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Zheng H, Lu Y, Yao M. Emerging health disparities among college graduates: Understanding the health consequences of education-occupation mismatch. SOCIAL SCIENCE RESEARCH 2024; 120:103015. [PMID: 38763535 DOI: 10.1016/j.ssresearch.2024.103015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 05/21/2024]
Abstract
This study examines the health consequences and underlying pathways of education-occupation mismatch. Using a longitudinal sample of college graduates from the Panel Studies of Income Dynamics (1984-2019) and employing longitudinal hybrid models, we found that contemporary vertical mismatch (between education level and educational requirements of occupation) was associated with poorer psychological well-being and bio-behaviors (obesity and smoking), but not physical health. In contrast, horizontal mismatch (between field of study and field required for occupation) did not show clear health consequences. Sequence analysis was employed to uncover the mismatch trajectories and revealed that persistent vertical mismatch over one's career had a greater impact on psychological distress and smoking than episodic mismatch experiences. Furthermore, the linkage between vertical mismatch and health outcomes was likely shaped by psychosocial processes rather than reduced material well-being. These findings imply that education-occupation vertical (mis)match produces health disparities between occupationally matched and mismatched college graduates.
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Affiliation(s)
- Hui Zheng
- Department of Sociology, Institute for Population Research, The Ohio State University, USA; Department of Sociology, Research Hub of Population Studies, University of Hong Kong, China.
| | - Yao Lu
- Department of Sociology, Columbia Population Research Center, Columbia University, USA
| | - Man Yao
- Department of Sociology, Institute for Population Research, The Ohio State University, USA
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Root L, Stevenson AJ, Genadek K, Yeatman S, Mollborn S, Menken J. U.S. Fertility in Life Course Context: A Research Note on Using Census-Held Linked Administrative Records for Geographic and Sociodemographic Subgroup Estimation. Demography 2024; 61:251-266. [PMID: 38506313 PMCID: PMC11108098 DOI: 10.1215/00703370-11234861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Fertility is a life course process that is strongly shaped by geographic and sociodemographic subgroup contexts. In the United States, scholars face a choice: they can situate fertility in a life course perspective using panel data, which is typically representative only at the national level; or they can attend to subnational contexts using rate schedules, which do not include information on life course statuses. The method and data source we introduce here, Census-Held Linked Administrative Records for Fertility Estimation (CLAR-FE), permits both. It derives fertility histories and rate schedules from U.S. Census Bureau-held data for the nation and by state, racial and ethnic subgroups, and the important life course status of parity. We generate three types of rates for 2000-2020 at the national and state levels by race and ethnicity: age-specific rates and both unconditional and conditional parity- and age-specific rates. Where possible, we compare these rates with those produced by the National Center for Health Statistics. Our new rate schedules illuminate state and racial and ethnic differences in transitions to parenthood, providing evidence of the important subgroup heterogeneity that characterizes the United States. CLAR-FE covers nearly the entire U.S. population and is available to researchers on approved projects through the Census Bureau's Federal Statistical Research Data Centers.
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Affiliation(s)
- Leslie Root
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
| | - Amanda Jean Stevenson
- Department of Sociology and Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
| | - Katie Genadek
- U.S. Census Bureau, Suitland, MD, USA
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
| | - Sara Yeatman
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA
| | - Stefanie Mollborn
- Department of Sociology, Stockholm University, Stockholm, Sweden
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
| | - Jane Menken
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
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Zheng H, Choi Y. Reevaluating the "deaths of despair" narrative: Racial/ethnic heterogeneity in the trend of psychological distress-related death. Proc Natl Acad Sci U S A 2024; 121:e2307656121. [PMID: 38315821 PMCID: PMC10895366 DOI: 10.1073/pnas.2307656121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 11/02/2023] [Indexed: 02/07/2024] Open
Abstract
Despite the significant scientific advancement in deciphering the "deaths of despair" narrative, most relevant studies have focused on drug-, alcohol-, and suicide-related (DAS) deaths. This study directly investigated despair as a determinant of death and the temporal variation and racial heterogeneity among individuals. We used psychological distress (PD) as a proxy for despair and drew data from the US National Health Interview Survey-Linked Mortality Files 1997 to 2014, CDC (Centers for Disease Control and Prevention) Multiple Cause of Death database 1997 to 2014, CDC bridged-race population files 1997 to 2014, Current Population Survey 1997 to 1999, and the American Community Survey 2000 to 2014. We used Cox proportional hazards models to estimate mortality hazard ratios of PD and compared age-standardized PD- and DAS-related mortality rates by race/ethnicity and over time. We found that while Whites had a lower prevalence of PD than Blacks and Hispanics throughout the whole period, they underwent distinctive increases in PD-related death and have had a higher PD-related mortality rate than Blacks and Hispanics since the early 2000s. This was predominantly due to Whites' relatively high and increasing vulnerability to PD less the prevalence of PD. Furthermore, PD induced a more pervasive mortality consequence than DAS combined for Whites and Blacks. In addition, PD- and DAS-related deaths displayed a concordant trend among Whites but divergent patterns for Blacks and Hispanics. These findings suggest that 1) DAS-related deaths underestimated the mortality consequence of despair for Whites and Blacks but overestimated it for Hispanics; and 2) despair partially contributed to the DAS trend among Whites but probably not for Blacks and Hispanics.
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Affiliation(s)
- Hui Zheng
- Department of Sociology, Institute for Population Research, The Ohio State University, Columbus, OH43210
- Department of Sociology, Research Hub of Population Studies, The University of Hong Kong, Hong Kong SAR
| | - Yoonyoung Choi
- Department of Sociology, Institute for Population Research, The Ohio State University, Columbus, OH43210
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Okobi OE, Akueme NT, Ugwu AO, Ebong IL, Osagwu N, Opiegbe L, Folorunsho IL, Mbah LA, Ude GI, Khan A, Leszkowitz D. Epidemiological Trends and Factors Associated With Mortality Rate in Psychoactive Substance Use-Related Mental and Behavioral Disorders: A CDC-WONDER Database Analysis. Cureus 2023; 15:e49647. [PMID: 38161954 PMCID: PMC10756164 DOI: 10.7759/cureus.49647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Background The persisting challenge of substance use disorder's impact on society prompts the need for insights into its mortality trends. This study examines epidemiological patterns and factors tied to mortality rates in individuals with psychoactive substance-related mental and behavioral disorders from 1999 to 2020. Methodology This study used a retrospective observational design. The study analyzed the Centers for Disease Control and Prevention's (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database information, encompassing mortality and population-based data. Data extraction focused on specific criteria such as age, sex, race/ethnicity, and geographic location. Descriptive statistics were employed to depict the study population and reveal epidemiological trends. Results The study encompassed data from 239,573 individuals who died due to psychoactive substance use-related mental and behavioral disorders between 1999 and 2020. The overall mortality rate was 3.55 per 100,000 individuals (95% confidence interval (CI) = 3.55-3.54) across the study period. Noticeable discrepancies in mortality rates emerged among various geographic regions, genders, races, and age groups. Males (5.32 per 100,000 individuals) experienced notably higher mortality rates than females (1.80 per 100,000 individuals), while the 55-64 age group faced elevated mortality risks (8.24 per 100,000 individuals) compared to the 25-34 age group (1.71 per 100,000 individuals). Significant variations in mortality rates were also evident across different racial and ethnic groups. Conclusions Between 1999 and 2020, the study explored mortality rates in individuals with psychoactive substance use-related mental and behavioral disorders. This analysis revealed variations in mortality across genders, ages (with the 55-64 age group facing higher risks compared to the 25-34 age group), and ethnicities. Notably, males exhibited higher mortality than females. Additionally, divergent rates were observed among different geographic regions. These insights can inform public health initiatives and support the development of targeted strategies to reduce mortality rates and improve the well-being of affected individuals.
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Affiliation(s)
- Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Ngozi T Akueme
- Dermatology, University of Medical Sciences (UNIMED), Ondo State, NGA
| | | | - Imoh L Ebong
- Internal Medicine, University of Ghana School of Medicine and Dentistry, Accra, GHA
| | - Nnena Osagwu
- Department of Medicine, All Saints University School of Medicine, Roseau, DMA
| | | | | | - Linda A Mbah
- Internal Medicine, International American University College of Medicine, Vieux Fort, LCA
| | - Gabriel I Ude
- Family Medicine, Federal Medical Centre, Jabi Abuja, Abuja, NGA
| | - Ambar Khan
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | - David Leszkowitz
- Substance Use and Addiction, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
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Powell D. Educational Attainment and US Drug Overdose Deaths. JAMA HEALTH FORUM 2023; 4:e233274. [PMID: 37801307 PMCID: PMC10559184 DOI: 10.1001/jamahealthforum.2023.3274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/02/2023] [Indexed: 10/07/2023] Open
Abstract
Importance 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. Objective 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. Exposure 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. Main Outcomes and Measures The main outcomes were rates of all overdose deaths, overdose deaths involving opioids, and overdose deaths involving synthetic opioids. Results 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. Conclusions and Relevance 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.
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Ho JY. Life Course Patterns of Prescription Drug Use in the United States. Demography 2023; 60:1549-1579. [PMID: 37728437 PMCID: PMC10656114 DOI: 10.1215/00703370-10965990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Prescription drug use has reached historic highs in the United States-a trend linked to increases in medicalization, institutional factors relating to the health care and pharmaceutical industries, and population aging and growing burdens of chronic disease. Despite the high and rising prevalence of use, no estimates exist of the total number of years Americans can expect to spend taking prescription drugs over their lifetimes. This study provides the first estimates of life course patterns of prescription drug use using data from the 1996-2019 Medical Expenditure Panel Surveys, the Human Mortality Database, and the National Center for Health Statistics. Newborns in 2019 could be expected to take prescription drugs for roughly half their lives: 47.54 years for women and 36.84 years for men. The number of years individuals can expect to take five or more drugs increased substantially. Americans also experienced particularly dramatic increases in years spent taking statins, antihypertensives, and antidepressants. There are also important differences in prescription drug use by race and ethnicity: non-Hispanic Whites take the most, Hispanics take the least, and non-Hispanic Blacks fall in between these extremes. Americans are taking drugs over a wide and expanding swathe of the life course, a testament to the centrality of prescription drugs in Americans' lives today.
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Affiliation(s)
- Jessica Y Ho
- Department of Sociology and Criminology, and Population Research Institute, The Pennsylvania State University, University Park, PA, USA
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Cano M, Mendoza N, Ignacio M, Rahman A, Daniulaityte R. Overdose deaths involving synthetic opioids: Racial/ethnic and educational disparities in the eastern and western US. Drug Alcohol Depend 2023; 251:110955. [PMID: 37699286 DOI: 10.1016/j.drugalcdep.2023.110955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/17/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND This study examined racial/ethnic and educational disparities in US synthetic opioid overdose mortality East and West of the Mississippi River. METHODS Using restricted-access 2018-2021 mortality data from the Centers for Disease Control and Prevention and population estimates from the American Community Survey, age-standardized rate ratios (SRRs) and 95% Confidence Intervals (CIs) were used to compare rates of synthetic opioid mortality by race/ethnicity and educational attainment level in the regions East and West of the Mississippi River. RESULTS Racial/ethnic disparities in synthetic opioid mortality rates, relative to the Non-Hispanic (NH) White population, were observed in the NH Black (SRR, 1.5 [95% CI, 1.5-1.6]) and NH American Indian/Alaska Native (SRR, 2.1 [95% CI, 1.9-2.2]) populations in the West, and the Puerto Rican (SRR, 1.3 [95% CI, 1.3-1.3]) and NH American Indian/Alaska Native (SRR, 1.5 [95% CI, 1.4-1.6]) populations in the East. Relative to those with a Bachelor's degree or higher: in the West, the synthetic opioid mortality rate was more than seven times as high for those with a high school diploma only (SRR 7.7 [95% CI, 7.4-8.0]), and in the East, approximately thirteen times as high for those with a high school diploma only (SRR, 13.0 [95% CI, 12.7-13.3]) or less than a high school diploma (SRR, 13.3 [95% CI, 13.0-13.7]). CONCLUSION Disparities in rates of synthetic opioid mortality differ in the eastern and western US, supporting tailored responses within each region.
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Affiliation(s)
- Manuel Cano
- School of Social Work, Arizona State University, Phoenix, AZ, USA.
| | - Natasha Mendoza
- School of Social Work, Arizona State University, Phoenix, AZ, USA
| | - Matt Ignacio
- School of Social Work, Arizona State University, Tucson, AZ, USA
| | - Abir Rahman
- Cabell-Huntington Health Department, Huntington, WV, USA
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Kelly BC, Vuolo M. Trends in Psychotropic Drug-Implicated Cardiovascular Mortality: Patterns in U.S. Mortality, 1999-2020. Am J Prev Med 2023; 65:377-384. [PMID: 36894483 PMCID: PMC10440260 DOI: 10.1016/j.amepre.2023.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Psychotropic drug-implicated (PDI) mortality-deaths in which psychotropic drugs were a contributing but not underlying cause of death-increased over two decades, with circulatory mortality as the primary cause leading to such deaths. Trends in PDI circulatory mortality over a 22-year period and its patterning in U.S. deaths are described. METHODS Deaths extracted from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research Multiple Causes of Death database from 1999 to 2020 were analyzed to generate annual counts and rates for drug-implicated deaths due to diseases of the circulatory system, including by specific drug, sex, race/ethnicity, age, and state. RESULTS During a period when overall age-adjusted circulatory mortality rates declined, PDI circulatory mortality more than doubled, from 0.22 per 100,000 in 1999 to 0.57 per 100,000 by 2020, now representing 1 in 444 circulatory deaths. Although PDI deaths from ischemic heart diseases are proportionally aligned with overall circulatory deaths (50.0% vs 48.5%), PDI deaths from hypertensive diseases represent a larger proportion (19.8% vs 8.0%). Psychostimulants generated the greatest escalation for PDI circulatory deaths (0.029-0.332 per 100,000). The sex gap in PDI mortality rates widened (0.291 females, 0.861 males). PDI circulatory mortality is particularly notable for Black Americans and midlife Americans, with considerable geographic variability. CONCLUSIONS Circulatory mortality with psychotropic drugs as a contributing cause escalated over 2 decades. Trends in PDI mortality are not evenly distributed across the population. Greater engagement with patients about their substance use is needed to intervene in cardiovascular deaths. Prevention and clinical intervention could contribute to reinvigorating previous trends of declining cardiovascular mortality.
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Affiliation(s)
- Brian C Kelly
- Department of Sociology, College of Liberal Arts, Purdue University, West Lafayette, Indiana
| | - Mike Vuolo
- Department of Sociology, College of Arts and Sciences, The Ohio State University, Columbus, Ohio.
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Junge JM, Murray H, Goldman AH, Booth GJ, Balazs GC. Oral opioid prescribing to active duty US military personnel: a cross-sectional population. Reg Anesth Pain Med 2023:rapm-2023-104495. [PMID: 37507224 DOI: 10.1136/rapm-2023-104495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION While civilian opioid prescriptions have seen a dramatic decline in recent years, there are few studies investigating trends in opioid prescription in the active duty military population. We evaluated oral opioid prescribing patterns to active duty military personnel in the Military Health System (MHS) from 2017 to 2020 to determine the incidence of opioid prescriptions as well as demographic and military-specific risk factors for receiving an oral opioid prescription. METHODS The MHS Data Repository was queried from 2017 to 2020 to identify all outpatient oral opioid prescriptions to active duty military personnel in August of each year as well as demographic information on the study population. Data were evaluated in a logistic regression model, and ORs of receiving an oral opioid prescription were calculated for each factor. RESULTS The proportion of active duty military personnel receiving an oral opioid prescription declined from 2.71% to 1.26% (53% relative reduction) over the study period. Within the logistic regression model, female military personnel were significantly more likely to receive opioid prescriptions compared with men, and there was a stepwise increase in likelihood of an opioid prescription with increasing age. Army and Marine personnel, personnel without a history of military deployment and those stationed within the continental USA were significantly more likely to receive an opioid prescription. DISCUSSION The substantial decrease in oral opioid prescriptions to active duty military personnel mirrors data published in the civilian community. The identified risk factors for receiving an opioid prescription may be potential targets for future interventions to further decrease prescribing.
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Affiliation(s)
- Joshua M Junge
- Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
- Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Naval Biotechnology Group, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Hailey Murray
- Family Medicine, US Naval Hospital Jacksonville, Jacksonville, Florida, USA
| | - Ashton H Goldman
- Bone & Joint Sports Medicine Institute, Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Gregory J Booth
- Department of Anesthesiology and Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
- Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Naval Biotechnology Group, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - George C Balazs
- Bone & Joint Sports Medicine Institute, Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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van Draanen J, Jamula R, Karamouzian M, Mitra S, Richardson L. Pathways connecting socioeconomic marginalization and overdose: A qualitative narrative synthesis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 113:103971. [PMID: 36822011 DOI: 10.1016/j.drugpo.2023.103971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE This qualitative narrative synthesis sought to identify pathways connecting socioeconomic marginalization (SEM) and overdose for people who use drugs. METHODS We included studies with qualitative examination of SEM and fatal and non-fatal overdose published in English between 2000 and 2021. Studies were systematically identified and screened by searching MEDLINE (Ovid), Embase (Ovid), PsycINFO (EBSCOhost), CINAHL (EBSCOhost), Google Scholar, Cochrane Central Registry of Controlled Trials (CENTRAL), and Cochrane Drug and Alcohol Group (CDAG) Specialized Registry, citations, and contacting experts. Risk of bias and quality assessments were performed using the Critical Appraisal Skills Programme checklist and the Confidence in the Evidence from Reviews of Qualitative Research approach. Data were synthesized using a thematic synthesis approach. RESULTS The primary search strategy found 5909 articles that met the initial screening criteria. The review and screening process led to a final dataset of 27 qualitative articles. The four key findings of this narrative synthesis revealed aspects of SEM which shaped drug poisoning risk for people who use drugs: (1) resource insufficiency, labor market exclusion and deindustrialization, (2) homelessness and housing, (3) policing, criminalization, and interactions with emergency services, and (4) gendered and racialized dimensions of inequality. Findings led to creating a typology that includes material, behavioral, psychological, social, and environmental pathways that contain multiple mechanisms connecting SEM to overdose. This review revealed reciprocal connections between overdose and SEM via institutional pathways with reinforcing mechanisms, and interrelationships present within and between pathways. Quality assessments indicated moderate confidence in three of four findings (Findings 2,3, and 4 above) and high confidence in one finding (Finding 1). CONCLUSION SEM is strongly linked to drug poisoning, and the mechanisms establishing these connections can be classified within four pathways. The interconnectedness of these mechanisms can lead to intensification of overdose risk and reinforcement of SEM itself.
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Affiliation(s)
- Jenna van Draanen
- BC Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Faculty of Arts, Department of Sociology, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada; Department of Child, Family, and Population Health Nursing; School of Nursing; University of Washington, Seattle, WA, USA; Department of Health Systems and Population Health; School of Public Health; University of Washington, Seattle, WA, USA
| | - Ryan Jamula
- BC Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Faculty of Arts, Department of Sociology, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada
| | - Mohammad Karamouzian
- BC Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Brown School of Public Health, Brown University, 121 S Main St, Providence, RI, 02903, USA; HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616913555, Iran; Centre On Drug Policy Evaluation, St. Michael's Hospital, Toronto, ON, Canada
| | - Sanjana Mitra
- BC Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Interdisciplinary Studies Graduate Program, 270, 2357 Main Mall, H. R. MacMillan Building, Vancouver, BC, V6T 1Z4, Canada; Centre On Drug Policy Evaluation, St. Michael's Hospital, Toronto, ON, Canada
| | - Lindsey Richardson
- BC Centre on Substance Use, 400 - 1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Faculty of Arts, Department of Sociology, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada.
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Lee JH, Wheeler DC, Zimmerman EB, Hines AL, Chapman DA. Urban-Rural Disparities in Deaths of Despair: A County-Level Analysis 2004-2016 in the U.S. Am J Prev Med 2023; 64:149-156. [PMID: 38584644 PMCID: PMC10997338 DOI: 10.1016/j.amepre.2022.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction The purpose of this study is to examine nationwide disparities in drug, alcohol, and suicide mortality; evaluate the association between county-level characteristics and these mortality rates; and illustrate spatial patterns of mortality risk to identify areas with elevated risk. Methods The authors applied a Bayesian spatial regression technique to investigate the association between U.S. county-level characteristics and drug, alcohol, and suicide mortality rates for 2004-2016, accounting for spatial correlation that occurs among counties. Results Mortality risks from drug, alcohol, and suicide were positively associated with the degree of rurality, the proportion of vacant housing units, the population with a disability, the unemployed population, the population with low access to grocery stores, and the population with no health insurance. Conversely, risks were negatively associated with Hispanic population, non-Hispanic Black population, and population with a bachelor's degree or higher. Conclusions Spatial disparities in drug, alcohol, and suicide mortality exist at the county level across the U.S. social determinants of health; educational attainment, degree of rurality, ethnicity, disability, unemployment, and health insurance status are important factors associated with these mortality rates. A comprehensive strategy that includes downstream interventions providing equitable access to healthcare services and upstream efforts in addressing socioeconomic conditions is warranted to effectively reduce these mortality burdens.
