Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the Mortality Disparities in American Communities Study (MDAC)


Autoři: Sean F. Altekruse aff001;  Candace M. Cosgrove aff002;  William C. Altekruse aff003;  Richard A. Jenkins aff004;  Carlos Blanco aff004
Působiště autorů: Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America aff001;  Center for Administrative Records Research and Applications, U.S. Bureau of the Census, Suitland, Maryland, United States of America aff002;  Division of Translational Research, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America aff003;  Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, United States of America aff004
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227966

Souhrn

Background

Understanding relationships between individual-level demographic, socioeconomic status (SES) and U.S. opioid fatalities can inform interventions in response to this crisis.

Methods

The Mortality Disparities in American Community Study (MDAC) links nearly 4 million 2008 American Community Survey responses to the 2008–2015 National Death Index. Univariate and multivariable models were used to estimate opioid overdose fatality hazard ratios (HR) and 95% confidence intervals (CI).

Results

Opioid overdose was an overrepresented cause of death among people 10 to 59 years of age. In multivariable analysis, compared to Hispanics, Whites and American Indians/Alaska Natives had elevated risk (HR = 2.52, CI:2.21–2.88) and (HR = 1.88, CI:1.35–2.62), respectively. Compared to women, men were at-risk (HR = 1.61, CI:1.50–1.72). People who were disabled were at higher risk than those who were not (HR = 2.80, CI:2.59–3.03). Risk was higher among widowed than married (HR = 2.44, CI:2.03–2.95) and unemployed than employed individuals (HR = 2.46, CI:2.17–2.79). Compared to adults with graduate degrees, those with high school only were at-risk (HR = 2.48, CI:2.00–3.06). Citizens were more likely than noncitizens to die from this cause (HR = 4.62, CI:3.48–6.14). Compared to people who owned homes with mortgages, those who rented had higher HRs (HR = 1.36, CI:1.25–1.48). Non-rural residents had higher risk than rural residents (HR = 1.46, CI:1.34, 1.59). Compared to respective referent groups, people without health insurance (HR = 1.30, CI:1.20–1.41) and people who were incarcerated were more likely to die from opioid overdoses (HR = 2.70, CI:1.91–3.81). Compared to people living in households at least five-times above the poverty line, people who lived in poverty were more likely to die from this cause (HR = 1.36, CI:1.20–1.54). Compared to people living in West North Central states, HRs were highest among those in South Atlantic (HR = 1.29, CI:1.11, 1.50) and Mountain states (HR = 1.58, CI:1.33, 1.88).

Discussion

Opioid fatality was associated with indicators of low SES. The findings may help to target prevention, treatment and rehabilitation efforts to vulnerable groups.

Klíčová slova:

Census – Death rates – Health insurance – Hispanic people – Housing – Opioids – Schools – Socioeconomic aspects of health


Zdroje

1. Hedegaard H, Miniño AM, Warner M. Drug Overdose Deaths in the United States, 1999–2017. NCHS Data Brief. 2018;329: 1–8.

2. Dasgupta N, Beletsky L, Ciccarone D. Opioid Crisis: No Easy Fix to Its Social and Economic Determinants. Am J Public Health. 2018;108: 182–186. doi: 10.2105/AJPH.2017.304187 29267060

3. Dowell D, Arias E, Kochanek K, Anderson R, Guy GP Jr, Losby JL, et al. Contribution of Opioid-Involved Poisoning to the Change in Life Expectancy in the United States, 2000–2015. JAMA. 2017;318: 1065–1067. doi: 10.1001/jama.2017.9308 28975295

4. Case A, Deaton A. “Mortality and Morbidity in the 21st Century.” Brookings Papers on Economic Activity, Spring 2017.

5. Masters RK, Tilstra AM, Simon DH. Explaining recent mortality trends among younger and middle-aged White Americans. Int J Epidemiol. 2018;47: 81–88. doi: 10.1093/ije/dyx127 29040539

6. Muennig PA, Reynolds M, Fink DS, Zafari Z, Geronimus AT. America's Declining Well-Being, Health, and Life Expectancy: Not Just a White Problem. Am J Public Health. 2018;108: 1626–1631. doi: 10.2105/AJPH.2018.304585 30252522

7. Ruhm CJ. Geographic Variation in Opioid and Heroin Involved Drug Poisoning Mortality Rates. Am J Prev Med. 2017;53: 745–753. doi: 10.1016/j.amepre.2017.06.009 28797652

