Bharat Chrianna, Hopkins Ria E, Chambers Mark, Degenhardt Louisa, Peacock Amy, Farrell Michael, Yuen Wing See, Man Nicola, Gisev Natasa
National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King St, Randwick, Sydney, NSW, 2031, Australia.
School of Psychology, University of Tasmania, Hobart, Australia.
Soc Psychiatry Psychiatr Epidemiol. 2025 Mar;60(3):693-703. doi: 10.1007/s00127-024-02749-4. Epub 2024 Aug 23.
Deaths due to substance poisoning, alcohol-related disease, and suicide pose a critical public health issue, and have been categorized as "deaths of despair" in the US. Whether these deaths represent a distinct phenomenon requires exploration, particularly in other countries.
This retrospective observational study examines age-period-cohort trends of (combined and cause-specific) substance poisoning, alcohol-related disease, and suicide deaths among Australians aged ≥15-years that occurred between 1980 and 2019 and compares trends between males and females.
Combined mortality rates were initially (1980-1999) relatively stable, reflecting a reduction in alcohol-related disease deaths offset by an increase in substance poisoning deaths. A decline (2000-2006) and subsequent increase (2007-2019) in combined rates were primarily attributable to corresponding changes in both substance poisoning and suicide deaths among males. Distinct age-period-cohort trends were observed between cause of death sub-types, with net drifts: increasing for male (net drift [95% CI]: 3.33 [2.84, 3.83]) and female (2.58 [2.18, 2.98]) substance poisoning deaths; decreasing among male alcohol-related disease (- 1.46 [- 1.75, - 1.16]) and suicide deaths (- 0.52[- 0.69, - 0.36]); and remaining relatively stable for female alcohol-related disease (- 0.28 [- 0.66, 0.09]) and suicide deaths (- 0.25 [- 0.52, 0.01]).
Although combined age-specific trends were relatively stable over the study period, different and distinct patterns were observed within cause-specific deaths, challenging the notion that these causes of death represent a distinct epidemiological phenomenon. These data indicate a critical need to review the appropriateness of guidance for clinical practice, prevention strategies, and policy initiatives aimed at preventing future deaths.
因物质中毒、酒精相关疾病和自杀导致的死亡构成了一个关键的公共卫生问题，在美国已被归类为“绝望死亡”。这些死亡是否代表一种独特的现象需要进行探究，尤其是在其他国家。
这项回顾性观察研究考察了1980年至2019年间澳大利亚15岁及以上人群中（综合及特定病因）物质中毒、酒精相关疾病和自杀死亡的年龄-时期-队列趋势，并比较了男性和女性之间的趋势。
综合死亡率最初（1980 - 1999年）相对稳定，这反映出酒精相关疾病死亡人数的减少被物质中毒死亡人数的增加所抵消。综合死亡率的下降（2000 - 2006年）及随后的上升（2007 - 2019年）主要归因于男性物质中毒和自杀死亡人数的相应变化。在死因亚型之间观察到了不同的年龄-时期-队列趋势，有净漂移：男性（净漂移[95%置信区间]：3.33[2.84，3.83]）和女性（2.58[2.18，2.98]）物质中毒死亡人数增加；男性酒精相关疾病（-1.46[-1.75，-1.16]）和自杀死亡人数（-0.52[-0.69，-0.36]）减少；女性酒精相关疾病（-0.28[-0.66，0.09]）和自杀死亡人数（-0.25[-0.52，0.01]）保持相对稳定。
尽管在研究期间特定年龄的综合趋势相对稳定，但在特定病因死亡中观察到了不同且独特的模式，这对这些死因代表一种独特的流行病学现象这一观点提出了挑战。这些数据表明迫切需要审查针对预防未来死亡的临床实践指南、预防策略和政策倡议的适当性。
