Refining cause of death attribution among opioid, opioid‐stimulant and stimulant acute toxicity deaths
Notice bibliographique
Résumé
BACKGROUND AND AIMS: Deaths attributed to a combination of opioids and stimulants have risen dramatically in recent years, largely attributed to fentanyl, yet little is understood about which drug class is primarily responsible. Attributing death to acute substance toxicity is complex and lacks clear standards. We aimed to determine whether additional causes of death and other significant conditions among deaths attributed to fentanyl were similar regardless of stimulant involvement, and distinct from deaths involving stimulants without opioids. DESIGN: Cross-sectional analysis using records from the California Electronic Death Registration System. SETTING AND CASES: Unintentional acute toxicity deaths involving fentanyl or stimulants (methamphetamine or cocaine) occurring in San Francisco, USA, during 2013-2023. MEASUREMENTS: We compared demographic characteristics and causes of death or other significant conditions (cardiovascular, cerebrovascular, other medical cause, or no other additional cause) among five mutually exclusive groups of deaths: stimulants without opioids (stimulant-only), fentanyl with stimulants (fentanyl-stimulant), fentanyl without stimulants (fentanyl-only), other opioids (e.g., heroin, oxycodone) with stimulants ("other opioid-stimulant"), and other opioids without stimulants ("other opioids-only"). We conducted separate unadjusted and adjusted multivariable logistic regression models for each outcome (cardiovascular, cerebrovascular, other medical, or no additional cause). The primary analysis included results for the fentanyl groups. FINDINGS: Of 4475 deaths attributed to acute opioid and/or stimulant toxicity, 24% involved stimulants-only, 45% fentanyl-stimulants, and 12% fentanyl-only; the remaining 20% involved other opioids. Stimulant-only decedents were the oldest (mean age 54 years), followed by fentanyl-stimulant (47 years) and fentanyl-only (44 years; p < 0.001 for all). The adjusted odds of having cardiovascular, cerebrovascular, or other medical causes of death (adjusted odds ratios [aORs] from 0.03 to 0.52, with 95% confidence intervals [CIs] from 0.01 to 0.68) were lower and the odds of no additional cause of death (aORs from 2.53 to 3.31, with 95% CIs from 2.00 to 3.40) were higher for both groups of deaths involving fentanyl compared with deaths attributed to stimulants-only. There were no statistically significant differences in causes of death when comparing fentanyl-only with fentanyl-stimulant deaths. Findings were similar for other opioid deaths. CONCLUSION: In San Francisco, USA, causes of death and other significant condition characteristics among deaths attributed to fentanyl appear to be similar regardless of the involvement of stimulants, but are markedly different from deaths involving stimulants without opioids. When reporting on drug-related mortality and developing interventions, deaths attributed to a combination of fentanyl and stimulants may be appropriately considered in the context of opioid overdose prevention, while deaths attributed to stimulants without opioids may require a response focused on preventing and treating underlying chronic medical conditions.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».