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Comparative Study
. 2023;29(4):272-284.
doi: 10.1159/000530822. Epub 2023 Jun 29.

Cause-Specific Mortality among Patients in Treatment for Opioid Use Disorder in Multiple Settings: A Prospective Comparative Cohort Study

Desiree Eide  1 , Svetlana Skurtveit  1   2 , Thomas Clausen  1 , Morten Hesse  3 , Viktor Mravčík  4   5 , Blanka Nechanská  4   5 , Gabriela Rolova  4   5 , Birgitte Thylstrup  3 , Christian Tjagvad  1 , Abdu Kedir Seid  3 , Ingvild Odsbu  2   4 , Roman Gabrhelík  4   5
Affiliations
Comparative Study

Cause-Specific Mortality among Patients in Treatment for Opioid Use Disorder in Multiple Settings: A Prospective Comparative Cohort Study

Desiree Eide et al. Eur Addict Res. 2023.

Abstract

Introduction: Among people receiving current or previous opioid maintenance treatment (OMT), the leading cause of premature death is an opioid overdose. However, other causes of mortality remain high in this group. An understanding of causes of deaths across multiple settings can be useful in informing more comprehensive prevention responses. The aim of this study was to describe all non-overdose causes of death in three national cohorts (Czechia, Denmark, and Norway) among OMT patients and to explore associations of non-overdose mortality with age and gender.

Methods: This prospective comparative cohort study used national mortality registry databases for OMT patients from Czechia (2000-2019), Denmark (2000-2018), and Norway (2010-2019). Crude mortality rates and age-standardized mortality rates (ASMRs) were calculated as deaths per 1,000 person years for cause-specific mortality.

Results: In total, 29,486 patients were included, with 5,322 deaths recorded (18%). We found variations in causes of death among the cohorts and within gender and age groups. The leading non-overdose causes of death were accidents in Czechia and Denmark, and neoplasms in Norway. Cardiovascular deaths were highest in Czechia, particularly for women in OMT (ASMR 3.59 vs. 1.24 in Norway and 1.87 in Denmark).

Conclusion: This study found high rates of preventable death among both genders and all age groups. Different demographic structures, variations in risk exposure, as well as variations in coding practices can explain the differences. The findings support increased efforts towards screening and preventative health initiatives among OMT patients specific to the demographic characteristics in different settings.

Keywords: Mortality; Opioid maintenance treatment; Overdose; Registry; Substance abuse.

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Conflict of interest statement

Morten Hesse and Birgitte Thylstrup received a grant from Reckitt Benckiser in 2011, when the company distributed buprenorphine. Roman Gabrhelík is the shareholder of Adiquit Ltd., which is currently developing apps for addictions recovery. Nevertheless, no funding was related to this study and the activities had no role in the study design or the data collection, analysis, and interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. The remaining authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Total causes of death by country.
Fig. 2.
Fig. 2.
a Causes of death for males by country. b Causes of death for females by country.
Fig. 3.
Fig. 3.
a Causes of death by age group in Czechia. b Causes of death by age group in Denmark. c Causes of death by age group in Norway.
See this image and copyright information in PMC

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