美国1999～2004年药物致死性不良反应分析

Drug-induced fatal adverse effects in the United States from 1999 to 2004

目的:分析美国1999～2004年药物致死性不良反应资料的特点,为我国药物不良反应控制工作提供建议。方法:数据来自美国居民死因登记资料,采用药物致死率评价致死性药物不良反应在性别、种族、药物类别和年龄组间的差别。结果:1999～2004年美国药物不良反应造成1700人死亡,药物致死率为0.10/10万,男性和女性之间无差别。美国黑人及印地安人药物致死率为0.12/10万,白人为0.10/10万,其他种族为0.04/10万。从5～9岁年龄组开始,药物致死率随年龄增长呈快速上升趋势。1999～2004年,造成死亡例数最多的前5类药物分别为血液和造血系统的药物、解热镇痛药和抗炎药、常用系统性药物、抗生素和激素类药及其拮抗药。在20～84岁的人群中,引发白人死亡的最主要的3类药物为抗凝药、阿片类镇痛药、胰岛素和口服降糖药,引发黑人和印地安人死亡最主要3种药物为乙内酰脲类药、抗凝药和未查明的麻醉药品。在84岁以上的人群中,造成白人死亡的最主要的3类药物为抗凝药、阿片类镇痛药和其他类非甾体类镇痛药;在黑人和印地安人及其他种族中,各类药物造成的死亡人数均少于3例。结论:美国1999～2004年药物致死性不良反应存在明显的种族、年龄和药物类别差异,政府在制定干预措施时应有所区别,我国政府应借鉴美国做法尽快完善药品不良反应监测系统。

Objective To examine the characteristics of drug-induced fatal adverse effects in the United States from 1999 to 2004 and put forward suggestions for China＇ s control of drug-induced adverse effects. Methods The data came from the compressed mortality file of Centers for Disease Control and Prevention （CDC） of the United States. Drug-induced mortality was used to an- alyze the effects of gender, race, age, and drug on drug-induced fatal adverse effects. Results During 1999 - 2004, 1 700 persons died of drug-induced adverse effects （mortality, 0. 10/ 100 000）. No difference was found in mortality between males and females. The drug-induced mortalities of whites, blacks and Native Americans, and other racial groups were respectively 0. 10, 0.12, and 0. 04 per 100 000 persons. The mortality increased quickly with the increase of age since the age group of 5 - 9. In this period, the 5 most common drugs that led to deaths were ： （ 1 ） agents primarily affecting blood constituents ; （ 2 ） analgesics, antlpyretics, ann antI-mnammatory drugs ; （ 3 ） primarily systemic agents ; （ 4 ） systemic antibiotics ; and （ 5 ） hormones and their synthetic substitutes and antagonists, not elsewhere classified. At the age group of 20 - 84, 3 most common drugs leading to deaths for whites were： anticoagulants, opioids and related analgesics, and insulin and fatal adverse effects in the United States during 1999-2004, and these differences should be con- sidered by the government when interventions are developed. China can learn something from the United States in controlling drug adverse effects, and improve its surveillance system of drug adverse effects as soon as possible.