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Affiliation(s)
- Jong Hyung Lee
- Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia
| | - David C. Wheeler
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Emily B. Zimmerman
- Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Anika L. Hines
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia
| | - Derek A. Chapman
- Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Virginia Commonwealth University, Richmond, Virginia
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Cano M, Salas-Wright CP, Oh S, Noel L, Hernandez D, Vaughn MG. Socioeconomic inequalities and Black/White disparities in US cocaine-involved overdose mortality risk. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2023-2035. [PMID: 35249125 DOI: 10.1007/s00127-022-02255-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/18/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study examined whether socioeconomic inequalities account for Black/White disparities in: (a) the prevalence of potential risk factors for overdose among adults using cocaine; and (b) national mortality rates for cocaine-involved overdose. METHODS Data from 2162 Non-Hispanic (NH) Black or White adults (26 +) who reported past-year cocaine use in the 2015-2019 National Survey of Drug Use and Health were analyzed to obtain predicted probabilities of potential overdose risk factors by race and sex, using marginal effects via regression analyses, adjusting for age and socioeconomic indicators. Next, National Center for Health Statistics data (for 47,184 NH Black or White adults [26 +] who died of cocaine-involved overdose between 2015 and 2019) were used to calculate cocaine-involved overdose mortality rates by race and sex across age and educational levels. RESULTS Several potential overdose vulnerabilities were disproportionately observed among NH Black adults who reported past-year cocaine use: poor/fair overall health; cocaine use disorder; more days of cocaine use yearly; hypertension (for women); and arrests (for men). Adjusting for age and socioeconomic indicators attenuated or eliminated many of these racial differences, although predicted days of cocaine use per year (for men) and cocaine use disorder (for women) remained higher in NH Black than White adults. Cocaine-involved overdose mortality rates were highest in the lowest educational strata of both races; nonetheless, Black/White disparities were observed even at the highest level of education, especially for adults ages 50 + . CONCLUSION Age and socioeconomic characteristics may account for some, yet not all, of Black/White disparities in vulnerability to cocaine-involved overdose.
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Affiliation(s)
- Manuel Cano
- Department of Social Work, University of Texas at San Antonio, 501 W. César E. Chávez Blvd., San Antonio, TX, 78207, USA.
| | - Christopher P Salas-Wright
- School of Social Work, Boston College, 140 Commonwealth Ave, Chestnut Hill, MA, 02467, USA
- Department of Public Health Sciences, Division of Prevention Science & Community Health, University of Miami, Miami, FL, USA
| | - Sehun Oh
- College of Social Work, The Ohio State University, 1947 College Rd, Columbus, OH, 43210, USA
| | - Lailea Noel
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd, Austin, TX, 78712, USA
| | - Dora Hernandez
- Department of Social Work, University of Texas at San Antonio, 501 W. César E. Chávez Blvd., San Antonio, TX, 78207, USA
| | - Michael G Vaughn
- School of Social Work, St. Louis University, 3550 Lindell Blvd, St. Louis, MO, 63103, USA
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13
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Vuolo M, Frizzell LC, Kelly BC. Surveillance, Self-Governance, and Mortality: The Impact of Prescription Drug Monitoring Programs on U.S. Overdose Mortality, 2000-2016. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:337-356. [PMID: 35001700 DOI: 10.1177/00221465211067209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Policy mechanisms shaping population health take numerous forms, from behavioral prohibitions to mandates for action to surveillance. Rising drug overdoses undermined the state's ability to promote population-level health. Using the case of prescription drug monitoring programs (PDMPs), we contend that PDMP implementation highlights state biopower operating via mechanisms of surveillance, whereby prescribers, pharmacists, and patients perceive agency despite choices being constrained. We consider whether such surveillance mechanisms are sufficient or if prescriber/dispenser access or requirements for use are necessary for population health impact. We test whether PDMPs reduced overdose mortality while considering that surveillance may require time to reach effectiveness. PDMPs reduced opioid overdose mortality 2 years postimplementation and sustained effects, with similar effects for prescription opioids, benzodiazepines, and psychostimulants. Access or mandates for action do not reduce mortality beyond surveillance. Overall, PDMP effects on overdose mortality are likely due to self-regulation under surveillance rather than mandated action.
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Affiliation(s)
- Mike Vuolo
- The Ohio State University, Columbus, OH, USA
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14
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Monnat SM. Demographic and Geographic Variation in Fatal Drug Overdoses in the United States, 1999-2020. THE ANNALS OF THE AMERICAN ACADEMY OF POLITICAL AND SOCIAL SCIENCE 2022; 703:50-78. [PMID: 37366474 PMCID: PMC10292656 DOI: 10.1177/00027162231154348] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
The U.S. drug overdose crisis has been described as a national disaster that has affected all communities. But overdose rates are higher among some subpopulations and in some places than they are in others. This article describes demographic (sex, racial/ethnic, age) and geographic variation in fatal drug overdose rates in the United States from 1999 to 2020. Across most of that timespan, rates were highest among young and middle-age (25-54 years) White and American Indian males and middle-age and older (45+ years) Black males. Rates have been consistently high in Appalachia, but the crisis has spread to several other regions in recent years, and rates are high across the urban-rural continuum. Opioids have been the main contributor, but overdoses involving cocaine and psychostimulants have also increased dramatically in recent years, demonstrating that our problem is bigger than opioids. Evidence suggests that supply-side interventions are unlikely to be effective in reducing overdoses. I argue that the U.S. should invest in policies that address the upstream structural drivers of the crisis.
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Affiliation(s)
- Shannon M Monnat
- Lerner Chair in Public Health Promotion and Population Health, director of the Center for Policy Research, and professor of sociology at Syracuse University. Her research examines demographic and geographic variation in health and mortality, with emphasis over the past several years on explaining variation in drug overdose mortality
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15
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Short SE, Zacher M. Women's Health: Population Patterns and Social Determinants. ANNUAL REVIEW OF SOCIOLOGY 2022; 48:277-298. [PMID: 38765764 PMCID: PMC11101199 DOI: 10.1146/annurev-soc-030320-034200] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Women's health, and what we know about it, are influenced by social factors. From the exclusion of women's bodies in medical research, to the silence and stigma of menstruation and menopause, to the racism reflected in maternal mortality, the relevance of social factors is paramount. After a brief history of research on women's health, we review selected patterns, trends, and inequalities in US women's health. These patterns reveal US women's poor and declining longevity relative to those in other high-income countries, gaps in knowledge about painful and debilitating conditions that affect millions of women, and deep inequalities that underscore the need to redress political and structural features of US society that enhance health for some and diminish it for others. We close by describing the challenges and opportunities for future research, and the promise of a social determinants of health approach for advancing a multilevel, intersectional, and biosocial understanding of women's health.
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Affiliation(s)
- Susan E Short
- Department of Sociology, Brown University, Providence, Rhode Island, USA
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
| | - Meghan Zacher
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
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16
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Nikpour J, Broome M, Silva S, Allen KD. Patient demographics and clinical characteristics influence opioid and nonopioid pain management prescriptions of primary care NPs, PAs, and physicians. J Am Assoc Nurse Pract 2022; 34:883-890. [PMID: 35544348 PMCID: PMC10201565 DOI: 10.1097/jxx.0000000000000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Evidence exists on racial and gender disparities in chronic pain management among veterans. Most literature has described physicians' disparate opioid prescribing patterns, although it is unknown if prescribing disparities exist among nurse practitioners (NPs) and physician assistants (PAs) or among prescription of nonopioid analgesic strategies. PURPOSE To identify patient characteristics associated with opioid and nonopioid prescriptions among Veterans Affairs (VA) chronic pain patients by primary care physicians, NPs, and PAs. METHODOLOGY We used data from the VA's Survey of Health care Experience of Patients and Corporate Data Warehouse from October 2015 to September 2016. Outcomes included opioid and nonopioid analgesic prescriptions. Patient characteristics included race/ethnicity, gender, education level, age, and clinical characteristics (comorbidities, self-reported health, and self-reported mental health). Logistic regression was performed to test for associations of patient characteristics with outcomes. RESULTS Patients who were White, male, age 41-64 years, and with no postsecondary education had higher odds of receiving an opioid prescription (all p -values ≤ .01), whereas patients who were Black, female, and <65 years old had higher odds of a nonopioid prescription (all p -values < .01). Having 5+ comorbidities and fair/poor self-reported health increased the odds of opioid and nonopioid prescriptions (all p -values < .01). CONCLUSIONS Disparities in race, gender, and educational level significantly affect how primary care NPs, PAs, and physicians manage chronic pain. IMPLICATIONS NPs and other primary care providers should pursue training opportunities to identify and mitigate potential biases that may affect their practice. Future research should take an intersectional lens in examining the source of chronic pain disparities.
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Affiliation(s)
- Jacqueline Nikpour
- University of Pennsylvania School of Nursing, Durham Veterans Affairs Healthcare System, University of North Carolina-Chapel Hill
| | - Marion Broome
- Duke University School of Nursing, Durham Veterans Affairs Healthcare System, University of North Carolina-Chapel Hill
| | - Susan Silva
- Duke University School of Nursing, Durham Veterans Affairs Healthcare System, University of North Carolina-Chapel Hill
| | - Kelli D. Allen
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Healthcare System, University of North Carolina-Chapel Hill
- School of Medicine, University of North Carolina-Chapel Hill
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17
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Variation in US drug overdose mortality within and between Hispanic/Latine subgroups: A disaggregation of national data. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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18
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Abstract
Over the past two decades, opioid overdose deaths contributed to the dramatic rise in all-cause mortality among non-Hispanic Whites. To date, efforts among scholars to understand the role of local area labor market conditions on opioid overdose mortality have led to mixed results. We argue the reason for these disparate findings is scholars have not considered the moderating effects of income support policies such as unemployment insurance. The present study leverages two sources of variation-county mass layoffs and changes in the generosity of state unemployment insurance benefits-to investigate if unemployment benefits moderate the relationship between job loss and county opioid overdose death rates. Our difference-in-differences estimation strategy reveals that the harmful effects of job loss on opioid overdose mortality decline with increasing state unemployment insurance benefit levels. These findings suggest that social policy in the form of income transfers played a crucial role in disrupting the link between job loss and opioid overdose mortality.
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Affiliation(s)
- Pinghui Wu
- The Federal Reserve Bank of Boston, Boston, MA, USA
| | - Michael Evangelist
- Department of Sociology, School of Social Work, and Poverty Solutions, University of Michigan, Ann Arbor, MI, USA
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19
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Lam J, Vuolo M. Later-life transitions and changes in prescription medication use for pain and depression. BMC Geriatr 2022; 22:222. [PMID: 35300602 PMCID: PMC8931979 DOI: 10.1186/s12877-022-02921-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/09/2022] [Indexed: 11/28/2022] Open
Abstract
Background Over the past two decades, prescription medication use for pain and depression increased dramatically. Most studies consider the early life course, despite a similar increase among those in later life. In this paper, we examine whether and how later life transitions may relate to changes in medication use. Methods We draw on data from the Health and Retirement Study and fixed-effects models to examine whether work, family, and civic transitions in later life are related to changes in the usage of prescription pain and depression medication. Results Results show that individuals had higher odds of regularly using prescription pain and depression medications in periods when out of the labor market. Higher odds of depression medication use were also associated with periods of widowhood, and lower odds of use when frequently volunteering. Such relations persist adjusting for reported levels of pain and depression. Conclusion Our findings call attention to the importance of social ties and the presence of actors that may regulate health behaviors, as well as a change in social context, that may shape medication use in later life. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02921-y.
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Affiliation(s)
- Jack Lam
- Institute for Social Science Research, Life Course Centre - University of Queensland, Level 2, Cycad Building (1018), 80 Meiers Road, Indooroopilly, QLD, 4068, Australia.
