We review evidence of determinants contributing to increased opioid-related mortality in the United States and Canada between 1990 and 2013.We identified 17 determinants of opioid-related mortality and mortality increases that we classified into 3 categories: prescriber behavior, user behavior and characteristics, and environmental and systemic determinants. These determinants operate independently but interact in complex ways that vary according to geography and population, making generalization from single studies inadvisable. Researchers in this area face significant methodological difficulties; most of the studies in our review were ecological or observational and lacked control groups or adjustment for confounding factors; thus, causal inferences are difficult.Preventing additional opioid-related mortality will likely require interventions that address multiple determinants and are tailored to specific locations and populations.

Objective To examine the frequency of reporting of absolute and relative effect measures in health inequalities research.Design Structured review of selected general medical and public health journals.Data sources 344 articles published during 2009 in American Journal of Epidemiology, American Journal of Public Health, BMJ, Epidemiology, International Journal of Epidemiology, JAMA, Journal of Epidemiology and Community Health, The Lancet, The New England Journal of Medicine, and Social Science and Medicine.Main outcome measures Frequency and proportion of studies reporting absolute effect measures, relative effect measures, or both in abstract and full text; availability of absolute risks in studies reporting only relative effect measures.Results 40% (138/344) of articles reported a measure of effect in the abstract; among these, 88% (122/138) reported only a relative measure, 9% (13/138) reported only an absolute measure, and 2% (3/138) reported both. 75% (258/344) of all articles reported only relative measures in the full text; among these, 46% (119/258) contained no information on absolute baseline risks that would facilitate calculation of absolute effect measures. 18% (61/344) of all articles reported only absolute measures in the full text, and 7% (25/344) reported both absolute and relative measures. These results were consistent across journals, exposures, and outcomes.Conclusions Health inequalities are most commonly reported using only relative measures of effect, which may influence readers’ judgments of the magnitude, direction, significance, and implications of reported health inequalities.

Life expectancy at birth (the average number of years an individual can expect to live under current age-specific mortality rates)¹ has generally been increasing in the United States since at least the late 19th century.² Additionally, for as long as data have been given by race/ethnicity, life expectancy of blacks has been lower than that of whites.^3,4 However, overall trends tend to obscure the fact that the gap in life expectancy between blacks and whites has varied considerably during the 20th century. The near elimination of typhoid and other waterborne communicable diseases improved black life expectancy in both absolute and relative terms compared with whites in the period 1900-1940, but black-white differences stabilized during the 1960s.⁵