目标:在加拿大,与物质相关的意外急性毒性死亡(AATDs)在国家和国家以下水平继续上升。然而,它是未知的,如果,where,when,以及AATDs在太空中聚集到什么程度,时间,和全国各地的时空。本研究的目的是1)评估2016年和2017年加拿大在国家和省/地区(P/T)级别发生的AATD集群,和2)检查每个集群内AATD病例中检测到的物质类型。
方法:使用标准化的数据收集工具,从验尸官和医学检查官档案中提取了两年的AATD人级数据,包括死者的邮政编码和居住地的市政信息,急性毒性(AT)事件,和死亡,以及在死亡中发现的物质.将数据与加拿大人口普查信息相结合,以创建描述人口普查部门AATD率的chroopleth地图。使用空间扫描统计来建立泊松模型,以识别在国家和空间P/T水平上的高速率(p<0.05)的AATD集群。时间,和研究期间的时空。进一步检查了集群中AATD病例中每个集群中最存在的物质类型。
结果:确定了加拿大五个地区在国家一级的八个集群和15个地区在P/T一级的24个集群,强调AATD的发生率远高于全国其他地区。已识别集群的风险比范围为1.28至9.62。在集群中检测到的物质因区域和时间而异,然而,阿片类药物,兴奋剂,和酒精通常是集群中最常检测到的物质。
结论:我们的发现是加拿大第一个使用空间扫描统计数据揭示国家和P/T水平的AATDs地理差异的发现。与每个簇内的物质类型相关的比率突出显示在所识别的区域中检测到的物质类型最多。研究结果可用于指导干预/计划计划,并提供2016年和2017年背景的图片,可用于比较不同时间段的AATD和物质的地理分布。
OBJECTIVE: In Canada, substance-related accidental acute toxicity deaths (AATDs) continue to rise at the national and sub-national levels. However, it is unknown if, where, when, and to what degree AATDs cluster in space, time, and space-time across the country. The objectives of this study were to 1) assess for clusters of AATDs that occurred in Canada during 2016 and 2017 at the national and provincial/territorial (P/T) levels, and 2) examine the substance types detected in AATD cases within each cluster.
METHODS: Two years of person-level data on AATDs were abstracted from coroner and medical examiner files using a standardized data collection tool, including the decedent\'s postal code and municipality information on the places of residence, acute toxicity (AT) event, and death, and the substances detected in the death. Data were combined with Canadian census information to create choropleth maps depicting AATD rates by census division. Spatial scan statistics were used to build Poisson models to identify clusters of high rates (p < 0.05) of AATDs at the national and P/T levels in space, time, and space-time over the study period. AATD cases within clusters were further examined for substance types most present in each cluster.
RESULTS: Eight clusters in five regions of Canada at the national level and 24 clusters in 15 regions at the P/T level were identified, highlighting where AATDs occurred at far higher rates than the rest of the country. The risk ratios of identified clusters ranged from 1.28 to 9.62. Substances detected in clusters varied by region and time, however, opioids, stimulants, and alcohol were typically the most commonly detected substances within clusters.
CONCLUSIONS: Our findings are the first in Canada to reveal the geographic disparities in AATDs at national and P/T levels using spatial scan statistics. Rates associated with substance types within each cluster highlight which substance types were most detected in the identified regions. Findings may be used to guide intervention/program planning and provide a picture of the 2016 and 2017 context that can be used for comparisons of the geographic distribution of AATDs and substances with different time periods.