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20
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Duan WR, Hand DJ. Association between opioid overdose death rates and educational attainment - United States, 2010-2019. Prev Med 2021; 153:106785. [PMID: 34506817 DOI: 10.1016/j.ypmed.2021.106785] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/30/2021] [Accepted: 09/04/2021] [Indexed: 10/20/2022]
Abstract
Educational attainment may be an indicator of disparities in the ongoing opioid-overdose crisis. To understand the association between educational attainment and fatal opioid overdose, death records in the mortality files published by the Centers for Disease Control and Prevention (CDC) from 2010 to 2019 were analyzed. Proportionate mortality due to opioid overdose, PMOD, was used, as age-adjusted death rates suffer dual data-source errors caused by differences in educational data reported in death records and in population surveys. From 2013 to 2019, PMOD increased by 120% for the "less-than-high-school-diploma" (<HS) education group, whereas the increase was 60% and 30% for groups with bachelor's and graduate-level educations, respectively. Educational gradient was observed for both males and females, with PMOD for males higher than females. From 2013 to 2019, males and females with <HS education experienced 142% and 85% increases in PMOD, respectively, compared with the 94% and 26% increases for males and females, respectively, with BS education. The PMOD increase was primarily driven by synthetic opioids (ICD-10 code T40.4). From 2013 to 2019, for males with <HS education, PMOD related to T40.4 opioids increased by 19-fold, whereas the increase was more than 100-fold for adult Black males with <HS education. These results suggest that the impact of lower educational attainment may be getting worse and furthering inequities in health. Responses to the opioid-overdose epidemic should consider the large educational gradient. Extra attention to the most vulnerable groups is necessary.
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Affiliation(s)
- William R Duan
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States of America.
| | - Dennis J Hand
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia, PA, United States of America; Department of Psychiatry & Human Behavior, Thomas Jefferson University; Philadelphia, PA, United States of America
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21
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Vuolo M, Frizzell LC, Kelly BC. Trends in psychotropic-drug-implicated mortality: Psychotropic drugs as a contributing but non-underlying cause of death. Drug Alcohol Depend 2021; 226:108843. [PMID: 34218006 PMCID: PMC8355085 DOI: 10.1016/j.drugalcdep.2021.108843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Drug overdoses have contributed to considerable years of life lost. However, focusing solely on drug overdoses, whereby drug poisoning defines the underlying cause of death, obscures the wider burden of the drug mortality crisis. We aim to describe 21 years of trends in "psychotropic-drug-implicated deaths," those where psychotropic drugs are a contributing (but not the underlying) cause of death. METHODS We analyze deaths extracted from CDC WONDER from 1999-2019 to generate annual counts and rates for psychotropic-drug-implicated deaths in the United States, including by underlying cause of death and drug implicated. RESULTS Over 21 years, 51,446 psychotropic-drug-implicated deaths occurred (33,885 medical; 17,561 external). Both medical and external psychotropic-drug-implicated deaths rose dramatically, increasing 2.5 and 5.0 times, respectively. Diseases of the circulatory system predominated underlying causes of medical deaths (74 %). Non-drug suicide, transport accidents, and drownings constitute 54 % of external underlying causes. Among the various underlying causes of death, psychotropic-drug-implicated deaths represent a considerable proportion, especially among external causes, with the proportion greatly increasing over the observation period. The drug implicated evolves from cocaine to opioids to psychostimulants, with the latter rising considerably. CONCLUSIONS The drug mortality crisis extends beyond overdose and may temper improvements observed within other causes of mortality, such as cardiovascular disease, transport accidents, and drownings. As with overdoses, psychotropic-drug-implicated deaths have risen dramatically during the 21st century. They include striking increases for drugs, such as psychostimulants, receiving less attention with overdoses. Research is needed to address prevention, intervention, and policy for psychotropic-drug-implicated deaths beyond overdose mortality.
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Affiliation(s)
- Mike Vuolo
- Department of Sociology, The Ohio State University, 236 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43201, USA
| | - Laura C Frizzell
- Department of Sociology, The Ohio State University, 236 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43201, USA
| | - Brian C Kelly
- Department of Sociology, Purdue University, 700 W. State St, West Lafayette, IN, 47907, USA.
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22
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Montez JK, Hayward MD, Zajacova A. Trends in U.S. Population Health: The Central Role of Policies, Politics, and Profits. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:286-301. [PMID: 34528482 PMCID: PMC8454055 DOI: 10.1177/00221465211015411] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Recent trends in U.S. health have been mixed, with improvements among some groups and geographic areas alongside declines among others. Medical sociologists have contributed to the understanding of those disparate trends, although important questions remain. In this article, we review trends since the 1980s in key indicators of U.S. health and weigh evidence from the last decade on their causes. To better understand contemporary trends in health, we propose that commonly used conceptual frameworks, such as social determinants of health, should be strengthened by prominently incorporating commercial, political-economic, and legal determinants. We illustrate how these structural determinants can provide new insights into health trends, using disparate health trajectories across U.S. states as an example. We conclude with suggestions for future research: focusing on structural causes of health trends and inequalities, expanding interdisciplinary perspectives, and integrating methods better equipped to handle the complexity of causal processes driving health trends and inequalities.
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23
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Hendi AS, Ho JY. Immigration and improvements in American life expectancy. SSM Popul Health 2021; 15:100914. [PMID: 34522764 PMCID: PMC8426263 DOI: 10.1016/j.ssmph.2021.100914] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 11/19/2022] Open
Abstract
Despite the immigrant mortality advantage and the increasing share of the population born abroad, relatively little is known about how immigration has impacted trends in US life expectancy. How immigrants contribute to national life expectancy trends is of increasing interest, particularly in the context of an unprecedented stagnation in American mortality. We find that immigration increases US life expectancy by 1.5 years for men and 1.4 years for women. Over half of these contributions occur at the prime working ages of 25-64. The difference between foreign-born and US-born mortality has grown substantially since 1990, with the ratio of US-born to foreign-born mortality rates nearly doubling by 2017. In that year, foreign-born life expectancy reached 81.4 and 85.7 years for men and women, respectively-7.0 and 6.2 years higher than their US-origin counterparts. These life expectancy levels are remarkable by most standards. Foreign-born male life expectancy exceeds that of Swiss men, the world leaders in male life expectancy. Life expectancy for foreign-born women is close to that of Japanese women, the world leaders in female life expectancy. The widening mortality difference between the US-born and foreign-born populations, coupled with an increase in the share of the population born abroad, has been responsible for much of the increase in national life expectancy in recent years. Between 2007 and 2017, foreign-born men and women were responsible for 44% and 60% of national life expectancy improvements. Between 2010 and 2017, immigrants experienced gains while the US-born experienced declines in life expectancy. Thus, nearly all of the post-2010 mortality stagnation is due to adverse trends among the US-born. Without immigrants and their children, national life expectancy in 2017 would be reduced to its 2003 levels. These findings demonstrate that immigration acts to bolster American life expectancy, with particularly valuable contributions at the prime working ages.
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Affiliation(s)
| | - Jessica Y Ho
- University of Southern California, United States
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24
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Heuveline P. The Mean Unfulfilled Lifespan (MUL): A new indicator of the impact of mortality shocks on the individual lifespan, with application to mortality reversals induced by COVID-19. PLoS One 2021; 16:e0254925. [PMID: 34314459 PMCID: PMC8315782 DOI: 10.1371/journal.pone.0254925] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 07/06/2021] [Indexed: 11/18/2022] Open
Abstract
Declines in period life expectancy at birth (PLEB) provide seemingly intuitive indicators of the impact of a cause of death on the individual lifespan. Derived under the assumption that future mortality conditions will remain indefinitely those observed during a reference period, however, their intuitive interpretation becomes problematic when period conditions reflect a temporary mortality "shock", resulting from a natural disaster or the diffusion of a new epidemic in the population for instance. Rather than to make assumptions about future mortality, I propose measuring the difference between a period average age at death and the average expected age at death of the same individuals (death cohort): the Mean Unfulfilled Lifespan (MUL). For fine-grained tracking of the mortality impact of an epidemic, I also provide an empirical shortcut to MUL estimation for small areas or short periods. For illustration, quarterly MUL values in 2020 are derived from estimates of COVID-19 deaths that might substantially underestimate overall mortality change in affected populations. These results nonetheless illustrate how MUL tracks the mortality impact of the pandemic in several national and sub-national populations. Using a seven-day rolling window, the empirical shortcut suggests MUL peaked at 6.43 years in Lombardy, 8.91 years in New Jersey, and 6.24 years in Mexico City for instance. Sensitivity analyses are presented, but in the case of COVID-19, the main uncertainty remains the potential gap between reported COVID-19 deaths and actual increases in the number of deaths induced by the pandemic in some of the most affected countries. Using actual number of deaths rather than reported COVID-19 deaths may increase seven-day MUL from 6.24 to 8.96 years in Mexico City and from 2.67 to 5.49 years in Lima for instance. In Guayas (Ecuador), MUL is estimated to have reached 12.7 years for the entire month of April 2020.
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Affiliation(s)
- Patrick Heuveline
- California Center for Population Research (CCPR), University of California, Los Angeles (UCLA), Los Angeles, CA, United States of America
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25
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Gutin I, Hummer RA. Social Inequality and the Future of U.S. Life Expectancy. ANNUAL REVIEW OF SOCIOLOGY 2021; 47:501-520. [PMID: 34366549 PMCID: PMC8340572 DOI: 10.1146/annurev-soc-072320-100249] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Despite decades of progress, the future of life expectancy in the United States is uncertain due to widening socioeconomic disparities in mortality, continued disparities in mortality across racial/ethnic groups, and an increase in extrinsic causes of death. These trends prompt us to scrutinize life expectancy in a high-income but enormously unequal society like the United States, where social factors determine who is most able to maximize their biological lifespan. After reviewing evidence for biodemographic perspectives on life expectancy, the uneven diffusion of health-enhancing innovations throughout the population, and the changing nature of threats to population health, we argue that sociology is optimally positioned to lead discourse on the future of life expectancy. Given recent trends, sociologists should emphasize the importance of the social determinants of life expectancy, redirecting research focus away from extending extreme longevity and towards research on social inequality with the goal of improving population health for all.
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Affiliation(s)
- Iliya Gutin
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516
- Corresponding author:
| | - Robert A. Hummer
- Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516
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26
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Sejdiu A, Pereira KN, Joundi H, Patel YR, Basith SA, Ayala V, Mathialagan K, Majumder P. Demographic Pattern and Mortality Risk Factors for Prescription Opioid Overdose Hospitalizations: Results From Nationwide Inpatient Sample Analysis. Cureus 2021; 13:e15674. [PMID: 34277265 PMCID: PMC8281797 DOI: 10.7759/cureus.15674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives To explore the demographic patterns of hospitalizations related to prescription opioid overdose (POD) and evaluate the mortality risk of association in POD inpatients. Methodology We conducted a cross-sectional study using the Nationwide Inpatient Sample of 184,711 POD inpatients. A binomial logistic regression model was used to evaluate the odds ratio (OR) of association for mortality risk due to comorbidities (substance use disorders (SUD) and medical complications) in POD inpatients. Results POD inpatients were majorly females (54.1%), older adults aged 51-75 years (48.5%), whites (81.5%), and from lower household income quartet (32.8%). The most prevalent comorbid SUD among POD inpatients was alcohol (15.7%), followed by cannabis (5.7%), cocaine (4.2%), and amphetamine (1.8%). Comorbid alcohol use disorders had a minimally increased association with mortality but were not statistically significant (OR = 1.036; P = 0.438). POD in patients with cardiac arrest had the highest risk of mortality (OR = 103.423; P < 0.001), followed by shock (OR = 15.367; P < 0.001), coma (OR = 13.427; P < 0.001), and respiratory failure (OR = 12.051; P < 0.001). Conclusions Our study indicates that the hospitalizations related to POD were more prevalent among females, elders between 51 and 75 years of age, whites, and those in the lower household income quartet. The prevalence of prescription opioid use and the hospitalization related to POD remains a significant public health issue. POD inpatients with medical complications were at a higher risk of mortality than with comorbid SUD.
