Glei Dana A, Lee Chioun, Weinstein Maxine
Center for Population and Health, Georgetown University, 5985 San Aleso Court, Santa Rosa, 95409-3912, CA, USA.
Department of Sociology, University of California, 1207 Watkins Hall, Riverside, 92521, CA, USA.
SSM Popul Health. 2020 Nov 25;12:100699. doi: 10.1016/j.ssmph.2020.100699. eCollection 2020 Dec.
Prior studies have identified smoking as a key driver of socioeconomic disparities in U.S. mortality, but the growing drug epidemic leads us to question whether drug abuse is exacerbating those disparities, particularly for mortality from external causes. We use data from a national survey of midlife Americans to evaluate socioeconomic disparities in all-cause and cause-specific mortality over an 18-year period (1995-2013). Then, we use marginal structural modeling to quantify the indirect effects of smoking and alcohol/drug abuse in mediating those disparities. Our results demonstrate that alcohol/drug abuse makes little contribution to socioeconomic disparities in all-cause mortality, probably because the prevalence of substance abuse is low and socioeconomic differences in abuse are small, especially at older ages when most Americans die. Smoking prevalence is much higher than drug/alcohol abuse and socioeconomic differentials in smoking are large and have widened among younger cohorts. Not surprisingly, smoking accounts for the majority (62%) of the socioeconomic disparity in mortality from smoking-related diseases, but smoking also makes a substantial contribution to cardiovascular (38%) and all-cause mortality (34%). Based on the observed cohort patterns of smoking, we predict that smoking will further widen SES disparities in all-cause mortality until at least 2045 for men and even later for women. Although we cannot yet determine the mortality consequences of recent widening of the socioeconomic disparities in drug abuse, social inequalities in mortality are likely to grow even wider over the coming decades as the legacy of smoking and the recent drug epidemic take their toll.
先前的研究已将吸烟确定为美国死亡率方面社会经济差距的一个关键驱动因素，但日益严重的药物泛滥问题让我们不禁要问，药物滥用是否正在加剧这些差距，尤其是在由外部原因导致的死亡率方面。我们使用来自一项针对美国中年人的全国性调查的数据，来评估18年期间（1995 - 2013年）全因死亡率和特定原因死亡率方面的社会经济差距。然后，我们使用边际结构模型来量化吸烟和酒精/药物滥用在介导这些差距方面的间接影响。我们的结果表明，酒精/药物滥用对全因死亡率方面的社会经济差距贡献不大，可能是因为药物滥用的流行率较低，且滥用方面的社会经济差异较小，特别是在大多数美国人死亡的老年阶段。吸烟流行率远高于药物/酒精滥用，而且吸烟方面的社会经济差异很大，并且在年轻人群体中有所扩大。不出所料，吸烟占与吸烟相关疾病死亡率方面社会经济差距的大部分（62%），但吸烟对心血管疾病死亡率（38%）和全因死亡率（34%）也有很大贡献。基于观察到的吸烟队列模式，我们预测吸烟将进一步扩大全因死亡率方面的社会经济地位差距，至少在2045年之前对男性如此，对女性则更晚。尽管我们尚无法确定近期药物滥用方面社会经济差距扩大所带来的死亡后果，但随着吸烟遗留问题和近期药物泛滥造成影响，未来几十年死亡率方面的社会不平等可能会变得更加严重。
