Historique
Article de Périodique
Association between automotive assembly plant closures and opioid overdose mortality in the United States: A difference-in-differences analysis (2020)
Auteur(s) :
A. S. VENKATARAMANI ;
E. F. BAIR ;
R. L. O’BRIEN ;
A. C. TSAI
Article en page(s) :
254-262
Refs biblio. :
59
Domaine :
Autres substances / Other substances ; Drogues illicites / Illicit drugs
Langue(s) :
Anglais
Discipline :
EPI (Epidémiologie / Epidemiology)
Thésaurus géographique
ETATS-UNIS
Thésaurus mots-clés
OPIOIDES
;
SURDOSE
;
MORTALITE
;
ECONOMIE
;
CRISE ECONOMIQUE
;
EVOLUTION
Résumé :
ENGLISH:
Importance: Fading economic opportunity has been hypothesized to be an important factor associated with the US opioid overdose crisis. Automotive assembly plant closures are culturally significant events that substantially erode local economic opportunities.
Objective: To estimate the extent to which automotive assembly plant closures were associated with increasing opioid overdose mortality rates among working-age adults.
Design, Setting, and Participants: A county-level difference-in-differences study was conducted among adults aged 18 to 65 years in 112 manufacturing counties located in 30 commuting zones (primarily in the US South and Midwest) with at least 1 operational automotive assembly plant as of 1999. The study analyzed county-level changes from January 1, 1999, to December 31, 2016, in age-adjusted, county-level opioid overdose mortality rates before vs after automotive assembly plant closures in manufacturing counties affected by plant closures compared with changes in manufacturing counties unaffected by plant closures. Data analyses were performed between April 1, 2018, and July 20, 2019.
Exposure: Closure of automotive assembly plants in the commuting zone of residence.
Main Outcomes and Measures: The primary outcome was the county-level age-adjusted opioid overdose mortality rate. Secondary outcomes included the overall drug overdose mortality rate and prescription vs illicit drug overdose mortality rates.
Results: During the study period, 29 manufacturing counties in 10 commuting zones were exposed to an automotive assembly plant closure, while 83 manufacturing counties in 20 commuting zones remained unexposed. Mean (SD) baseline opioid overdose rates per 100?000 were similar in exposed (0.9 [1.4]) and unexposed (1.0 [2.1]) counties. Automotive assembly plant closures were associated with statistically significant increases in opioid overdose mortality. Five years after a plant closure, mortality rates had increased by 8.6 opioid overdose deaths per 100?000 individuals (95% CI, 2.6-14.6; P = .006) in exposed counties compared with unexposed counties, an 85% increase relative to the mortality rate of 12 deaths per 100 000 observed in unexposed counties at the same time point. In analyses stratified by age, sex, and race/ethnicity, the largest increases in opioid overdose mortality were observed among non-Hispanic white men aged 18 to 34 years (20.1 deaths per 100 000; 95% CI, 8.8-31.3; P = .001) and aged 35 to 65 years (12.8 deaths per 100 000; 95% CI, 5.7-20.0; P = .001). We observed similar patterns of prescription vs illicit drug overdose mortality. Estimates for opioid overdose mortality in nonmanufacturing counties were not statistically significant.
Conclusions and Relevance: From 1999 to 2016, automotive assembly plant closures were associated with increases in opioid overdose mortality. These findings highlight the potential importance of eroding economic opportunity as a factor in the US opioid overdose crisis.
KEY POINTS:
Question: Are closures of US automobile assembly plants associated with increases in opioid overdose mortality rates among working-age adults?
Findings: In this difference-in-differences study, US manufacturing counties that experienced an automotive assembly plant closure were compared with counties in which automotive plants remained open from 1999 to 2016. Automotive assembly plant closures were associated with a statistically significant increase in county-level opioid overdose mortality rates among adults aged 18 to 65 years.
Meaning: Automotive assembly plant closures were associated with increases in opioid overdose mortality, highlighting the potential importance of the role of declining economic opportunity in the US opioid overdose crisis.
FRANÇAIS :
Alors que la problématique des surdoses touche particulièrement certaines régions, s'intéresser à la diminution des opportunités économiques, notamment les fermetures d'usines, permet de mieux comprendre la situation.
La situation économique s'est rapidement écroulée dans certaines régions des États-Unis, notamment dans le domaine de l'industrie automobile, et pourrait expliquer une partie de l'augmentation des surdoses. Très concrètement, une recherche récente s'est posé la question de l'effet des fermetures d'usines de montage automobile dans la région du sud et du Midwest, connue comme la Rust belt - ceinture de la rouille, métaphore de la précarisation économique de ces régions industrielles - sur le nombre de surdoses. Les résultats mettent en évidence l'effet de la baisse de l'activité économique, d'après une étude s'étendant sur la période 1999-2016 comparant des comtés ayant connu des fermetures à ceux qui n'en ont pas vécues.