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Affiliation(s)
- Albulena Sejdiu
- Psychiatry, Saints Cyril and Methodius University, Skopje, MKD
| | | | - Hajara Joundi
- Internal Medicine, University Cadi Ayyad, Faculty of Medicine and Pharmacy, Marrakesh, MAR
| | | | - Sayeda A Basith
- Psychiatry and Behavioral Sciences, Medical University of the Americas, Charlestown, KNA
| | - Victoria Ayala
- Psychiatry, Ross University School of Medicine, Bridgetown, BRB
| | | | - Pradipta Majumder
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA.,Psychiatry, WellSpan Health, York, USA
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27
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Heuveline P, Tzen M. Beyond deaths per capita: comparative COVID-19 mortality indicators. BMJ Open 2021; 11:e042934. [PMID: 33692179 PMCID: PMC7948156 DOI: 10.1136/bmjopen-2020-042934] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/11/2021] [Accepted: 02/17/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Following well-established practices in demography, this article discusses several measures based on the number of COVID-19 deaths to facilitate comparisons over time and across populations. SETTINGS National populations in 186 United Nations countries and territories and populations in first-level subnational administrative entities in Brazil, China, Italy, Mexico, Peru, Spain and the USA. PARTICIPANTS None (death statistics only). PRIMARY AND SECONDARY OUTCOME MEASURES An unstandardised occurrence/exposure rate comparable to the Crude Death Rate; an indirectly age-and-sex standardised rate that can be derived even when the breakdown of COVID-19 deaths by age and sex required for direct standardisation is unavailable; the reduction in life expectancy at birth corresponding to the 2020 number of COVID-19 deaths. RESULTS To date, the highest unstandardised rate has been in New York, at its peak exceeding the state 2017 crude death rate. Populations compare differently after standardisation: while parts of Italy, Spain and the USA have the highest unstandardised rates, parts of Mexico and Peru have the highest standardised rates. For several populations with the necessary data by age and sex for direct standardisation, we show that direct and indirect standardisation yield similar results. US life expectancy is estimated to have declined this year by more than a year (-1.26 years), far more than during the worst year of the HIV epidemic, or the worst 3 years of the opioid crisis, and to reach its lowest level since 2008. Substantially larger reductions, exceeding 2 years, are estimated for Panama, Peru, and parts of Italy, Spain, the USA and especially, Mexico. CONCLUSIONS With lesser demand on data than direct standardisation, indirect standardisation is a valid alternative to adjust international comparisons for differences in population distribution by sex and age-groups. A number of populations have experienced reductions in 2020 life expectancies that are substantial by recent historical standards.
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Affiliation(s)
- Patrick Heuveline
- California Center for Population Research (CCPR), University of California, Los Angeles, CA, USA
| | - Michael Tzen
- California Center for Population Research (CCPR), University of California, Los Angeles, CA, USA
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Hendi AS, Elo IT, Martikainen P. The implications of changing education distributions for life expectancy gradients. Soc Sci Med 2021; 272:113712. [PMID: 33571942 PMCID: PMC7969123 DOI: 10.1016/j.socscimed.2021.113712] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 01/05/2023]
Abstract
Recent research has proposed that shifting education distributions across cohorts are influencing estimates of educational gradients in mortality. We use data from the United States and Finland covering four decades to explore this assertion. We base our analysis around our new finding: a negative logarithmic relationship between relative education and relative mortality. This relationship holds across multiple age groups, both sexes, two very different countries, and time periods spanning four decades. The inequality parameters from this model indicate increasing relative mortality differentials over time. We use these findings to develop a method that allows us to compute life expectancy for any given segment of the education distribution (e.g., education quintiles). We apply this method to Finnish and American data to compute life expectancy gradients that are adjusted for changes in the education distribution. In Finland, these distribution-adjusted education differentials in life expectancy between the top and bottom education quintiles have increased by two years for men, and remained stable for women between 1971 and 2010. Similar distribution-adjusted estimates for the U.S. suggest that educational disparities in life expectancy increased by 3.3 years for non-Hispanic white men and 3.0 years for non-Hispanic white women between the 1980s and 2000s. For men and women, respectively, these differentials between the top and bottom education quintiles are smaller than the differentials between the top and bottom education categories by 18% and 39% in the U.S. and by 39% and 100% in Finland. Had the relative inequality parameters of mortality governing the Finnish and U.S. populations remained constant at their earliest period values, the difference in life expectancy between the top and bottom education quintiles would - because of overall mortality reductions - have declined moderately. The findings suggest that educational expansion may bias estimates of trends in educational differences in life expectancy upwards.
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Affiliation(s)
| | | | - Pekka Martikainen
- University of Helsinki, Finland; Stockholm University, Sweden; Max Planck Institute for Demographic Research, Germany
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29
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Wishik G, Gaeta JM, Racine MW, O'Connell JJ, Baggett TP. Substance consumption and intoxication patterns in a medically supervised overdose prevention program for people experiencing homelessness. Subst Abus 2021; 42:851-857. [PMID: 33617749 DOI: 10.1080/08897077.2021.1876201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Opioid overdose is a leading cause of death among homeless individuals. Combining psychoactive substances with opioids increases overdose risk. This study aimed to describe intoxication patterns at a drop-in space offering medical monitoring and harm reduction services to individuals who arrive intoxicated and at risk of overdose. Methods: We examined data from visits to the Supportive Place for Observation and Treatment at Boston Health Care for the Homeless Program between January 1, 2017 and December 31, 2017. We used k-means cluster analysis to characterize intoxication patterns based on clinically assessed sedation levels and vital sign parameters. Multinomial logistic regression analysis assessed demographic and substance consumption predictors of cluster membership. Linear and logistic regression models examined associations between cluster membership and care outcomes. Results: Across 305 care episodes involving 156 unique patients, cluster analysis revealed 3 distinct intoxication patterns. Cluster A (26.6%) had mild sedation and normal vital signs. Cluster B (44.5%) featured greater sedation with bradycardia and/or hypotension. Cluster C (28.9%) was comparable to cluster B but with the addition of hypoxia. Self-reported consumption of non-opioid sedatives prior to arrival was common (63.3% of episodes) and predicted membership in cluster B (aOR 2.75, 95% CI 1.40, 5.40) and cluster C (aOR 3.38, 95% CI 1.48, 7.70). In comparison to cluster A episodes, cluster C episodes were longer (mean 4.8 vs. 2.3 hours, p < 0.001) and more likely to require supplemental oxygen (27.3% vs. 2.5%, p < 0.001). Few episodes required hospital transfer (4.7%) or naloxone (1.0%). No deaths occurred. Conclusions: In a medically supervised overdose monitoring program, reported use of non-opioid sedatives strongly predicted more complex clinical courses and should be factored into overdose prevention efforts. Low-threshold medical monitoring in an ambulatory setting was sufficient for most episodes, suggesting a role for such programs in reducing harm and averting costly emergency services.
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Affiliation(s)
- Gabriel Wishik
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts, USA
| | - Jessie M Gaeta
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Melanie W Racine
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts, USA
| | - James J O'Connell
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Travis P Baggett
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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30
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Heuveline P. The Mean Unfulfilled Lifespan (MUL): A new indicator of the impact of mortality shocks on the individual lifespan, with application to global 2020 quarterly mortality from COVID-19. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2020.08.09.20171264. [PMID: 32817982 PMCID: PMC7430627 DOI: 10.1101/2020.08.09.20171264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Declines in period life expectancy at birth (PLEB) provide intuitive indicators of the impact of a cause of death on the individual lifespan. Derived under the assumption that future mortality conditions will remain indefinitely those observed during a reference period, however, the intuitive interpretation of a PLEB becomes problematic when that period conditions reflect a temporary mortality "shock", resulting from a natural disaster or the diffusion of a new epidemic in the population for instance. Rather than to make assumptions about future mortality, I propose measuring the difference between a period average age at death and the average expected age at death of the same individuals (death cohort): the Mean Unfulfilled Lifespan (MUL). For fine-grained tracking of the mortality impact of an epidemic, I also provide an empirical shortcut to MUL estimation for small areas or short periods. For illustration, quarterly MUL values in 2020 are derived from estimates of COVID-19 deaths in 159 national populations and 122 sub-national populations in Italy, Mexico, Spain and the US. The highest quarterly values in national populations are obtained for Ecuador (5.12 years, second quarter) and Peru (4.56 years, third quarter) and, in sub-national populations, for New York (5.52 years), New Jersey (5.56 years, second quarter) and Baja California (5.19 years, fourth quarter). Using a seven-day rolling window, the empirical shortcut suggests the MUL peaked at 9.12 years in Madrid, 9.20 years in New York, and 9.15 years in Baja California, and in Guayas (Ecuador) it even reached 12.6 years for the entire month of April. Based on reported COVID-19 deaths that might substantially underestimate overall mortality change in affected populations, these results nonetheless illustrate how the MUL tracks the mortality impact of the pandemic, or any mortality shock, retaining the intuitive metric of differences in PLEB, without their problematic underlying assumptions.
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Affiliation(s)
- Patrick Heuveline
- California Center for Population Research (CCPR), University of California, Los Angeles (UCLA)
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31
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Caudillo ML, Villarreal A. The Opioid Epidemic and Nonmarital Childbearing in the United States, 2000-2016. Demography 2021; 58:345-378. [PMID: 33834244 PMCID: PMC8363233 DOI: 10.1215/00703370-8937348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The United States has experienced a dramatic rise in opioid addiction and opioid overdose deaths in recent years. We investigate the effect of the opioid epidemic at the local level on nonmarital fertility using aggregate- and individual-level analyses. Opioid overdose death rates and prescriptions per capita are used as indicators of the intensity of the opioid epidemic. We estimate area fixed-effects models to test the effect of the opioid epidemic on nonmarital birth rates obtained from vital statistics for 2000-2016. We find an increase in nonmarital birth rates in communities that experienced a rise in opioid overdose deaths and higher prescription rates. Our analyses also show that the local effect of the opioid epidemic is not driven by a reduction in marriage rates and that marital birth rates are unaffected. Individual-level data from the ACS 2008-2016 are then used to further assess the potential causal mechanisms and to test heterogeneous effects by education and race/ethnicity. Our findings suggest that the opioid epidemic increased nonmarital birth rates through social disruptions primarily affecting unmarried women but not through changes in their economic condition.
