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# Austrian opioid agonist treatment cohort has excess mortality across all major causes
- URL: https://www.coios.me/austrian-opioid-agonist-treatment-cohort-has-excess/
- Published: 2026-10-16T13:20:29.000Z
- Updated: 2026-10-18T12:16:01.000Z
- Description: Among 26,031 people in Austria's opioid agonist treatment registry, all-cause mortality was 7.06 times the general population rate in women and 3.86 times in men.
- Author: Daniel Ryan
- Tags: Behavioural science, Alcohol and drug use, What linked data reveals, Austria, #peer-reviewed, #refines, #item, #source-2026-10, #score-80

All 26,031 people recorded in Austria's national opioid agonist treatment registry, 2002 to 2019, were followed to 2021\. Records were linked to the national causes of death registry and rates compared with the general population. Across 278,959 person-years there were 2,358 deaths; standardised rate ratios were 7.06 in women and 3.86 in men. The highest cause-specific SMRs were viral hepatitis 63.8, HIV 48.6 and substance use-related causes 33.2\. Valvular heart disease and endocarditis gave an SMR of 28.4\. By the early to mid-40s, deaths from non-communicable diseases collectively exceeded substance use-related deaths. The authors note that linkage to further data sources is needed to disentangle the contributions to this excess mortality.

*Why it is interesting: Cause-specific mortality beyond overdose is rarely characterised in a whole national treatment population. The crossover to non-communicable disease deaths in the mid-40s is observed within a single cohort.*

Source

[European Addiction Research, 15 October 2026](https://doi.org/10.1159/ear/acrag005?ref=coios.me)

Paper

Mortality and causes of death among individuals in a national opioid agonist treatment cohort

Authors

Schwarz T, Anzenberger J, Busch M, Schernhammer ES, Strohmaier S

DOI

10.1159/ear/acrag005

Type

Peer-reviewed article

Design

Retrospective national cohort, 26,031 people in the Austrian OAT registry 2002-2019 linked to the death registry, followed to 2021; 278,959 person-years, 2,358 deaths; SMRs and standardised rate ratios

Verdict

Refines prior evidence

Driver

[Alcohol and drug use](https://www.coios.me/d-alcohol-drugs/)

Driver

[What linked data reveals](https://www.coios.me/d-linked-data/)

Free full text

[Free to read at the publisher](https://doi.org/10.1159/ear/acrag005?ref=coios.me)

Abstract — the authors' own words, CC BY

Background People with opioid use disorder experience markedly elevated all-cause and cause-specific mortality. Opioid agonist treatment (OAT) reduces mortality risk, and OAT populations across Europe are aging, with cardiovascular, respiratory, and liver diseases accounting for a growing proportion of deaths. However, cause-specific mortality beyond overdose remains poorly characterized in large national cohorts. Methods We conducted a retrospective cohort study including all 26,031 individuals (76% men) recorded in the Austrian national OAT registry between January 1, 2002 and December 31, 2019, linked to the national causes of death registry with follow-up through December 31, 2021\. We calculated sex-specific age-standardized mortality rates per 100,000 person-years (2013 European Standard Population), standardized rate ratios (SRR), and cause-specific standardized mortality ratios (SMR) compared with the Austrian general population. Results Across 278,959 person-years of follow-up, 2,358 deaths occurred. Cohort members had substantially higher mortality across all causes, with greater excess among women (SRR 7.06, 95% CI 6.45-7.72) than men (3.86; 3.69-4.04). Beyond substance use-related causes (SMR 33.2, 95% CI 31.4-35.2), the highest SMRs were found for viral hepatitis (63.8, 52.3-77.8), HIV (48.6, 39.0-60.6), and valvular heart diseases and endocarditis (28.4, 18.6-43.6). By the early to mid-40s, deaths from non-communicable diseases collectively exceeded those from substance use-related causes. Conclusion Austria’s national OAT cohort experiences substantial excess mortality across all major causes, with high relative excess for substance use-related, infectious, and liver-related conditions. As OAT populations age, non-communicable diseases account for an increasing share of deaths. Future analyses linking the cohort to additional data sources will be needed to disentangle the underlying contributions to this excess mortality.