Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, Illinois, USA
Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan, USA.
BMJ Open. 2022 May 2;12(5):e053686. doi: 10.1136/bmjopen-2021-053686.
The rate of drug overdose deaths in the USA has more than tripled since the turn of the century, and rates are disproportionately high among the American Indian/Alaska Native (AI/AN) population. Little is known about the overall historical trends in AI/AN opioid-only and opioid/polysubstance-related mortality. This study will address this gap.
This is a retrospective longitudinal ecological study.
US death records from 1999 to 2019 using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research.
US non-Hispanic AI/AN people age 12 years and older.
The primary outcomes, identified via the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes, included overdose deaths due to (1) opioids only, opioids in combination with any other substance, all-opioid related overdoses; (2) combinations of opioids and alcohol, opioids and methamphetamine, opioids and cocaine, opioids and benzodiazepines; and (3) specific types of opioids.
From 1999 to 2019, opioid-only mortality rates increased from 2.8 to 15.8 per 100 000 (p<0.001) for AI/AN women and 4.6 to 25.6 per 100 000 (p<0.001) for AI/AN men. All opioid-related mortality rates increased significantly (p<0.001) from 5.2 to 33.9 per 100 000 AI/AN persons, 3.9 to 26.1 for women and 6.5 to 42.1 for men. AI/AN also exhibited significant increases in mortality rates due to opioids and alcohol, opioids and benzodiazepines, opioids and methamphetamine, and AI/AN men experienced substantial increases in mortality due to opioids and cocaine. Mortality rates by individual opioid types increased significantly over time for heroin, natural and semi-synthetic (prescription), and synthetic opioids (fentanyl/fentanyl analogues) other than methadone.
These findings highlight magnification over time in opioid-related deaths and may point to broader systemic factors that may disproportionately affect members of AI/AN communities and drive inequities.
自本世纪初以来，美国的药物过量死亡人数增加了两倍多，而美国印第安人/阿拉斯加原住民（AI/AN）人群中的这一比例过高。关于 AI/AN 人群中仅阿片类药物和阿片类药物/多种物质相关死亡率的总体历史趋势知之甚少。本研究将解决这一差距。
这是一项回顾性纵向生态学研究。
美国疾病控制与预防中心广域在线流行病学研究使用的 1999 年至 2019 年的死亡记录。
年龄在 12 岁及以上的非西班牙裔 AI/AN 人。
主要结局是通过国际疾病分类第 10 次修订版和相关健康问题代码确定的，包括（1）仅阿片类药物、阿片类药物与任何其他物质联合、所有阿片类药物相关的过量死亡；（2）阿片类药物和酒精、阿片类药物和冰毒、阿片类药物和可卡因、阿片类药物和苯二氮䓬类药物的组合；和（3）特定类型的阿片类药物。
从 1999 年到 2019 年，AI/AN 女性的阿片类药物单一死亡率从每 10 万人 2.8 例增加到 15.8 例（p<0.001），AI/AN 男性的阿片类药物单一死亡率从每 10 万人 4.6 例增加到 25.6 例（p<0.001）。所有阿片类药物相关死亡率均显著增加（p<0.001），AI/AN 人群从每 10 万人 5.2 例增加到 33.9 例，女性从每 10 万人 3.9 例增加到 26.1 例，男性从每 10 万人 6.5 例增加到 42.1 例。AI/AN 人群因阿片类药物和酒精、阿片类药物和苯二氮䓬类药物、阿片类药物和冰毒而导致的死亡率也显著增加，而 AI/AN 男性因阿片类药物和可卡因而导致的死亡率大幅增加。在特定的阿片类药物类型中，海洛因、天然和半合成（处方）以及除美沙酮以外的合成阿片类药物（芬太尼/芬太尼类似物）的死亡率随着时间的推移而显著增加。
这些发现突出了阿片类药物相关死亡人数随时间的放大效应，这可能表明存在更广泛的系统性因素，这些因素可能不成比例地影响 AI/AN 社区成员，并造成不平等。
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