Rengifo Santiago, Wu Alice, Ioffreda Patrick, Ilyas Asif M
Foundation for Opioid Research & Education, Rothman Orthopaedic Institute, Philadelphia, USA.
Orthopedic Surgery, Drexel University College of Medicine, Philadelphia, USA.
Cureus. 2023 Jun 15;15(6):e40480. doi: 10.7759/cureus.40480. eCollection 2023 Jun.
Introduction The rapid increase in opioid-related deaths since the early 2000s is a major US public health concern. This crisis has transitioned from pharmaceuticals to illicit synthetic opioids and street mixtures. This epidemic has significantly impacted the Appalachian region. This study investigated opioid-related death rates among the Appalachian states, focusing on death rates among urban, suburban, and rural counties. Methods Opioid-related death data from 2018-2021 for the 13 states that make up the Appalachian region were collected using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Opioid analgesic overdose deaths were defined using ICD-10 codes X40-X44, X60-X64, and Y10-Y14, where an opioid analgesic was also coded (T40.2-T40.4). US census data was used to calculate opioid-related death rates by population. Counties were classified as urban, suburban, and rural using the 2013 Rural-Urban Continuum Codes from the US Department of Agriculture. The data were descriptively broken down and reported as either percentages or means. Results Of the opioid-related deaths between 2018 and 2021, 498 counties were identified in the 13 Appalachian states as having reported at least 10 opioid-related deaths per year. Among these counties, 337 (67.7%) were classified as urban/metropolitan, 138 (27.7%) as suburban, and 23 (4.62%) as rural. Overall, mean opioid-related deaths by populations per 1000 among all counties were 0.24 in 2018, 0.24 in 2019, 0.33 in 2020, and 0.38 in 2021. For urban/metropolitan counties, opioid-related deaths per 1000 gradually increased from 0.23 in 2018 to 0.35 in 2021. For suburban counties, the mean opioid-related deaths per 1000 increased from 0.25 in 2018 to 0.43 in 2021. For rural counties, the mean opioid-related deaths per 1000 increased from 0.43 in 2018 to 0.62 in 2021. Conclusion Opioid-related deaths, on average and by population, have risen steadily in the Appalachian region from 2018-2021 across all geographic areas (urban/metropolitan, suburban, rural). Rural counties consistently showed the highest opioid-related deaths per population compared to urban/metropolitan and suburban areas. Addressing social determinants of health such as income level, education level, healthcare access, and community-based interventions is crucial in combating this issue. Community and health system interventions must be implemented to combat the disproportionately high rate of opioid prescribing in the Appalachian region.
引言 自21世纪初以来，与阿片类药物相关的死亡人数迅速增加，这是美国主要的公共卫生问题。这场危机已从药品转向非法合成阿片类药物和街头混合物。这场疫情对阿巴拉契亚地区产生了重大影响。本研究调查了阿巴拉契亚各州与阿片类药物相关的死亡率，重点关注城市、郊区和农村县的死亡率。方法 使用疾病控制和预防中心的广泛流行病学研究在线数据（CDC WONDER）数据库，收集了2018 - 2021年构成阿巴拉契亚地区的13个州与阿片类药物相关的死亡数据。阿片类镇痛药物过量死亡使用ICD - 10编码X40 - X44、X60 - X64和Y10 - Y14进行定义，其中还对阿片类镇痛药物进行了编码（T40.2 - T40.4）。美国人口普查数据用于按人口计算与阿片类药物相关的死亡率。使用美国农业部2013年的城乡连续编码将县分为城市、郊区和农村。数据进行了描述性分类，并以百分比或均值形式报告。结果 在2018年至2021年与阿片类药物相关的死亡中，在13个阿巴拉契亚州确定有498个县每年报告至少10例与阿片类药物相关的死亡。在这些县中，337个（67.7%）被归类为城市/大都市，138个（27.7%）为郊区，23个（4.62%）为农村。总体而言，所有县每1000人中与阿片类药物相关的平均死亡人数在2018年为0.24，2019年为0.24，2020年为0.33，2021年为0.38。对于城市/大都市县，每1000人中与阿片类药物相关的死亡人数从2018年的0.23逐渐增加到2021年的0.35。对于郊区县，每1000人中与阿片类药物相关的平均死亡人数从2018年的0.25增加到2021年的0.43。对于农村县，每1000人中与阿片类药物相关的平均死亡人数从2018年的0.43增加到2021年的0.62。结论 从2018年至2021年，在阿巴拉契亚地区，所有地理区域（城市/大都市、郊区、农村）与阿片类药物相关的平均死亡人数和按人口计算的死亡人数均稳步上升。与城市/大都市和郊区相比，农村县每人口中与阿片类药物相关的死亡人数一直最高。解决诸如收入水平、教育水平、医疗保健可及性等健康的社会决定因素以及基于社区的干预措施对于应对这一问题至关重要。必须实施社区和卫生系统干预措施，以应对阿巴拉契亚地区阿片类药物处方率过高的问题。
