Center for Suicide Prevention and Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.
Department of Geography, The Ohio State University, Columbus, Ohio.
Am J Prev Med. 2023 Aug;65(2):192-200. doi: 10.1016/j.amepre.2023.02.020. Epub 2023 Mar 22.
Deaths of despair (i.e., suicide, drug/alcohol overdose, and chronic liver disease and cirrhosis) have been increasing over the past 2 decades. However, no large-scale studies have examined geographic patterns of deaths of despair in the U.S. This ecologic study identifies geographic and temporal patterns of individual and co-occurring clusters of deaths of despair.
All individuals aged ≥10 years who died in the U.S. between 2000 and 2019 and resided within the 48 contiguous states and Washington, District of Columbia were included (N=2,171,105). Causes of death were limited to deaths of despair, namely suicide, drug/alcohol overdose, and chronic liver disease and cirrhosis. Univariate and multivariate space-time scan statistics were used to identify individual and co-occurring clusters with excess risk of deaths of despair. County-level RRs account for heterogeneity within each cluster. Analyses were conducted from late 2021 to early 2022.
Six suicide clusters, four overdose clusters, nine liver disease clusters, and three co-occurring clusters of all three types of deaths were identified. A large portion of the western U.S., southeastern U.S., and Appalachia/rust belt were contained within the co-occurring clusters. The co-occurring clusters had average county RRs ranging from 1.17 (p<0.001) in the southeastern U.S. to 4.90 (p<0.001) in the western U.S.
Findings support identifying and targeting risk factors common to all types of deaths of despair when planning public health interventions. Resources and policies that address all deaths of despair simultaneously may be beneficial for the areas contained within the co-occurring high-risk clusters.
过去 20 年来，绝望致死（即自杀、药物/酒精过量和慢性肝病和肝硬化）的人数一直在增加。然而，目前还没有大规模的研究来调查美国绝望致死的地理模式。本生态研究旨在确定美国个别和同时发生的绝望致死集群的地理和时间模式。
本研究纳入了 2000 年至 2019 年期间在美国居住在 48 个州和哥伦比亚特区的所有年龄≥10 岁的死亡者（N=2,171,105）。死亡原因仅限于绝望致死，即自杀、药物/酒精过量和慢性肝病和肝硬化。采用单变量和多变量时空扫描统计方法来识别个体和同时发生的具有过度绝望致死风险的集群。县级相对风险（RR）考虑了每个集群内的异质性。分析于 2021 年末至 2022 年初进行。
确定了 6 个自杀集群、4 个过量使用药物集群、9 个肝病集群和 3 个同时发生的三种类型死亡的集群。西部、东南部和阿巴拉契亚/铁锈带的大部分地区都包含在同时发生的集群中。同时发生的集群的平均县级 RR 范围从东南部的 1.17（p<0.001）到西部的 4.90（p<0.001）。
研究结果支持在规划公共卫生干预措施时，识别和针对所有类型的绝望致死的共同风险因素。同时解决所有绝望致死的资源和政策可能对同时发生的高危集群中的地区有益。
