Division of Population Health, Health Services Research and Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK; National Institute for Health and Care Research (NIHR), Applied Research Collaboration Greater Manchester (ARC-GM), UK.
Division of Psychology and Mental Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK; National Institute for Health and Care Research (NIHR), Applied Research Collaboration Greater Manchester (ARC-GM), UK.
Soc Sci Med. 2024 Feb;342:116560. doi: 10.1016/j.socscimed.2024.116560. Epub 2024 Jan 5.
Deaths of Despair (DoD) are socially patterned fatalities encompassing those attributable to drug and alcohol misuse and suicide. DoD occur much more frequently in socially deprived communities. This ecological study aimed to yield new knowledge on the spatial distribution of DoD, and socioeconomic factors that predict DoD risk in England. Via ICD-10 coding, deaths nationally during 2019-2021 were classified to non-overlapping categories of drug-related death, alcohol-specific death, and suicide. The proportion of DoD from each of these causes was calculated and age standardised DoD rates were generated for local authorities. A multivariable regression model for DoD risk was developed using 25 socioeconomic indicators. In 2019-2021, an estimated 46,200 people lost their lives due to DoD. Rates were higher in the North and in coastal areas (p < 0.001), ranging regionally from 25.1/100,000 (SD 6.3) in London to 54.7/100,000 (SD 9.5) in the North East. Alcohol-specific deaths were the largest contributor of DoD, accounting for 44.1% (95%CI 43.5-44.8%) of all such deaths. Living in the North, unemployment, White British ethnicity, living alone, economic inactivity, employment in elementary occupations, and living in urban areas were significantly associated with elevated DoD risk. DoD in England are spatially patterned, with northern regions experiencing a much higher burden of mortality from these avoidable causes. This study provides novel insights into the area-level factors associated with DoD in England. Potential ecological error is a key limitation.
死亡归因于绝望（DoD）是一种社会模式化的死亡，包括那些与药物和酒精滥用以及自杀有关的死亡。DoD 在社会贫困社区中更为常见。这项生态研究旨在提供关于 DoD 的空间分布以及预测英格兰 DoD 风险的社会经济因素的新知识。通过 ICD-10 编码，2019-2021 年期间全国的死亡人数被分为相互不重叠的药物相关死亡、特定于酒精的死亡和自杀类别。计算了这些原因导致的 DoD 比例，并为地方当局生成了年龄标准化的 DoD 率。使用 25 个社会经济指标开发了 DoD 风险的多变量回归模型。在 2019-2021 年期间，估计有 46200 人因 DoD 而丧生。北部和沿海地区的死亡率较高（p<0.001），区域范围从伦敦的 25.1/100000（SD 6.3）到东北的 54.7/100000（SD 9.5）。特定于酒精的死亡是 DoD 的最大贡献者，占所有此类死亡的 44.1%（95%CI 43.5-44.8%）。居住在北部、失业、白种英国人种、独居、经济不活跃、从事初级职业和居住在城市地区与 DoD 风险升高显著相关。英格兰的 DoD 存在空间模式，北部地区这些可避免原因导致的死亡率负担更高。这项研究提供了关于与英格兰 DoD 相关的区域因素的新见解。潜在的生态错误是一个关键的限制。
