“工作年龄段白人和美国黑人的绝望死亡”趋势,1990-2017 年。

Trends in "Deaths of Despair" Among Working-Aged White and Black Americans, 1990-2017.

出版信息

Am J Epidemiol. 2021 Sep 1;190(9):1751-1759. doi: 10.1093/aje/kwab088.

Abstract

Life expectancy for US White men and women declined between 2013 and 2017. Initial explanations for the decline focused on increases in "deaths of despair" (i.e., deaths from suicide, drug use, and alcohol use), which have been interpreted as a cohort-based phenomenon afflicting middle-aged White Americans. There has been less attention on Black mortality trends from these same causes, and whether the trends are similar or different by cohort and period. We complement existing research and contend that recent mortality trends in both the US Black and White populations most likely reflect period-based exposures to 1) the US opioid epidemic and 2) the Great Recession. We analyzed cause-specific mortality trends in the United States for deaths from suicide, drug use, and alcohol use among non-Hispanic Black and non-Hispanic White Americans, aged 20-64 years, over 1990-2017. We employed sex-, race-, and cause-of-death-stratified Poisson rate models and age-period-cohort models to compare mortality trends. Results indicate that rising "deaths of despair" for both Black and White Americans are overwhelmingly driven by period-based increases in drug-related deaths since the late 1990s. Further, deaths related to alcohol use and suicide among both White and Black Americans changed during the Great Recession, despite some racial differences across cohorts.

摘要

1990 年至 2017 年间,美国白人和女性的预期寿命在 2013 年至 2017 年间下降。最初对这一下降的解释集中在“绝望死亡”(即自杀、吸毒和酗酒导致的死亡)的增加上,这些死亡被解释为影响中年美国白人的基于队列的现象。人们对导致黑人死亡的同样原因的趋势关注较少,也较少关注这些原因的死亡率趋势是否因队列和时期而不同。我们补充了现有研究,并认为美国黑人和白人最近的死亡率趋势很可能反映了 1)美国阿片类药物流行和 2)大衰退时期基于时期的暴露。我们分析了美国非西班牙裔黑人和非西班牙裔白人美国人(年龄在 20-64 岁之间)自杀、吸毒和酗酒导致的特定原因死亡率趋势,时间跨度为 1990 年至 2017 年。我们采用了按性别、种族和死因分层的泊松率模型和年龄-时期-队列模型来比较死亡率趋势。结果表明,黑人和白人的“绝望死亡”人数的增加主要是由于 20 世纪 90 年代末以来与药物相关的死亡人数的增加所致。此外,尽管不同队列之间存在一些种族差异,但在大衰退期间,美国白人和黑人的与酒精使用和自杀相关的死亡人数也发生了变化。

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