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Affiliation(s)
- Mónica L. Caudillo
- Department of Sociology, University of Maryland, College Park, 2112 Parren Mitchell Art-Sociology Building, 3834 Campus Dr., College Park, MD 20742
| | - Andrés Villarreal
- Department of Sociology, University of California, Los Angeles, 264 Haines Hall, 375 Portola Plaza Los Angeles, CA
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32
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Cobert J, Lantos PM, Janko MM, Williams DGA, Raghunathan K, Krishnamoorthy V, JohnBull EA, Barbeito A, Gulur P. Geospatial Variations and Neighborhood Deprivation in Drug-Related Admissions and Overdoses. J Urban Health 2020; 97:814-822. [PMID: 32367203 PMCID: PMC7704893 DOI: 10.1007/s11524-020-00436-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Drug overdoses are a national and global epidemic. However, while overdoses are inextricably linked to social, demographic, and geographical determinants, geospatial patterns of drug-related admissions and overdoses at the neighborhood level remain poorly studied. The objective of this paper is to investigate spatial distributions of patients admitted for drug-related admissions and overdoses from a large, urban, tertiary care center using electronic health record data. Additionally, these spatial distributions were adjusted for a validated socioeconomic index called the Area Deprivation Index (ADI). We showed spatial heterogeneity in patients admitted for opioid, amphetamine, and psychostimulant-related diagnoses and overdoses. While ADI was associated with drug-related admissions, it did not correct for spatial variations and could not account alone for this spatial heterogeneity.
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Affiliation(s)
- Julien Cobert
- Department of Anesthesia, Critical Care Medicine division, University of California at San Francisco, 505 Parnassus Ave, Room M917, Box 0624, San Francisco, CA, 94143, USA.
| | - Paul M Lantos
- Department of Internal Medicine, Duke University Medical Center, Durham, NC, 27710, USA
- Duke University Global Health Institute, Durham, NC, 27710, USA
| | - Mark M Janko
- Duke University Global Health Institute, Durham, NC, 27710, USA
| | - David G A Williams
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Karthik Raghunathan
- Department of Anesthesiology, Durham Veterans Affairs Hospital, Durham, NC, 27710, USA
| | - Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Eric A JohnBull
- Department of Anesthesiology, Durham Veterans Affairs Hospital, Durham, NC, 27710, USA
| | - Atilio Barbeito
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Anesthesiology, Durham Veterans Affairs Hospital, Durham, NC, 27710, USA
| | - Padma Gulur
- Department of Anesthesiology, Duke University Medical Center, Durham, NC, 27710, USA
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33
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Glei DA, Lee C, Weinstein M. Socioeconomic disparities in U.S. mortality: The role of smoking and alcohol/drug abuse. SSM Popul Health 2020; 12:100699. [PMID: 33335972 PMCID: PMC7734303 DOI: 10.1016/j.ssmph.2020.100699] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/22/2020] [Accepted: 11/18/2020] [Indexed: 11/21/2022] Open
Abstract
Prior studies have identified smoking as a key driver of socioeconomic disparities in U.S. mortality, but the growing drug epidemic leads us to question whether drug abuse is exacerbating those disparities, particularly for mortality from external causes. We use data from a national survey of midlife Americans to evaluate socioeconomic disparities in all-cause and cause-specific mortality over an 18-year period (1995-2013). Then, we use marginal structural modeling to quantify the indirect effects of smoking and alcohol/drug abuse in mediating those disparities. Our results demonstrate that alcohol/drug abuse makes little contribution to socioeconomic disparities in all-cause mortality, probably because the prevalence of substance abuse is low and socioeconomic differences in abuse are small, especially at older ages when most Americans die. Smoking prevalence is much higher than drug/alcohol abuse and socioeconomic differentials in smoking are large and have widened among younger cohorts. Not surprisingly, smoking accounts for the majority (62%) of the socioeconomic disparity in mortality from smoking-related diseases, but smoking also makes a substantial contribution to cardiovascular (38%) and all-cause mortality (34%). Based on the observed cohort patterns of smoking, we predict that smoking will further widen SES disparities in all-cause mortality until at least 2045 for men and even later for women. Although we cannot yet determine the mortality consequences of recent widening of the socioeconomic disparities in drug abuse, social inequalities in mortality are likely to grow even wider over the coming decades as the legacy of smoking and the recent drug epidemic take their toll.
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Affiliation(s)
- Dana A. Glei
- Center for Population and Health, Georgetown University, 5985 San Aleso Court, Santa Rosa, 95409-3912, CA, USA
| | - Chioun Lee
- Department of Sociology, University of California, 1207 Watkins Hall, Riverside, 92521, CA, USA
| | - Maxine Weinstein
- Center for Population and Health, Georgetown University, 312 Healy Hall, 37th & O Streets, 20057-1197, Washington, DC, NW, USA
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34
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Greenspan LS, Alley L, Rice SPM, Olson R. Exploring biopsychosocial correlates of pain, pain management strategies, and risk for opioid misuse among home care workers in Washington State. Home Health Care Serv Q 2020; 40:54-74. [PMID: 32972327 DOI: 10.1080/01621424.2020.1810191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Home care workers (HCWs) are at high risk for musculoskeletal pain and injury, and they are an important population for pain management research and intervention. The purpose of this study was to gather novel data on HCWs' work characteristics, pain experiences, pain management strategies, and risk for opioid misuse. A survey invitation was e-mailed to a random sub-sample of HCWs in Washington State, and 421 responded. Over half (54.2%) reported chronic or currently elevated pain. Pharmacological pain management strategies were used by 67.3% of all respondents with 4.8% reporting prescription opioid use. Biopsychosocial factors like injuries, interpersonal conflict, financial strain, and anxiety were associated with increased opioid misuse risk. Multimodal primary and secondary interventions are recommended to improve HCWs' pain management.
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Affiliation(s)
- Leah S Greenspan
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University , Portland, Oregon, USA
| | - Lindsey Alley
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University , Portland, Oregon, USA
| | - Sean P M Rice
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University , Portland, Oregon, USA
| | - Ryan Olson
- Oregon Institute of Occupational Health Sciences, Oregon Health & Science University , Portland, Oregon, USA.,School of Public Health, Oregon Health & Science University and Portland State University , Portland, Oregon, USA.,Department of Psychology, Portland State University , Portland, Oregon, USA
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35
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van Draanen J, Tsang C, Mitra S, Karamouzian M, Richardson L. Socioeconomic marginalization and opioid-related overdose: A systematic review. Drug Alcohol Depend 2020; 214:108127. [PMID: 32650191 PMCID: PMC7313902 DOI: 10.1016/j.drugalcdep.2020.108127] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/11/2020] [Accepted: 06/13/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Socioeconomic marginalization (SEM) is an important but under-explored determinant of opioid overdose with important implications for health equity and associated public policy initiatives. This systematic review synthesizes evidence on the role of SEM in both fatal and non-fatal overdose among people who use opioids. METHODS Studies published between January 1, 2000 and March 31, 2018 were identified through searching electronic databases, citations, and by contacting experts. The titles, abstracts, citation information, and descriptor terms of citations were screened by two team members. Data were synthesized using the lumping technique. RESULTS A total of 37 studies met inclusion criteria and were included in the review, with 34 of 37 finding a significant association between at least one socioeconomic factor and overdose. The included studies contained variables related to eight socioeconomic factors: criminal justice system involvement, income, employment, social support, health insurance, housing/homelessness, education, and composite measures of socio-economic status. Most studies found associations in the hypothesized direction, whereby increased SEM was associated with a higher rate or increased likelihood of the overdose outcome measured. The review revealed an underdeveloped evidence base. CONCLUSIONS Nearly all reviewed studies found a connection between a socioeconomic variable and overdose, but more research is needed with an explicit focus on SEM, using robust and nuanced measures that capture multiple dimensions of disadvantage, and collect data over time to better inform decision making around opioid overdose.
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Affiliation(s)
- Jenna van Draanen
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Department of Sociology, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada
| | - Christie Tsang
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, School of Social Work, The Jack Bell Building, 2080 West Mall, Vancouver, BC, V6T 1Z2, Canada
| | - Sanjana Mitra
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Interdisciplinary Studies Graduate Program, 270, 2357 Main Mall, H. R. MacMillan Building, Vancouver, BC, V6T 1Z4, Canada
| | - Mohammad Karamouzian
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, School of Population and Public Health, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada; HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616913555, Iran
| | - Lindsey Richardson
- BC Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; University of British Columbia, Department of Sociology, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, Canada.
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36
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Ho JY. Cycles of Gender Convergence and Divergence in Drug Overdose Mortality. POPULATION AND DEVELOPMENT REVIEW 2020; 46:443-470. [PMID: 33583972 PMCID: PMC7880043 DOI: 10.1111/padr.12336] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The United States is 25 years into a large-scale drug overdose epidemic, yet its consequences for gender differences remain largely unexplored. This study finds that drug overdose mortality increased seven- and fivefold for men and women, respectively; accounts for 0.8-year (men) and 0.4-year (women) deficits in life expectancy at birth in 2017; and has made an increasing contribution (from 1 percent to 17 percent) to women's life expectancy advantage at the prime adult ages between 1990 and 2017. I document a distinctive cyclicality to sex differences in drug overdose. During the epidemic's early stages - the heyday of prescription opioids - gender differences narrowed, but once the epidemic transitioned to illicit drugs in 2010, gender differences widened again. This pattern holds across racial/ethnic groups, and in fact may be even stronger among Hispanics and non-Hispanic Blacks than among non-Hispanic Whites. That we observe this gender dynamic across racial/ethnic groups is surprising since very different trends in drug overdose mortality have been observed for Whites versus other groups. The contemporary epidemic is a case of dynamic change in gender differences, and the differential mortality risks experienced by men and women reflect gendered social norms, attitudes towards risk, and patterns of diffusion.
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Affiliation(s)
- Jessica Y Ho
- Assistant Professor of Gerontology and Sociology, Leonard Davis School of Gerontology and Department of Sociology, University of Southern California, Los Angeles, CA 90089-0191
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37
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Rudolph KE, Kinnard EN, Rivera Aguirre A, Goin DE, Feelemyer J, Fink D, Cerda M. The Relative Economy and Drug Overdose Deaths. Epidemiology 2020; 31:551-558. [PMID: 32332222 PMCID: PMC7505523 DOI: 10.1097/ede.0000000000001199] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Overdose deaths increased exponentially in the United States to be the leading cause of adult injury deaths, and declining economic opportunity may contribute. To our knowledge, there has been no quantitative research into the impact of relative economic measures on overdose risk. Prior longitudinal studies on impact of socioeconomic conditions used fixed effects approaches that can result in biased estimates in the presence of time-varying confounders. METHODS We estimated county-level longitudinal associations between drug overdose deaths and unemployment and labor-force nonparticipation rates by gender and racial/ethnic subgroup using longitudinal g-computation and the clustered bootstrap. RESULTS We find evidence for associations between both overall and relative aspects of unemployment and labor-force nonparticipation and drug overdose mortality; patterns of associations differed, sometime qualitatively, across subgroups. For males across racial-ethnic groups, greater overall and relative unemployment rates were generally associated with greater overdose mortality in both the short and long terms [e.g., for white males, increasing the overall percentage of unemployed adults by 5% points in 2000, 2009, and 2015 is associated with an increase of 3.2 overdose deaths (95% confidence interval [CI] = -2.8, 14) in 2015, and increasing the ratio by 0.5 in 2000, 2009, and 2015 is associated with an increase of 9.1 overdose deaths (95% CI = 1.6, 24)]. CONCLUSIONS These findings point to important complexity in how the economic and contextual landscape differentially shapes overdose risks, underscoring a need for increased understanding of the mechanisms operating for women and minority groups.
