Dornsife School of Public Health, Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania, USA
Dornsife School of Public Health, Department of Community Health and Prevention, Drexel University, Philadelphia, Pennsylvania, USA.
BMJ Open. 2022 Mar 3;12(3):e048831. doi: 10.1136/bmjopen-2021-048831.
To describe the association between population size, population growth and opioid overdose deaths-overall and by type of opioid-in US commuting zones (CZs) in three periods between 2005 and 2017.
741 CZs covering the entirety of the US CZs are aggregations of counties based on commuting patterns that reflect local economies.
We used mortality data at the county level from 2005 to 2017 from the National Center for Health Statistics.
Opioid overdose deaths were defined using underlying and contributory causes of death codes from the International Classification of Diseases, 10th revision (ICD-10). We used the underlying cause of death to identify all drug poisoning deaths. Contributory cause of death was used to classify opioid overdose deaths according to the three major types of opioid, that is, prescription opioids, heroin and synthetic opioids other than methadone.
Opioid overdose deaths were disproportionally higher in largely populated CZs. A CZ with 1.0% larger population had 1.10%, 1.10%, and 1.16% higher opioid death count in 2005-2009, 2010-2014, and 2015-2017, respectively. This pattern was largely driven by a high number of deaths involving heroin and synthetic opioids, particularly in 2015-2017. Population growth over time was associated with lower age-adjusted opioid overdose mortality rate: a 1.0% increase in population over time was associated with 1.4% (95% CI: -2.8% to 0.1%), 4.5% (95% CI: -5.8% to -3.2%), and 1.2% (95% CI: -4.2% to 1.8%) lower opioid overdose mortality in 2005-2009, 2010-2014, and 2015-2017, respectively. The association between positive population growth and lower opioid mortality rates was stronger in larger CZs.
Opioid overdose mortality in the USA was disproportionately higher in mid-sized and large CZs, particularly those affected by declines in population over time, regardless of the region where they are located.
描述 2005 年至 2017 年三个时期内，美国通勤区（CZ）的人口规模、人口增长与阿片类药物过量死亡之间的总体关系，以及不同类型阿片类药物之间的关系。
CZ 是基于通勤模式聚集的县，反映了当地经济。
我们使用了国家卫生统计中心 2005 年至 2017 年的县级死亡率数据。
人口众多的 CZ 区的阿片类药物过量死亡率不成比例地更高。人口增加 1.0%的 CZ，2005-2009 年、2010-2014 年和 2015-2017 年阿片类药物死亡人数分别增加 1.10%、1.10%和 1.16%。这种模式主要是由涉及海洛因和合成阿片类药物的大量死亡所驱动，尤其是在 2015-2017 年。随着时间的推移，人口增长与较低的年龄调整后阿片类药物过量死亡率相关：人口随时间增加 1.0%，与 2005-2009 年、2010-2014 年和 2015-2017 年的阿片类药物过量死亡率分别降低 1.4%（95%CI：-2.8%至 0.1%）、4.5%（95%CI：-5.8%至-3.2%）和 1.2%（95%CI：-4.2%至 1.8%）相关。人口增长与较低的阿片类药物死亡率之间的关联在较大的 CZ 中更强。
无论所在地区如何，美国阿片类药物过量死亡率在中等和大型 CZ 中不成比例地更高，尤其是那些随着时间的推移人口下降的地区。
