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.
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.
Cite this item
BibTeX
Free sign-up. A digest of the new papers twice a week, grouped by domain.
Other drivers in Behavioural science
-
Diet, exercise and sleep
What people eat and how much they move: what the measured evidence says each does to mortality, and what has been shown to change either.
4 this week -
Smoking and vaping
How far smoking has fallen and how many deaths it still causes, what vaping is doing to the people who take it up, and what generational bans will show.
1 this week -
Alcohol and drug use
What is happening to deaths from alcohol, drugs and suicide, whether they move together, and how much of it is behaviour and how much circumstance.
3 this week -
Social connection
Isolation, loneliness and mortality: what the evidence shows, how far the relationship is causal, and what interventions have shown.
2 this week -
Infection and pandemics
Infection and pandemics: the risks, and how well prepared we are
5 this week -
Adherence and persistence
Whether a treatment is actually taken, for how long, and what changes either.
2 this week
