BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Department of Sociology, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada.
BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, School of Social Work, The Jack Bell Building, 2080 West Mall, Vancouver, BC, V6T 1Z2, Canada.
Drug Alcohol Depend. 2020 Sep 1;214:108127. doi: 10.1016/j.drugalcdep.2020.108127. Epub 2020 Jun 20.
Socioeconomic marginalization (SEM) is an important but under-explored determinant of opioid overdose with important implications for health equity and associated public policy initiatives. This systematic review synthesizes evidence on the role of SEM in both fatal and non-fatal overdose among people who use opioids.
Studies published between January 1, 2000 and March 31, 2018 were identified through searching electronic databases, citations, and by contacting experts. The titles, abstracts, citation information, and descriptor terms of citations were screened by two team members. Data were synthesized using the lumping technique.
A total of 37 studies met inclusion criteria and were included in the review, with 34 of 37 finding a significant association between at least one socioeconomic factor and overdose. The included studies contained variables related to eight socioeconomic factors: criminal justice system involvement, income, employment, social support, health insurance, housing/homelessness, education, and composite measures of socio-economic status. Most studies found associations in the hypothesized direction, whereby increased SEM was associated with a higher rate or increased likelihood of the overdose outcome measured. The review revealed an underdeveloped evidence base.
Nearly all reviewed studies found a connection between a socioeconomic variable and overdose, but more research is needed with an explicit focus on SEM, using robust and nuanced measures that capture multiple dimensions of disadvantage, and collect data over time to better inform decision making around opioid overdose.
社会经济边缘化（SEM）是阿片类药物过量的一个重要但研究不足的决定因素，对健康公平和相关公共政策倡议有重要影响。本系统综述综合了关于 SEM 在阿片类药物使用者的致命和非致命性药物过量中的作用的证据。
通过搜索电子数据库、参考文献和联系专家，确定了 2000 年 1 月 1 日至 2018 年 3 月 31 日期间发表的研究。两名团队成员筛选了标题、摘要、引用信息和引用的描述性术语。使用合并技术综合数据。
共有 37 项研究符合纳入标准并纳入综述，其中 34 项研究发现至少有一个社会经济因素与药物过量之间存在显著关联。纳入的研究包含与八个社会经济因素相关的变量：刑事司法系统参与、收入、就业、社会支持、医疗保险、住房/无家可归、教育和社会经济地位的综合衡量标准。大多数研究发现，假设的方向存在关联，即 SEM 增加与更高的药物过量发生率或更高的药物过量可能性有关。该综述揭示了一个欠发达的证据基础。
几乎所有审查的研究都发现了社会经济变量与药物过量之间的联系，但需要更多的研究，重点是 SEM，使用稳健和细致的措施来捕捉多个劣势维度，并随着时间的推移收集数据，以便更好地为阿片类药物过量的决策提供信息。
