RAND, Arlington, Virginia.
JAMA Health Forum. 2023 Oct 6;4(10):e233274. doi: 10.1001/jamahealthforum.2023.3274.
Educational attainment in the US is associated with life expectancy. As the opioid crisis worsens, it is critical to understand how overdose death rate trends evolve across education groups.
To investigate the association between educational attainment and overdose death rates, with emphasis on trends during the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used National Vital Statistics System Mortality Multiple Cause-of-Death data describing overdose death rates in the US by educational attainment from January 1, 2000, to December 31, 2021, with a focus on 2018 to 2021. Overdose deaths were aggregated by year and educational level for decedents aged 25 years or older.
Educational attainment, categorized as no high school (HS) diploma, HS diploma (or General Educational Development) but no college, some college but no bachelor's degree, and bachelor's degree or more.
The main outcomes were rates of all overdose deaths, overdose deaths involving opioids, and overdose deaths involving synthetic opioids.
Of 912 057 overdose deaths with education information from 2000 to 2021 (mean [SD] age at death, 44.9 [12.3] years; 64.1% male), there were 625 400 deaths (68.6%) among individuals with no college education and 286 657 deaths (31.4%) among those with at least some college. The overdose death rate was 19.9 per 100 000 population. From 2018 to 2021, there were 301 557 overdose deaths, including 58 319 (19.3%) among individuals without an HS diploma, 153 603 (50.9%) among people with an HS diploma, 64 682 (21.4%) among individuals with some college, and 24 953 (8.3%) among individuals with a bachelor's degree. There were 3324 overdose deaths (1.1%) among American Indian or Alaska Native individuals, 2968 (1.0%) among Asian American or Pacific Islander individuals, 49 152 (16.3%) among Black individuals, 31 703 (10.5%) among Hispanic individuals, 211 359 (70.1%) among White individuals, and 3051 (1.0%) among multiracial individuals. From 2018 to 2021, the overdose death rate was 33.4 per 100 000 population, the opioid-related overdose death rate was 24.2 per 100 000 population, and the synthetic opioid overdose death rate was 19.1 per 100 000 population. From 2018 to 2021, the overdose death rate for those without a HS diploma increased by 35.4 per 100 000 population compared with 1.5 per 100 000 population for those with a bachelor's degree. This differential growth was primarily due to increased rates of death involving synthetic opioids.
In this cross-sectional study, lower educational attainment was found to be associated with higher growth in overdose deaths. As the opioid crisis has transitioned to fentanyl and polysubstance use, overdose deaths have become more prevalent in groups with lower socioeconomic status, potentially exacerbating existing life-expectancy disparities.
在美国，受教育程度与预期寿命有关。随着阿片类药物危机的恶化，了解教育程度群体中过量死亡趋势如何演变至关重要。
研究受教育程度与过量死亡之间的关联，重点关注 COVID-19 大流行期间的趋势。
设计、地点和参与者：本横断面研究使用国家生命统计系统死亡率多死因数据，描述了 2000 年 1 月 1 日至 2021 年 12 月 31 日期间美国按受教育程度划分的过量死亡率，重点是 2018 年至 2021 年。将 25 岁及以上死者的过量死亡人数按年份和教育水平进行汇总。
受教育程度分为没有高中（HS）文凭、HS 文凭（或普通教育发展）但没有大学学历、部分大学但没有学士学位和学士学位或以上。
主要结果是所有过量死亡、涉及阿片类药物的过量死亡和涉及合成阿片类药物的过量死亡的比率。
在 2000 年至 2021 年有教育信息的 912057 例过量死亡中（死亡时的平均[SD]年龄，44.9[12.3]岁；64.1%为男性），有 625400 例死亡（68.6%）发生在没有大学教育的个体中，有 286657 例死亡（31.4%）发生在至少有一些大学教育的个体中。过量死亡率为每 10 万人 19.9 例。2018 年至 2021 年，有 301557 例过量死亡，其中 58319 例（19.3%）发生在没有高中文凭的个体中，153603 例（50.9%）发生在有高中文凭的个体中，64682 例（21.4%）发生在有部分大学教育的个体中，24953 例（8.3%）发生在有学士学位的个体中。有 3324 例（1.1%）过量死亡发生在美洲印第安人或阿拉斯加原住民个体中，有 2968 例（1.0%）发生在亚裔或太平洋岛民个体中，有 49152 例（16.3%）发生在黑人个体中，有 31703 例（10.5%）发生在西班牙裔个体中，有 211359 例（70.1%）发生在白人个体中，有 3051 例（1.0%）发生在多种族个体中。2018 年至 2021 年，过量死亡率为每 10 万人 33.4 例，涉及阿片类药物的过量死亡率为每 10 万人 24.2 例，涉及合成阿片类药物的过量死亡率为每 10 万人 19.1 例。2018 年至 2021 年，没有高中文凭的个体过量死亡率比有学士学位的个体每年增加 35.4 例，而有学士学位的个体每年增加 1.5 例。这种差异的增长主要是由于涉及合成阿片类药物的死亡人数增加所致。
在这项横断面研究中，发现较低的受教育程度与过量死亡的增长呈正相关。随着阿片类药物危机向芬太尼和多物质使用转变，过量死亡在社会经济地位较低的群体中更为普遍，这可能加剧了现有的预期寿命差距。
