New York State Psychiatric Institute, New York, NY, USA.
Columbia University Mailman School of Public Health, New York, NY, USA.
Addiction. 2023 Jun;118(6):1072-1082. doi: 10.1111/add.16123. Epub 2023 Jan 26.
Both local socio-economic conditions and prescription opioid supply are associated with drug overdose deaths, which exhibit substantial geographical heterogeneity across the United States. We measured whether the associations of prescription opioid supply with drug overdose deaths vary by local socio-economic conditions.
Ecological county-level study, including 3109 US counties between 2006 and 2019 (n = 43 526 county-years) using annual mortality data.
United States.
A total of 711 447 drug overdose deaths.
We modeled overdose counts using Bayesian hierarchical Poisson models, estimating associations between four types of drug overdose deaths (deaths involving any drugs, any opioid, prescription opioids only and heroin), prescription opioid supply and five socio-economic indicators: unemployment, poverty rate, income inequality, Rey index (components include mean household income, % high school graduates, % blue-collar workers and unemployment rate), and American human development index (HDI; an indicator of community wellbeing).
Drug overdose deaths and all substance-specific overdose deaths were higher in counties with higher income inequality [adjusted odds ratios (aORs) = 1.09-1.13], Rey index (aORs = 1.15-1.21) and prescription opioid supply (aORs = 1.14-1.21), and lower in counties with higher HDI scores (aORs = 0.75-0.92). Poverty rate, income inequality and HDI scores were found to modify the effect of prescription opioid supply on heroin overdose deaths. The plot of the interactions showed that when disadvantage is high, increasing prescription opioid supply does not increase heroin overdose deaths. The less disadvantage there is, indicated by lower poverty rates, higher HDI scores and lower income inequality, the greater the effect of increasing prescription opioid supply relative to population size on heroin overdose deaths in US counties.
In the United States, prescription opioid supply is associated with higher drug overdose deaths; associations are stronger in counties with less disadvantage and less income inequality, but only for heroin overdose deaths.
当地社会经济条件和处方类阿片供应都与药物过量死亡有关，而在美国，药物过量死亡的情况存在显著的地域差异。我们评估了处方类阿片供应与药物过量死亡之间的关联是否因当地社会经济条件而异。
包括 2006 年至 2019 年期间美国 3109 个县的生态县级研究（n=43526 个县年），使用年度死亡率数据。
美国。
共 711447 例药物过量死亡。
我们使用贝叶斯分层泊松模型对过量死亡人数进行建模，估计了四种药物过量死亡（涉及任何药物、任何阿片类药物、仅处方类阿片类药物和海洛因的死亡）、处方类阿片供应和五个社会经济指标之间的关联：失业率、贫困率、收入不平等、雷指数（包括家庭平均收入、高中毕业生比例、蓝领工人比例和失业率）和美国人类发展指数（HDI；社区福祉的一个指标）。
药物过量死亡和所有物质特异性过量死亡在收入不平等程度较高的县更高（调整后的优势比[aOR]为 1.09-1.13）、雷指数（aOR 为 1.15-1.21）和处方类阿片供应（aOR 为 1.14-1.21），而在人类发展指数（HDI）评分较高的县则较低（aOR 为 0.75-0.92）。发现贫困率、收入不平等和 HDI 得分会影响处方类阿片供应对海洛因过量死亡的影响。交互作用的图表明，当劣势较高时，增加处方类阿片供应并不会增加海洛因过量死亡。劣势越低，即贫困率越低、HDI 得分越高、收入不平等程度越低，相对于人口规模，增加处方类阿片供应对美国县海洛因过量死亡的影响就越大。
在美国，处方类阿片供应与更高的药物过量死亡有关；在劣势较小和收入不平等程度较低的县，关联更强，但仅限于海洛因过量死亡。