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Affiliation(s)
- Kara E. Rudolph
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Elizabeth N. Kinnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California
| | - Ariadne Rivera Aguirre
- Department of Population Health, School of Medicine, New York University, New York, New York
| | - Dana E. Goin
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California
| | - Jonathan Feelemyer
- Department of Population Health, School of Medicine, New York University, New York, New York
| | - David Fink
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Magdalena Cerda
- Department of Population Health, School of Medicine, New York University, New York, New York
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38
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Thakur T, Barnet JH, LeCaire T, Bersch A, Peppard P, Malecki K, Moberg DP. Prescribed Opioid Use in Wisconsin 2008-2016: Findings From the Survey of the Health of Wisconsin. WMJ : OFFICIAL PUBLICATION OF THE STATE MEDICAL SOCIETY OF WISCONSIN 2020; 119:102-109. [PMID: 32659062 PMCID: PMC7492104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The opioid epidemic is a national crisis. The objectives of this report were to describe prescription opioid use in Wisconsin from 2008 through 2016 using unique populationrepresentative data and to assess which demographic, health, and behavioral health characteristics were related to past 30-day prescribed opioid use. METHODS Data were obtained from the Survey of the Health of Wisconsin (SHOW), a statewide representative sample of 4,487 adults. Prescription medication use was ascertained via in-person interviews that included an inventory of all prescription medications used by the respondent in the past 30 days. The data were weighted to represent the adult population of Wisconsin, aged 21 to 74. Chi-square, logistic regression, and descriptive statistics were used to analyze data. RESULTS From 2008 to 2016, 6.4% (95% CI, 5.5-7.3) of adults age 21 years or older reported using a prescribed opioid in the past 30 days. Hydrocodone was the most prescribed opioid class followed by oxycodone. People 50 years of age and older, self-identified black or Hispanic, urban dwellers, those with a high school education or less, and those having incomes below 200% of the federal poverty level (FPL) reported significantly higher rates of prescribed opioid use relative to others. Participants reporting physician-diagnosed drug or alcohol abuse, current smokers, and those currently suffering from depression also reported significantly higher use. CONCLUSION These data from 2008-2016 demonstrate concerning levels of prescription opioid use and provide data on which population groups may be most vulnerable. While policies and clinical practice have changed since 2016, ongoing evaluation of prescribing practices, including consideration of behavioral health issues when prescribing opioids, is called for.
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Affiliation(s)
- Tanvee Thakur
- University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin
| | - Jodi H Barnet
- Survey of the Health of Wisconsin, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Tamara LeCaire
- Survey of the Health of Wisconsin, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Andrew Bersch
- Survey of the Health of Wisconsin, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Paul Peppard
- Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kristen Malecki
- Survey of the Health of Wisconsin, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - D Paul Moberg
- Population Health Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin,
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39
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Dembek ZF, Chekol T, Wu A. The Opioid Epidemic: Challenge to Military Medicine and National Security. Mil Med 2020; 185:e662-e667. [DOI: 10.1093/milmed/usz487] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Introduction
We examine the current status of the military relevance of opioids, their use and misuse in military and veteran populations, the national security consequences of opioid use in our military age population, public health implications, and military, veteran, and government solutions for opioid addiction.
Materials and Methods
A literature search of recent published research, federal government, and related open source materials was conducted using PubMed, Google, and Google Scholar, and all materials retrieved were manually identified, screened, and evaluated for inclusion. A modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach was used for the selection of relevant articles. Heath policy literature and relevant demographic information published within the last 5 years was also included to provide current information and search for solutions to address the escalating national opioid crisis.
Results
Synthetic opioids are used for pain and trauma management, not readily substituted, and have exceptionally high addiction potential. Combat wounded veterans have greater potential for opioid misuse than civilian populations. Assessment, management, and treatment of opioid use in this population are essential. Veterans receiving synthetic opioids have been noted to have multiple overdose risk factors. Opioids are readily available nationally as “street drugs” and also in the form of fentanyl-contaminated heroin. The opioid crisis affects the military age population and the top states for military enlistments. Younger age males with lower education and income are at significant risk for opioid use disorder. Recently increased drug overdose deaths contribute to an increased U.S. mortality rate with a commensurate decline in life expectancy at birth. Opioid abuse contributes to increased incidence of infectious disease. Behavioral health programs directed at military and veterans to identify risk factors for opioid misuse have been introduced. Prescription drug monitoring initiatives continue for these populations with increased information exchanged between military and civilian healthcare. Lifesaving interventions for opioid addiction include methadone maintenance and fentanyl test strip accessibility. Newly implemented federal funding healthcare initiatives to the states are now directed at opioid use prevention and enhanced surveillance.
Conclusions
Given increasing rates of opioid addiction and death, viable solutions are universally needed. Successful intervention measures should be widely shared between military, veteran, and civilian healthcare and public health communities. Increased collaboration between these groups could inculcate successful programs to prevent and decrease opioid use. Results received from recent military and veterans’ programs for prescription and electronic medical record (EMR) monitoring and data sharing may also prove useful for civilian healthcare providers and hospital systems. Future evaluations from ongoing federally funded programs to the states for addiction surveillance and intervention may help create measures to address the proliferation of opioid addiction with increased death rates. Anticipated results from these federal efforts should help inform opioid programs in military and veterans’ health systems.
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Affiliation(s)
- Zygmunt F Dembek
- Battelle Connecticut Operations, 50 Woodbridge Drive, Suffield, CT 06078-1200
| | - Tesema Chekol
- Battelle, Defense Threat Reduction Agency, Technical Reachback (J9-ISR), 8725 John J. Kingman Road, Stop 6201, Fort Belvoir, VA 22060-6201
| | - Aiguo Wu
- Defense Threat Reduction Agency, Technical Reachback (J9-ISR), 8725 John J. Kingman Road, Stop 6201, Fort Belvoir, VA 22060-6201
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Vierboom YC. Trends in alcohol-related mortality by educational attainment in the U.S., 2000-2017. POPULATION RESEARCH AND POLICY REVIEW 2020; 39:77-97. [PMID: 32038052 PMCID: PMC7006889 DOI: 10.1007/s11113-019-09527-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 03/28/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Alcohol-related mortality rates in the U.S. have risen since 2000, though how trends vary across socio-economic status is unclear. METHODS This analysis combines data from vital statistics and the National Health Interview Survey (NHIS) to estimate alcohol-related mortality rates at four levels of educational attainment (less than high school, high school/GED, some college/associate's degree, four-year degree or more) over the period 2000-2017. The analysis includes a comprehensive set of 48 alcohol-related causes of death, including causes which are indirectly influenced by alcohol use. I consider period and cohort patterns in inequality using the relative index of inequality (RII). RESULTS Mortality rates increased over the study period, at all levels of educational attainment. Relative increases were larger for females than males at nearly all ages and levels of educational attainment, and were largest among 45-59 year-old women. Male and female members of the 1950-1959 birth cohort exhibited elevated rates of alcohol-related mortality relative to neighboring cohorts. Despite widespread increases in alcohol-related mortality, educational inequalities present at the beginning of the analysis persisted and exceeded those in all-cause mortality. Disparities were typically greatest among younger adults ages 30-44, though inequality in this age group declined over time. Inequality increased among females ages 60-74, as well as among males ages 45-74. IMPLICATIONS While interventions targeting these groups may reduce educational disparities, care should also be taken to stem the increasing prevalence of alcohol-related deaths at all levels of educational attainment.
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Affiliation(s)
- Yana C Vierboom
- Population Studies Center, University of Pennsylvania, McNeil Building, 3718 Locust Walk, Philadelphia, PA, U.S
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41
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Estimating the impact of drug use on US mortality, 1999-2016. PLoS One 2020; 15:e0226732. [PMID: 31940370 PMCID: PMC6961845 DOI: 10.1371/journal.pone.0226732] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/04/2019] [Indexed: 01/07/2023] Open
Abstract
The impact of rising drug use on US mortality may extend beyond deaths coded as drug-related to include excess mortality from other causes affected by drug use. Here, we estimate the full extent of drug-associated mortality. We use annual death rates for 1999–2016 by state, sex, five-year age group, and cause of death to model the relationship between drug-coded mortality—which serves as an indicator of the population-level prevalence of drug use—and mortality from other causes. Among residents aged 15–64 living in the 50 US states, the estimated number of drug-associated deaths in 2016 (141,695) was 2.2 times the number of drug-coded deaths (63,000). Adverse trends since 2010 in midlife mortality are largely attributable to drug-associated mortality. In the absence of drug use, we estimate that the probability of dying between ages 15 and 65 would have continued to decline after 2010 among men (to 15% in 2016) and would have remained at a low level (10%) among women. Our results suggest that an additional 3.9% of men and 1.8% of women died between ages 15 and 65 in 2016 because of drug use. In terms of life expectancy beyond age 15, we estimate that drug use cost men 1.4 years and women 0.7 years, on average. In the hardest-hit state (West Virginia), drug use cost men 3.6 and women 1.9 life years. Recent declines in US life expectancy have been blamed largely on the drug epidemic. Consistent with that inference, our results imply that, in the absence of drug use, life expectancy at age 15 would have increased slightly between 2014 and 2016. Drug-associated mortality in the US is roughly double that implied by drug-coded deaths alone. The drug epidemic is exacting a heavy cost to American lives, not only from overdoses but from a variety of causes.
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42
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Haider MR, Brown MJ, Gupta RD, Karim S, Olatosi B, Li X. Psycho-Social Correlates of Opioid Use Disorder among the US Adult Population: Evidence from the National Survey on Drug Use and Health, 2015-2018. Subst Use Misuse 2020; 55:2002-2010. [PMID: 32633664 PMCID: PMC7952032 DOI: 10.1080/10826084.2020.1788086] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The United States (US) has experienced an opioid epidemic over the last two decades. Drug overdose deaths increased by 21% from 2015 to 2016, with two-thirds of these deaths attributed to opioid use disorder (OUD). This study assessed the psycho-social correlates associated with OUD over 2015-2018 in the US. Methods: This study used data collected from 171,766 (weighted = 245,838,163) eligible non-institutionalized US adults in the pooled National Survey on Drug Use and Health from 2015-2018. Survey-weighted descriptive, bivariate, and multivariable analyses were performed to assess the psycho-social correlates of OUD. Results: About 0.85% of the respondents reported having OUD in the past year. About one-quarter (26.3%), one-sixth (14.8%), and half (47.3%) of the respondents with OUD reported alcohol, marijuana, and nicotine dependence, respectively. One-sixth (16.7%) had a criminal justice involvement history, and almost one-third (30.8%) experienced a major depressive episode (MDE) in the past year. In multivariable analysis, ≤64 years, White race, male gender, lower educational attainment, unemployment, large metro area residence, history of alcohol, marijuana, nicotine use disorder, history of criminal justice involvement, and MDE in previous year were associated with higher odds of OUD. In contrast, being married, non-Hispanic African American, non-Hispanic Other, and Hispanic ethnicity, good physical health, private health insurance, and higher risk perception about addictive substance use were associated with lower odds of OUD. Conclusions: OUD is more prevalent among certain sociodemographic groups in the US. Targeted interventions focusing on young, White, unmarried, male, and uninsured/Medicaid/Medicare populations should be implemented to reduce the OUD.
