Department of Epidemiology & Biostatistics, University of Maryland School of Public Health , College Park, MD, USA.
Mortality Research Branch, Center for Economic Studies, U.S. Bureau of the Census , Suitland, MD, USA.
Am J Drug Alcohol Abuse. 2020 Nov 1;46(6):769-776. doi: 10.1080/00952990.2020.1820018. Epub 2020 Sep 29.
Since 1999, over 702,000 people in the US have died of a drug overdose, and the drug overdose death rate has increased from 6.2 to 21.8 per 100,000. Employment status and occupation may be important social determinants of overdose deaths.
Estimate the risk of drug overdose death by employment status and occupation, controlling for other social and demographic factors known to be associated with overdose deaths.
Proportional hazard models were used to study US adults in the National Longitudinal Mortality Study with baseline measurements taken in the early 2000s and up to 6 years of follow-up (n = 438,739, 53% female, 47% male). Comparisons were made between adults with different employment statuses (employed, unemployed, disabled, etc.) and occupations (sales, construction, service occupations, etc.). Models were adjusted for age, sex, race/ethnicity, education, income and marital status.
Adults who were disabled (hazard ratio (HR) = 6.96 (95% CI = 6.81-7.12)), unemployed (HR = 4.20, 95% CI = 4.09-4.32) and retired (HR = 2.94, 95% CI = 2.87-3.00) were at higher risk of overdose death relative to those who were employed. By occupation, those working in service (HR = 2.05, 95% CI = 1.97-2.13); construction and extraction (HR = 1.69, 95% CI = 1.64-1.76); management, business and financial (HR = 1.39, 95% CI = 1.33-1.44); and installation, maintenance and repair (HR = 1.32, 95% CI = 1.25-1.40) occupations displayed higher risk relative to professional occupations.
In a large national cohort followed prospectively for up to 6 years, several employment statuses and occupations are associated with overdose deaths, independent of a range of other factors. Efforts to prevent overdose deaths may benefit from focusing on these high-risk groups.
自 1999 年以来，美国已有超过 70.2 万人死于药物过量，药物过量死亡率已从每 10 万人 6.2 人上升到每 10 万人 21.8 人。就业状况和职业可能是药物过量死亡的重要社会决定因素。
通过控制已知与药物过量死亡相关的其他社会和人口统计学因素，估计按就业状况和职业划分的药物过量死亡风险。
使用比例风险模型研究了参加国家纵向死亡率研究的美国成年人，基线测量值在 21 世纪初，随访时间长达 6 年（n=438739，53%为女性，47%为男性）。对不同就业状况（就业、失业、残疾等）和职业（销售、建筑、服务职业等）的成年人进行了比较。模型调整了年龄、性别、种族/民族、教育、收入和婚姻状况。
与就业成年人相比，残疾（危险比（HR）=6.96（95%置信区间（CI）=6.81-7.12））、失业（HR=4.20，95% CI=4.09-4.32）和退休（HR=2.94，95% CI=2.87-3.00）的成年人药物过量死亡风险更高。按职业划分，从事服务（HR=2.05，95% CI=1.97-2.13）；建筑和采掘业（HR=1.69，95% CI=1.64-1.76）；管理、商业和金融（HR=1.39，95% CI=1.33-1.44）；安装、维护和修理（HR=1.32，95% CI=1.25-1.40）职业的风险高于专业职业。
在一项前瞻性随访长达 6 年的大型全国队列研究中，几种就业状况和职业与药物过量死亡相关，独立于一系列其他因素。预防药物过量死亡的工作可能受益于关注这些高风险群体。
