Variable Classification of Drug-Intoxication Suicides across US States: A Partial Artifact of Forensics?

BackgroundThe 21st-century epidemic of pharmaceutical and other drug-intoxication deaths in the United States (US) has likely precipitated an increase in misclassified, undercounted suicides. Drug-intoxication suicides are highly prone to be misclassified as accident or undetermined. Misclassification adversely impacts suicide and other injury mortality surveillance, etiologic understanding, prevention, and hence clinical and public health policy formation and practice.ObjectiveTo evaluate whether observed variation in the relative magnitude of drug-intoxication suicides across US states is a partial artifact of the scope and quality of toxicological testing and type of medicolegal death investigation system.MethodsThis was a national, state-based, ecological study of 111,583 drug-intoxication fatalities, whose manner of death was suicide, accident, or undetermined. The proportion of (nonhomicide) drug-intoxication deaths classified by medical examiners and coroners as suicide was analyzed relative to the proportion of death certificates citing one or more specific drugs and two types of state death investigation systems. Our model incorporated five sociodemographic covariates. Data covered the period 2008-2010, and derived from NCHS's Multiple Cause-of-Death public use files.ResultsAcross states, the proportion of drug-intoxication suicides ranged from 0.058 in Louisiana to 0.286 in South Dakota and the rate from 1 per 100,000 population in North Dakota to 4 in New Mexico. There was a low correlation between combined accident and undetermined drug-intoxication death rates and corresponding suicide rates (Spearman's rho =0.38; p

背景 21世纪美国药物及其他药物中毒致死的流行情况可能导致误分类且少计的自杀数量增加。药物中毒自杀极有可能被误分类为意外或死因不明。误分类对自杀及其他伤害死亡率监测、病因理解、预防以及临床和公共卫生政策的制定与实施产生不利影响。 目的 评估美国各州观察到的药物中毒自杀相对数量的差异是否是毒理学检测范围和质量以及法医死亡调查系统类型的部分人为结果。 方法 这是一项基于全国各州的生态学研究，涉及111,583例药物中毒死亡案例，其死亡方式为自杀、意外或死因不明。分析了法医和验尸官将（非他杀）药物中毒死亡归类为自杀的比例，与提及一种或多种特定药物的死亡证明比例以及两种类型的州死亡调查系统相关联。我们的模型纳入了五个人口社会学协变量。数据涵盖2008 - 2010年期间，来源于美国国家卫生统计中心（NCHS）的多死因公共使用文件。 结果 在各州之间，药物中毒自杀的比例从路易斯安那州的0.058到南达科他州的0.286不等，比率从北达科他州每10万人中有1例到新墨西哥州的每10万人中有4例不等。综合意外和死因不明的药物中毒死亡率与相应的自杀率之间相关性较低（斯皮尔曼等级相关系数ρ = 0.38；p （最后一个单词“p”后面似乎内容不完整，如果还有需要翻译的完整内容，请继续向我提问。）