW45-54 mortality and APC Medicaid spending show strong, linear correlations: females, coefficient 0.168, (R 0.956; < 0.0001; CI95 0.15, 0.19); and males, coefficient 0.139 (R 0.746; < 0.0001; CI95 0.10, 0.18). County-level regression models reveal that AI/NHW45-54 mortality is strongly associated with APC Medicaid spending, adjusting for Medicare opioid claims, smoking, obesity, and poverty. In females: [R 0.545; (F) < 0.0001; Medicaid spending coefficient 0.137; < 0.004; 95% CI 0.05, 0.23]. In males: [R 0.719; (F) < 0.0001; Medicaid spending coefficient 0.330; < 0.001; 95% CI 0.21, 0.45]. In Oklahoma, per capita Medicaid spending is a very strong risk factor for all-cause mortality in the combined AI/NHW45-54 population, after controlling for Medicare opioid claims, smoking, obesity, and poverty.
到2030年将非传染性疾病导致的过早死亡减少三分之一是联合国可持续发展卫生目标的一项内容。与其他发达国家不同，美国的过早死亡率正在上升。俄克拉荷马州的全因死亡率和过量用药死亡率在美国处于最高水平。在患者层面，医疗补助计划中的阿片类药物与过量用药死亡有关，但这种接触对总体全因死亡率的影响尚不清楚。本研究的目的是寻找作为医疗补助计划阿片类药物接触替代指标的医疗补助支出与45至54岁美国印第安人/阿拉斯加原住民（AI/AN45 - 54）和非西班牙裔白人（NHW45 - 54）人群的全因死亡率之间的关联。全因死亡率数据来自美国疾病控制与预防中心的Wonder详细死亡率数据库。人均年度（APC）医疗补助支出、APC医疗保险阿片类药物索赔、吸烟、肥胖和贫困数据也从现有数据库中收集。进行了县级多元线性回归（MLR）分析。已知美国印第安人死亡时的死亡误分类很常见，且某些县的人口稀少；因此，将这两个人群作为一个合并人群（AI/NHW45 - 54）进行研究，并将结果与单独的NHW45 - 54人群进行比较。AI/NHW45 - 54死亡率与APC医疗补助支出的州级简单线性回归显示出强烈的线性相关性：女性，系数0.168，（R 0.956；<0.0001；CI95 0.15，0.19）；男性，系数0.139（R 0.746；<0.0001；CI95 0.10，0.18）。县级回归模型显示，在调整了医疗保险阿片类药物索赔、吸烟、肥胖和贫困因素后，AI/NHW45 - 54死亡率与APC医疗补助支出密切相关。女性：[R 0.545；（F）<0.0001；医疗补助支出系数0.137；<0.004；95% CI 0.05，0.23]。男性：[R 0.719；（F）<0.0001；医疗补助支出系数0.330；<0.001；95% CI 0.21，0.45]。在俄克拉荷马州，在控制了医疗保险阿片类药物索赔、吸烟、肥胖和贫困因素后，人均医疗补助支出是AI/NHW45 - 54合并人群全因死亡率的一个非常强的风险因素。
