Association of globalization with the burden of opioid use disorders 2019. A country-level analysis using targeted maximum likelihood estimation

Dados Bibliográficos

ID19533798
AutoresGuillaume Barbalat (0000-0002-8212-8053, Lyon 1 Université), Geeta Reddy (International Committee of the Red Cross), Nicolás Franck (0000-0002-2894-5108, Lyon 1 Université)
Ano2023
Volume19
Fascículo1
Páginas76-76
Data de publicação2023-10-16
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoGlobalization and Health (JOURNAL)
Identificadores do periódicoISSN: 1744-8603 • E-ISSN: 1744-8603
EditoraSpringer Science and Business Media LLC (PUBLISHER)
DOI10.1186/s12992-023-00980-3
PMID37845722
OpenAlexW4387668980
IdiomaEN
Citações recebidas2
Referências citadas63

BACKGROUND: The "opioid crisis" has been responsible for hundreds of thousands deaths in the US, and is at risk of dissemination worldwide. Within-country studies have demonstrated that the rise of opioid use disorders (OUD) is linked to increased access to opioid prescriptions and to so-called "diseases of despair". Both have been related to the emergence of globalization policies since the 1980s. First, globalized countries have seen a reorganization of healthcare practices towards quick and easy answers to complex needs, including increased opioid prescriptions. Second, despair has gained those suffering from the mutations of socio-economic systems and working conditions that have accompanied globalization policies (e.g. delocalization, deindustrialization, and the decline of social services). Here, using data with high quality ratings from the Global Burden of Disease database, we evaluated the country-based association between four levels of globalization and the burden of OUD 2019. RESULTS: The sample included 87 countries. Taking into account potential country-level confounders, we found that countries with the highest level of globalization were associated with a 31% increase in the burden of OUD 2019 compared to those with the lowest level of globalization (mean log difference: 0.31; 95%CI, 0.04-0.57; p = 0.02). Additional analyses showed a significant effect for low back pain (mean log difference: 0.07; 95%CI, 0.02-0.12; p = 0.007). In contrast, despite sharing some of the risk factors of OUD, other mental and substance use disorders did not show any significant relationship with globalization. Finally, socio-cultural de jure globalization, which compiles indicators related to gender equality, human capital and civil rights, was specifically associated with the burden of OUD (mean log difference: 0.49; 95%CI: 0.23,0.75; p < 0.001). CONCLUSIONS: These findings suggest that OUD may have inherent underpinnings linked to globalization, and more particularly socio-cultural aspects of globalization. Key factors may be increased rights to access prescriptions, as well as increased feelings of despair related to the erosion of local cultures and widening educational gaps

Disease burden · Economics · Environmental health · Globalization · Population · Sociology · Demography · HIV, Drug Use, Sexual Risk · Medicine · Opioid Use Disorder Treatment · Substance Abuse Treatment and Outcomes