Cadet Kechna, Smith Bianca D, Martins Silvia S
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
JAMA Netw Open. 2025 Apr 1;8(4):e252728. doi: 10.1001/jamanetworkopen.2025.2728.
There are several apparent research gaps based on the intersectional sociodemographic dimensions of drug-related mortality disparities. Relatively marginal evidence exists on the potential roles of intersecting forms of race and sexual marginalization on the disparities across drug-related mortality.
To examine intersectional sex-specific White and Black racial disparities in drug poisoning mortality across states from 2010 to 2020.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used unintentional fatal drug poisoning mortality data from the Centers for Disease Control and Prevention's Web-Based Injury Statistics Query and Reporting System. Trends from 2010 through 2020 were analyzed by Black men, Black women, White men, and White women across states. One-sided Mann-Kendall trend analysis was used to examine statistically significant increasing or decreasing trends in age-adjusted mortality rates. Statistical analysis was performed from June to July 2024.
White and Black groups intersecting with male and female sex.
Analysis of age-adjusted mortality rates, excess years of potential life lost (reference group: White men), years of potential life lost ratios (reference group: White men), and percentage change to highlight state differences.
From a total sample of 518 724 unintentional fatal drug poisoning deaths (9.0% in Black men, 3.9% in Black women, 29.0% in White women, and 58.1% in White men), 11 820 781 years of potential life lost were recorded. Black men had the highest mean (SD) age-adjusted mortality rate (23.25 [22.65]), followed by White men (22.49 [14.32]), with lower rates for White women (11.71 [5.96]) and Black women (9.01 [8.04]) (P < .001). Compared with White men, both Black men (τ = 0.298, slope = 0.002, intercept = 0.381, P < .001) and Black women (τ = 0.157, slope = 0.0004, intercept = 0.271, P < .001) had worsening YPLL over time, while White women (τ = -0.146, slope = -0.0003, intercept = 0.5252, P < .001) showed improvement in their YPLL over time compared with White men. At the state level, there was a disproportionate burden of deaths due to drug poisonings, with Maryland showing the highest increase in mortality rates among Black men (485.4%), while decreases were observed for White women in states such as Alaska (-23.0%).
In this cross-sectional study of overdose deaths, disparities in overdose mortality were evident, with Black men and Black women experiencing a pronounced and increasing burden of mortality compared with their White counterparts. Addressing these disparities will require a multipronged approach targeting the social, physical, economic, and policy risk environments.
基于与药物相关的死亡率差异的交叉社会人口统计学维度，存在几个明显的研究空白。关于种族和性边缘化的交叉形式对药物相关死亡率差异的潜在作用，相关证据相对较少。
研究2010年至2020年各州药物中毒死亡率中按性别划分的白人和黑人的交叉种族差异。
设计、背景和参与者：这项横断面研究使用了疾病控制和预防中心基于网络的伤害统计查询和报告系统中的非故意致命药物中毒死亡率数据。分析了2010年至2020年各州黑人男性、黑人女性、白人男性和白人女性的趋势。采用单侧曼-肯德尔趋势分析来检验年龄调整死亡率的统计学显著上升或下降趋势。统计分析于2024年6月至7月进行。
与男性和女性交叉的白人和黑人群体。
分析年龄调整死亡率、潜在寿命损失年数（参照组：白人男性）、潜在寿命损失年数比率（参照组：白人男性）以及百分比变化，以突出各州差异。
在总共518724例非故意致命药物中毒死亡样本中（黑人男性占9.0%，黑人女性占3.9%，白人女性占29.0%，白人男性占58.1%），记录了11820781年的潜在寿命损失。黑人男性的平均（标准差）年龄调整死亡率最高（23.25[22.65]），其次是白人男性（22.49[14.32]），白人女性（11.71[5.96]）和黑人女性（9.01[8.04]）的死亡率较低（P < 0.001）。与白人男性相比，黑人男性（τ = 0.298，斜率 = 0.002，截距 = 0.381，P < 0.001）和黑人女性（τ = 0.157，斜率 = 0.0004，截距 = 0.271，P < 0.001）的潜在寿命损失年数随时间推移均有所恶化；而与白人男性相比，白人女性（τ = -0.146，斜率 = -0.0003，截距 = 0.5252，P < 0.001）的潜在寿命损失年数随时间推移有所改善。在州层面，药物中毒导致的死亡负担不均衡，马里兰州黑人男性的死亡率增幅最高（485.4%），而阿拉斯加等州的白人女性死亡率有所下降（-23.0%）。
在这项关于过量用药死亡的横断面研究中，过量用药死亡率的差异明显，与白人相比，黑人男性和黑人女性的死亡负担更为显著且呈上升趋势。解决这些差异需要采取多管齐下针对社会、身体、经济和政策风险环境的方法。