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Affiliation(s)
- Mohammad Rifat Haider
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
| | - Monique J Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Rajat Das Gupta
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Sabrina Karim
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Department of Health, Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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43
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Abstract
The US drug overdose crisis has devastated communities across the nation, yet relatively little is known about recent impacts in diverse Hispanic populations. Purpose: This study explored demographic and drug patterns in overdose deaths among US Hispanics in 2017, as well as longer-term time trends in drug overdose mortality among Hispanics from 2000 to 2017. Methods: Death certificate data were obtained from the National Center for Health Statistics. Bivariate analyses examined demographic and drug characteristics of the 5,988 drug overdose deaths among Hispanics in 2017. Data from 2017 were also utilized to compute age-adjusted drug overdose mortality rates for Hispanics overall, for specific Hispanic heritage groups, and for Non-Hispanic Whites (as a frame of reference). Joinpoint Regression was used to characterize trends in drug overdose mortality among US Hispanic men and women between 2000 and 2017. Results: The majority of Hispanic drug overdose decedents in 2017 were male (76.1%) and US-born (70.0%). Synthetic opioids were involved in the highest proportion of deaths in all Hispanic heritages, except the Mexican heritage group, in which psychostimulants were most commonly involved. The 2017 age-adjusted drug overdose mortality rate for Hispanics overall was lower than the rate among Non-Hispanic Whites, yet the rate among Puerto Rican-heritage Hispanics (29.0, 95% CI 27.6-30.4) was 6% higher than among Non-Hispanic Whites (27.4, 95% CI 27.2-27.6). Conclusions: Results highlight substantial variation in Hispanic drug overdose mortality rates, indicating that national rates for Hispanics obscure higher-risk subgroups. The diverse demographic profiles of Hispanic drug overdose decedents underscore the need for culturally tailored interventions.
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Affiliation(s)
- Manuel Cano
- Department of Social Work, University of Texas at San Antonio, San Antonio, Texas, USA
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44
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Elo IT, Hendi AS, Ho JY, Vierboom YC, Preston SH. Trends in Non-Hispanic White Mortality in the United States by Metropolitan-Nonmetropolitan Status and Region, 1990-2016. POPULATION AND DEVELOPMENT REVIEW 2019; 45:549-583. [PMID: 31588154 PMCID: PMC6771562 DOI: 10.1111/padr.12249] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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45
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Sasson I, Hayward MD. Association Between Educational Attainment and Causes of Death Among White and Black US Adults, 2010-2017. JAMA 2019; 322:756-763. [PMID: 31454044 PMCID: PMC6714034 DOI: 10.1001/jama.2019.11330] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE There are substantial and increasing educational differences in US adult life expectancy. To reduce social inequalities in mortality, it is important to understand how specific causes of death have contributed to increasing educational differences in adult life expectancy in recent years. OBJECTIVE To estimate the relationship of specific causes of death with increasing educational differences in adult life expectancy from 2010 to 2017. DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional study of 4 690 729 deaths recorded in the US National Vital Statistics System in 2010 and 2017. EXPOSURES Sex, race/ethnicity, and educational attainment. MAIN OUTCOMES AND MEASURES Life expectancy at age 25 years and years of life lost between ages 25 and 84 years by cause of death. RESULTS The analysis included a total of 2 211 633 deaths in 2010 and 2 479 096 deaths in 2017. Between 2010 and 2017, life expectancy at age 25 significantly declined among white and black non-Hispanic US residents from an expected age at death of 79.34 to 79.15 years (difference, -0.18 [95% CI, -0.23 to -0.14]). Greater decreases were observed among persons with a high school degree or less (white men: -1.05 years [95% CI, -1.15 to -0.94], white women: -1.14 years [95% CI, -1.24 to -1.04], and black men: -0.30 years [95% CI, -0.56 to -0.04]). White adults with some college education but no 4-year college degree experienced similar declines in life expectancy (men: -0.89 years [95% CI, -1.07 to -0.73], women: -0.59 years [95% CI, -0.77 to -0.42]). In contrast, life expectancy at age 25 significantly increased among the college-educated (white men: 0.58 years [95% CI, 0.42 to 0.73], white women: 0.78 years [95% CI, 0.57 to 1.00], and black women: 1.70 years [95% CI, 0.91 to 2.53]). The difference between high- and low-education groups increased from 2010 to 2017, largely because life-years lost to drug use increased among those with a high school degree or less (white men: 0.93 years [95% CI, 0.90 to 0.96], white women: 0.50 years [95% CI, 0.47 to 0.52], black men: 0.75 years [95% CI, 0.71 to 0.79], and black women: 0.28 years [95% CI, 0.25 to 0.31]). CONCLUSIONS AND RELEVANCE In this serial cross-sectional study, estimated life expectancy at age 25 years declined overall between 2010 and 2017; however, it declined among persons without a 4-year college degree and increased among college-educated persons. Much of the increasing educational differences in years of life lost may be related to deaths attributed to drug use.
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Affiliation(s)
- Isaac Sasson
- Department of Sociology and Anthropology and the Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel
| | - Mark D. Hayward
- Department of Sociology and Population Research Center, University of Texas at Austin
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46
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Sanmartin MX, Ali MM, Novak P, Chen J. Polysubstance use among reproductive-aged parenting women who misused prescription opioids in the United States. J Addict Dis 2019; 37:142-145. [PMID: 31232212 DOI: 10.1080/10550887.2019.1630237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Research has shown a significant increase in overdose deaths among reproductive-aged parenting women in the United States. Given the alarming rise of opioid use disorder, this study analyzes polysubstance use among reproductive-aged parenting women. Using data from 2015 to 2016 National Survey of Drug Use and Health (NSDUH), this study examines data on prevalence and patterns of polysubstance use among US reproductive-aged parenting women who misused prescription opioids in the past 30 days. Results show that 87% of parenting women who misused prescription opioids reported using other substances concurrently in the past 30 days.
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Affiliation(s)
- Maria X Sanmartin
- Department of Health Professions, Hofstra University, Hempstead, NY, USA
| | - Mir M Ali
- Office of the Assistant Secretary for Planning & Evaluation, US Department of Health & Human Services, Washington, DC, USA
| | - Priscilla Novak
- Department of Health Services Administration, University of Maryland, College Park, MD, USA
| | - Jie Chen
- Department of Health Services Administration, University of Maryland, College Park, MD, USA
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47
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Geronimus AT, Bound J, Waidmann TA, Rodriguez JM, Timpe B. Weathering, Drugs, and Whack-a-Mole: Fundamental and Proximate Causes of Widening Educational Inequity in U.S. Life Expectancy by Sex and Race, 1990-2015. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:222-239. [PMID: 31190569 PMCID: PMC6684959 DOI: 10.1177/0022146519849932] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Discussion of growing inequity in U.S. life expectancy increasingly focuses on the popularized narrative that it is driven by a surge of "deaths of despair." Does this narrative fit the empirical evidence? Using census and Vital Statistics data, we apply life-table methods to calculate cause-specific years of life lost between ages 25 and 84 by sex and educational rank for non-Hispanic blacks and whites in 1990 and 2015. Drug overdoses do contribute importantly to widening inequity for whites, especially men, but trivially for blacks. The contribution of suicide to growing inequity is unremarkable. Cardiovascular disease, non-lung cancers, and other internal causes are key to explaining growing life expectancy inequity. Results underline the speculative nature of attempts to attribute trends in life-expectancy inequity to an epidemic of despair. They call for continued investigation of the possible weathering effects of tenacious high-effort coping with chronic stressors on the health of marginalized populations.
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Affiliation(s)
| | - John Bound
- 1 University of Michigan, Ann Arbor, MI, USA
- 2 National Bureau of Economic Research, Cambridge, MA, USA
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48
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Abstract
This study examines proximate sources of change in first-marriage trajectories in the United States between 1960 and 2010. This was a period of tremendous social change: divorce became more common, people started marrying later or not marrying at all, innovations in medicine and changes in social and behavioral factors led to reduced mortality, inequality grew stronger and was reflected by more intense assortative mating, and the country underwent a massive educational expansion. Each of these factors influenced the formation and dissolution of first marriages over this period. This article extends the multiple-decrement life table to incorporate heterogeneity and assortative mating, which allows the quantification of how changes in the incidence of marriage, divorce, and mortality, along with changes in educational attainment and assortative mating, have shaped trends in first-marriage trajectories. The model is used to prove that stronger educational assortative mating leads to longer average durations of first marriage. Using data from multiple sources and this model, this study shows that although the incidence of divorce was the primary determinant of changes in first-marriage trajectories between 1960 and 1980, it has played a relatively smaller role in driving change in marital trajectories between 1980 and 2010. Instead, factors such as later age at first marriage, educational expansion, declining mortality, narrowing sex differences in mortality, and more intense educational assortative mating have been the major drivers of changes in first-marriage trajectories since 1980.
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Affiliation(s)
- Arun S Hendi
- Office of Population Research and Department of Sociology, Princeton University, Second Floor, Wallace Hall, Princeton, NJ, 08544, USA.
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49
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Abstract
This review focuses on the widening disparities in death rates by socioeconomic class. In recent years, there has been a major increase in the availability of data linking mortality risk and measures of socioeconomic status. The result has been a virtual explosion of new empirical research showing not only the existence of large inequities in the risk of death between those at the top and those at the bottom of the socioeconomic distribution, but also that the gaps have been growing. This assessment of the empirical research finds a consistent pattern of growing disparities within the United States. However, this widening gap in death rates does appear to be a uniquely American phenomenon, as the disparities by socioeconomic class appear to be stable or even declining in Europe and Canada.
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Affiliation(s)
- Barry Bosworth
- Economics Studies Program, The Brookings Institution, Washington, DC 20036, USA;
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50
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Congdon P. Geographical Patterns in Drug-Related Mortality and Suicide: Investigating Commonalities in English Small Areas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101831. [PMID: 31126097 PMCID: PMC6572137 DOI: 10.3390/ijerph16101831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 01/14/2023]
Abstract
There are increasing concerns regarding upward trends in drug-related deaths in a number of developed societies. In some countries, these have been paralleled by upward trends in suicide. Of frequent concern to public health policy are local variations in these outcomes, and the factors underlying them. In this paper, we consider the geographic pattern of drug-related deaths and suicide for 2012-2016 across 6791 small areas in England. The aim is to establish the extent of commonalities in area risk factors between the two outcomes, with a particular focus on impacts of deprivation, fragmentation and rurality.
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Affiliation(s)
- Peter Congdon
- School of Geography, Queen Mary University of London, Mile End Rd, London E1 4NS, UK.
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