Division of Public Health, Michigan State University College of Human Medicine, Flint, MI, USA.
Department of Medicine, Michigan State University College of Human Medicine, East Lansing, MI, USA.
Addiction. 2021 Mar;116(3):677-683. doi: 10.1111/add.15233. Epub 2020 Sep 15.
To estimate racial differences in rates of opioid-involved overdose deaths (OOD) between whites and African Americans in the United States from 1999 to 2018 to (1) identify racial variation in the temporal trends of OOD during the 20-year period and (2) compare trends in OOD rates between whites and African Americans using the Centers for Disease Control and Prevention's (CDC) three defined OOD epidemic periods.
Data were obtained from the CDC wide-ranging on-line data for epidemiological research, which combines OOD data from the National Vital Statistics System, and population data from the US Census Bureau. Joinpoint regression models were used to estimate age-adjusted annual percentage change (APC) in OOD by race from 1999 to 2018.
The temporal trends of OOD varied by race. African Americans had a persistently low rate of OOD and statistically non-significant rate of change in OOD from 1999 to 2012 (APC = 0.47; P > 0.05), with a statistically significant and rapid acceleration in OOD rates in 2012 that persisted to 2018 (APC = 26.16; P < 0.01). Whites had three statistically significant periods of acceleration in OOD rate from 1999 to 2006 (APC = 12.43; P < 0.01), 2006 to 2013 (APC = 4.34, P < 0.01) and the greatest increase from 2013 to 2016 (APC = 18.96; P < 0.01). Whites had a statistically non-significant decrease in OOD from 2016 to 2018 (P = 0.16). The trend for whites more closely aligned with the CDC-defined epidemic periods than for African Americans. During wave 1 (1999-2010), the average annual percentage change (AAPC) for African Americans was significantly lower than for whites (0.47 versus 9.42, P < 0.01); however, by wave 3 (2013-current; defined by the introduction of illicitly manufactured fentanyl), the AAPC was significantly higher in African Americans (26.16 versus 13.19, P < 0.01).
Despite historically lower rates of opioid misuse and opioid-involved overdose deaths among African Americans compared with whites, the growth in opioid-involved overdose deaths among African Americans now outpaces that of whites in the United States.
评估美国白人与非裔美国人在阿片类药物相关过量死亡（OOD）率方面的种族差异，目的是：（1）确定在 20 年期间 OOD 的时间趋势存在种族差异；（2）使用疾病控制与预防中心（CDC）定义的三个 OOD 流行期，比较白人与非裔美国人的 OOD 率趋势。
数据来自 CDC 广泛的流行病学在线数据，该数据结合了国家生命统计系统的 OOD 数据和美国人口普查局的人口数据。使用 Joinpoint 回归模型，按种族估计 1999 年至 2018 年 OOD 的年龄调整年百分比变化（APC）。
OOD 的时间趋势因种族而异。非裔美国人的 OOD 率一直较低，且从 1999 年至 2012 年 OOD 的变化率无统计学意义（APC=0.47；P>0.05），但 2012 年 OOD 率呈统计学显著快速加速，一直持续到 2018 年（APC=26.16；P<0.01）。白人从 1999 年至 2006 年、2006 年至 2013 年和 2013 年至 2016 年期间有三个统计学显著的 OOD 率加速期（APC 分别为 12.43、4.34 和 18.96；P<0.01）。从 2016 年至 2018 年，白人的 OOD 呈统计学非显著下降（P=0.16）。白人的趋势与疾病预防控制中心定义的流行期更为吻合，而非裔美国人的趋势则不然。在第 1 波（1999-2010 年）中，非裔美国人的平均年百分比变化（AAPC）明显低于白人（0.47 比 9.42，P<0.01）；然而，在第 3 波（2013 年至今；定义为非法制造的芬太尼的引入）中，非裔美国人的 AAPC 明显更高（26.16 比 13.19，P<0.01）。
尽管非裔美国人与白人相比，阿片类药物滥用和阿片类药物相关过量死亡的历史发生率较低，但非裔美国人阿片类药物相关过量死亡的增长速度现在超过了美国白人。