8. Hedegaard H, Miniño AM, Warner M. Urban–rural Differences in Drug Overdose Death Rates, by Sex, Age, and Type of Drugs Involved, 2017. NCHS Data Brief 2019; No. 345. 31442197

9. Woolf SH, Schoomaker H. Life Expectancy and Mortality Rates in the United States, 1959–2017. JAMA. 2019;322(20):1996–2016 doi: 10.1001/jama.2019.16932 31769830

10. Martins SS, Sampson L, Cerdá M, Galea S. Worldwide Prevalence and Trends in Unintentional Drug Overdose: A Systematic Review of the Literature. Am J Public Health 2015;105: 2373–2393. doi: 10.2105/AJPH.2015.302843a 26451757

11. Lanier WA, Johnson EM, Rolfs RT, Friedrichs MD, Grey TC. Risk factors for prescription opioid-related death, Utah, 2008–2009. Pain Med. 2012;13: 1580–1589. doi: 10.1111/j.1526-4637.2012.01518.x 23137228

12. Monnat SM. Factors Associated With County-Level Differences in U.S. Drug-Related Mortality Rates. Am J Prev Med. 2018;54: 611–619. doi: 10.1016/j.amepre.2018.01.040 29598858

13. U. S. Census Bureau. American Community Survey. Available from: https://www.census.gov/acs

14. Bohnert ASB, Ilgen MA. Understanding Links among Opioid Use, Overdose, and Suicide. NEJM 2019;380: 71–79. doi: 10.1056/NEJMra1802148 30601750

15. U.S. Census Bureau. Mortality Disparities in American Communities (MDAC). Available from: https://www.census.gov/mdac

16. Centers for Disease Control and Prevention, National Center for Health Statistics. National Death Index. Available from: https://www.cdc.gov/nchs/ndi/index.htm

17. International Classification of Diseases, 10th Revision (ICD-10). Stylus Publishing, LLC, 22883 Quicksilver Drive, P.O. Box 605, Herndon, VA 20172–605

18. Cox DR. Regression models and life-tables. J R Stat Soc Ser B (Methodol). 1972;34: 187–220.

19. Meara ER, Richards S, Cutler DM. The gap gets bigger: changes in mortality and life expectancy, by education, 1981–2000. Health Aff (Millwood). 2008;27: 350–360.

20. Ratcliffe M, Burd C, Holder K, Fields A. Defining Rural at the U.S. Census Bureau. American Community Survey and Geography Brief. December 2018. Available from: https://www.census.gov

21. Census Bureau. Census Regions and Divisions of the United States. Available from: https://www.census.gov

22. Ho JY, Hendi AS. Recent trends in life expectancy across high income countries: retrospective observational study. BMJ. 2018;362: k2562 doi: 10.1136/bmj.k2562 30111634

23. Hedegaard H, Warner M, Minino AM. Drug Overdose Deaths in the United States, 1999–2015. NCHS Data Brief. 2017;273: 1–8.

24. Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health. Ann Intern Med. 2017; 167: 293–301. doi: 10.7326/M17-0865 28761945

25. Stoicea N, Costa A, Periel L, Uribe A, Weaver T, Bergese SD. Current perspectives on the opioid crisis in the US healthcare system: A comprehensive literature review. Medicine (Baltimore). 2019;98: e15425. doi: 10.1097/MD.0000000000015425 31096439

26. Blanco C, Volkow ND. Management of opioid use disorder in the USA: present status and future directions. Lancet. 2019;393: 1760–1772. doi: 10.1016/S0140-6736(18)33078-2 30878228

27. Abrecht CR, Brovman EY, Greenberg P, Song E, Rathmell JP, Urman RD. A Contemporary Medicolegal Analysis of Outpatient Medication Management in Chronic Pain. Anesth Analg. 2017;125: 1761–1768. doi: 10.1213/ANE.0000000000002499 29049120

28. Economic Innovation Group. Escape Velocity: How elite communities are pulling away in the 21st century race for jobs, businesses, and human capital. Available from: www.eig.org.

29. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. MMWR. Recommendations and Reports. 65:1;1–49. doi: 10.15585/mmwr.rr6501e1 26987082

30. Kroenke K, Alford DP, Argoff C, Canlas B, Covington E, Frank JW, et al. Challenges with Implementing the Centers for Disease Control and Prevention Opioid Guideline: A Consensus Panel Report. Pain Med. 2019;20:724–735. doi: 10.1093/pm/pny307 30690556

31. Dowell D, Haegerich T, Chou R. No Shortcuts to Safer Opioid Prescribing. N Engl J Med. 2019;380:2285–2287. doi: 10.1056/NEJMp1904190 31018066

32. National Academies of Sciences, Engineering, and Medicine. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press. 2019.

33. Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999–2010. JAMA Intern Med. 2014;174: 1668–73. doi: 10.1001/jamainternmed.2014.4005 25154332

34. Day BF, Rosenthal GL. Social isolation proxy variables and prescription opioid and benzodiazepine misuse among older adults in the U.S.: A cross-sectional analysis of data from the National Survey on Drug Use and Health, 2015–2017. Drug Alcohol Depend. 2019;204: 107518. doi: 10.1016/j.drugalcdep.2019.06.020 31494444

35. Lo CC, Cheng TC, Simpson GM. Marital status and work-related health limitation: a longitudinal study of young adult and middle-aged Americans. Int Journal Public Health. 2016;61: 91–100.

36. McLean K. "There's nothing here": Deindustrialization as risk environment for overdose. Int J Drug Policy. 2016;29: 19–26. doi: 10.1016/j.drugpo.2016.01.009 26868674

37. Hollingsworth A, Ruhm CJ, Simon K. Macroeconomic conditions and opioid abuse. J Health Econ. 2017;56: 222–233. doi: 10.1016/j.jhealeco.2017.07.009 29128677

38. Johnson EM, Lanier WA, Merrill RM, Crook J, Porucznik CA, Rolfs RT, et al. Unintentional prescription opioid-related overdose deaths: description of decedents by next of kin or best contact, Utah, 2008–2009. J Gen Intern Med. 2013;28: 522–529. doi: 10.1007/s11606-012-2225-z 23070654

39. Martins SS, Kim JH, Chen LY, Levin D, Keyes KM, Cerdá M, et al. Nonmedical prescription drug use among US young adults by educational attainment. Soc Psychiatry Psychiatr Epidemiol. 2015;50: 713–724. doi: 10.1007/s00127-014-0980-3 25427665

40. Schepis TS, Teter CJ, McCabe SE. Prescription drug use, misuse and related substance use disorder symptoms vary by educational status and attainment in U.S. adolescents and young adults. Drug Alcohol Depend. 2018;189: 172–177. doi: 10.1016/j.drugalcdep.2018.05.017 29960204

41. Arias E, Eschbach K, Schauman W, Backlund EL, Sorlie PD. The Hispanic Mortality Advantage and Ethnic Misclassification on US Death Certificates. Am J Public Health. 2010; 100: S171–177. doi: 10.2105/AJPH.2008.135863 19762677

42. Caetano R, Vaeth PA, Mills B, Canino G. Employment status, depression, drinking, and alcohol use disorder in Puerto Rico. Alcohol Clin Exp Res. 2016;40: 806–815. doi: 10.1111/acer.13020 27038594

43. Caetano R, Vaeth PA, Canino G. Family cohesion and pride, drinking and alcohol use disorder in Puerto Rico. Am J Drug Alcohol Abuse. 2017;43: 87–94 doi: 10.1080/00952990.2016.1225073 27808561

44. Cano MA, Sánchez M, Rojas P, Ramírez-Ortiz D, Polo KL, Romano E, et al. Alcohol Use Severity among Adult Hispanic Immigrants: Examining the Roles of Family Cohesion, Social Support, and Gender. Subst Use Misuse. 2018;53: 668–676. doi: 10.1080/10826084.2017.1356333 28910173

45. Ellaway E, Macintyre S. Does housing tenure predict health in the UK because it exposes people to different levels of housing-related hazards in the home or its surroundings? Health & Place. 1998;4: 141–150.

46. Miranda PY, Reyes A, Hudson D, Yao N, Bleser WK, Snipes SA, et al. Reports of self-rated health by citizenship and homeownership, United States 2000–2010. Prev Med. 2017;100: 3–9. doi: 10.1016/j.ypmed.2017.03.006 28322883

47. Willison C. Shelter from the Storm: Roles, responsibilities, and challenges in United States housing policy governance. Health Policy. 2017;121: 1113–1123. doi: 10.1016/j.healthpol.2017.08.002 28851590

48. Wagner KD, Valente TW, Casanova M, Partovi SM, Mendenhall BM, Hundley JH, et al. Evaluation of an overdose prevention and response training programme for injection drug users in the Skid Row area of Los Angeles, CA. Int J Drug Policy. 2010;21: 186–193. doi: 10.1016/j.drugpo.2009.01.003 19268564

49. Linton SL, Haley DF, Hunter-Jones J, Ross Z, Cooper HLF. Social causation and neighborhood selection underlie associations of neighborhood factors with illicit drug-using social networks and illicit drug use among adults relocated from public housing. Soc Sci Med. 2017;185: 81–90. doi: 10.1016/j.socscimed.2017.04.055 28554162

50. Paulozzi LJ, Xi Y. Recent changes in drug poisoning mortality in the United States by urban-rural status and by drug type. Pharmacoepidemiol. Drug Saf. 2008;17: 997–1005. doi: 10.1002/pds.1626 18512264

51. Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths—United States, 2010–2015. Morb. Mortal. Rep. Surveill. Summ., 2016;65: 1445–1452.

52. Pear VA, Ponicki WR, Gaidus A, Keyes KM, Martins SS, Fink DS, et al. Urban-rural variation in the socioeconomic determinants of opioid overdose. Drug Alcohol Depend. 2019;195: 66–73. doi: 10.1016/j.drugalcdep.2018.11.024 30592998

53. Rigg KK, Monnat SM. Urban vs. rural differences in prescription opioid misuse among adults in the United States: informing region specific drug policies and interventions. Int J Drug Policy. 2015;26: 484–491. doi: 10.1016/j.drugpo.2014.10.001 25458403

54. Kiang MV, Basu S, Chen J, Alexander MJ. Assessment of Changes in the Geographical Distribution of Opioid-Related Mortality Across the United States by Opioid Type, 1999–2016. JAMA Network Open. 2019;2: e190040. doi: 10.1001/jamanetworkopen.2019.0040 30794299

55. Smith DE. Medicalizing the Opioid Epidemic in the U.S. in the Era of Health Care Reform. J Psychoactive Drugs. 2017;49: 95–101. doi: 10.1080/02791072.2017.1295334 28296623

56. Preuss CV, Kalava A, King KC. Prescription of Controlled Substances: Benefits and Risks. StatPearls [Internet]. 2019. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537318/

57. Orgera K, Tolbert J. Key Facts about Uninsured Adults with Opioid Use Disorder. Available from: https://www.kff.org,

58. Centers for Disease Control and Prevention. CDC in Action: 2018. Response to the Opioid Crisis. Available from: www.cdc.gov.

59. Kroelinger CD, Rice ME, Cox S, Hickner HR, Weber MK, Romero L, et al. State Strategies to Address Opioid Use Disorder Among Pregnant and Postpartum Women and Infants Prenatally Exposed to Substances, Including Infants with Neonatal Abstinence Syndrome. MMWR Morb Mortal Wkly Rep. 2019;68:777–783. doi: 10.15585/mmwr.mm6836a1 31513558

60. Hagan J, Foster H. Imprisonment, opioids and health care reform: The failure to reach a high-risk population. Prev Med. 2019: 105897. doi: 10.1016/j.ypmed.2019.105897 31765710

61. Binswanger IA, Stern MF, Yamashita TE, Mueller SR, Baggett TP, Blatchford PJ. Clinical risk factors for death after release from prison in Washington State: a nested case–control study. Addiction. 2016;111, 499–510 doi: 10.1111/add.13200 26476210

62. Brinkley-Rubinstein L, Macmadu A, Marshall BDL, Heise A, Ranapurwala SI, Rich JD, et al. Risk of fentanyl-involved overdose among those with past year incarceration: Findings from a recent outbreak in 2014 and 2015. Drug Alcohol Depend. 2018;185: 189–191. doi: 10.1016/j.drugalcdep.2017.12.014 29459328

63. Imtiaz S, Probst C, Rehm J. Substance use and population life expectancy in the USA: Interactions with health inequalities and implications for policy. Drug Alcohol Rev. 2018;37 Suppl 1: S263–S267. doi: 10.1111/dar.12616 29737615

64. Pitt AL, Humphreys K, Brandeau ML. Modeling Health Benefits and Harms of Public Policy Responses to the US Opioid Epidemic. Am J Public Health. 2018;108: 1394–1400. doi: 10.2105/AJPH.2018.304590 30138057

65. Bozinoff N, Anderson BJ, Bailey GL, Stein MD. Correlates of stigma severity among persons seeking opioid detoxification. J Addict Med. 2018;12: 19–23. doi: 10.1097/ADM.0000000000000355 28885299

66. Smith Sehdev AE, Hutchins GM. Problems with proper completion and accuracy of the cause-of-death statement. Arch Intern Med. 2001;161: 277–84. doi: 10.1001/archinte.161.2.277 11176744


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