Cette étude met en avant le fait que les addictions sont effectivement un phénomène social complet et que les vulnérabilités existantes ou émergentes, notamment économiques, sont facteurs de complications. Si la majorité des consommations sont non problématiques ou cessent lors du passage à l'âge adulte, une instabilité économique ou professionnelle pose problème. [Actualités des addictions, 18/02/2020]
Importance: Fading economic opportunity has been hypothesized to be an important factor associated with the US opioid overdose crisis. Automotive assembly plant closures are culturally significant events that substantially erode local economic opportunities.
Objective: To estimate the extent to which automotive assembly plant closures were associated with increasing opioid overdose mortality rates among working-age adults.
Design, Setting, and Participants: A county-level difference-in-differences study was conducted among adults aged 18 to 65 years in 112 manufacturing counties located in 30 commuting zones (primarily in the US South and Midwest) with at least 1 operational automotive assembly plant as of 1999. The study analyzed county-level changes from January 1, 1999, to December 31, 2016, in age-adjusted, county-level opioid overdose mortality rates before vs after automotive assembly plant closures in manufacturing counties affected by plant closures compared with changes in manufacturing counties unaffected by plant closures. Data analyses were performed between April 1, 2018, and July 20, 2019.
Exposure: Closure of automotive assembly plants in the commuting zone of residence.
Main Outcomes and Measures: The primary outcome was the county-level age-adjusted opioid overdose mortality rate. Secondary outcomes included the overall drug overdose mortality rate and prescription vs illicit drug overdose mortality rates.
Results: During the study period, 29 manufacturing counties in 10 commuting zones were exposed to an automotive assembly plant closure, while 83 manufacturing counties in 20 commuting zones remained unexposed. Mean (SD) baseline opioid overdose rates per 100?000 were similar in exposed (0.9 [1.4]) and unexposed (1.0 [2.1]) counties. Automotive assembly plant closures were associated with statistically significant increases in opioid overdose mortality. Five years after a plant closure, mortality rates had increased by 8.6 opioid overdose deaths per 100?000 individuals (95% CI, 2.6-14.6; P = .006) in exposed counties compared with unexposed counties, an 85% increase relative to the mortality rate of 12 deaths per 100 000 observed in unexposed counties at the same time point. In analyses stratified by age, sex, and race/ethnicity, the largest increases in opioid overdose mortality were observed among non-Hispanic white men aged 18 to 34 years (20.1 deaths per 100 000; 95% CI, 8.8-31.3; P = .001) and aged 35 to 65 years (12.8 deaths per 100 000; 95% CI, 5.7-20.0; P = .001). We observed similar patterns of prescription vs illicit drug overdose mortality. Estimates for opioid overdose mortality in nonmanufacturing counties were not statistically significant.
Conclusions and Relevance: From 1999 to 2016, automotive assembly plant closures were associated with increases in opioid overdose mortality. These findings highlight the potential importance of eroding economic opportunity as a factor in the US opioid overdose crisis.
KEY POINTS:
Question: Are closures of US automobile assembly plants associated with increases in opioid overdose mortality rates among working-age adults?
Findings: In this difference-in-differences study, US manufacturing counties that experienced an automotive assembly plant closure were compared with counties in which automotive plants remained open from 1999 to 2016. Automotive assembly plant closures were associated with a statistically significant increase in county-level opioid overdose mortality rates among adults aged 18 to 65 years.
Meaning: Automotive assembly plant closures were associated with increases in opioid overdose mortality, highlighting the potential importance of the role of declining economic opportunity in the US opioid overdose crisis.
FRANÇAIS :
Alors que la problématique des surdoses touche particulièrement certaines régions, s'intéresser à la diminution des opportunités économiques, notamment les fermetures d'usines, permet de mieux comprendre la situation.
La situation économique s'est rapidement écroulée dans certaines régions des États-Unis, notamment dans le domaine de l'industrie automobile, et pourrait expliquer une partie de l'augmentation des surdoses. Très concrètement, une recherche récente s'est posé la question de l'effet des fermetures d'usines de montage automobile dans la région du sud et du Midwest, connue comme la Rust belt - ceinture de la rouille, métaphore de la précarisation économique de ces régions industrielles - sur le nombre de surdoses. Les résultats mettent en évidence l'effet de la baisse de l'activité économique, d'après une étude s'étendant sur la période 1999-2016 comparant des comtés ayant connu des fermetures à ceux qui n'en ont pas vécues.
Cette étude met en avant le fait que les addictions sont effectivement un phénomène social complet et que les vulnérabilités existantes ou émergentes, notamment économiques, sont facteurs de complications. Si la majorité des consommations sont non problématiques ou cessent lors du passage à l'âge adulte, une instabilité économique ou professionnelle pose problème. [Actualités des addictions, 18/02/2020]
Affiliation :
Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA