Causes of death among people who use illicit opioids in England between 2001 and 2018: a matched cohort study

Dan Lewer*, Thomas D Brothers, Naomi Van Hest, Matt Hickman, Adam R G Holland, Prianka Padmanathan, Paola Zaninotto

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

Abstract

Background: In many countries, the average age of people who use illicit opioids, such as heroin, is increasing. This has been suggested as a reason for increasing numbers of opioid related deaths seen in surveillance data. We aimed to describe causes of death among people who use illicit opioids in England, how causes of death have changed over time, and how they change with age.
Methods: We studied 106,789 participants in the Clinical Practice Research Datalink with illicit opioid use recorded by general practitioners between 1 January 2001 and 30 October 2018. We also sampled an age, sex, and practice-matched comparison group with no records of illicit opioid use. Dates and causes of death were provided by the Office for National Statistics, with median 8.7 years follow-up. We described rates of death and calculated cause-specific
standardised mortality ratios (SMRs). We used Poisson regression to estimate associations between age, calendar year, and cause-specific death.
Findings: 13,209/106,789 (12.4%) participants died, with an SMR of 7.72 (95% CI 7.47-7.97). The most common causes of death were drug poisoning (33.1%), liver disease (9.6%), chronic lung disease (5.2%), and suicide (4.9%). Participants who use illicit opioids had higher mortality rates than the comparison group for all causes of death, with highest SMRs for viral hepatitis, HIV, and chronic lung disease. At age 20 the rate of fatal drug poisonings was 271 (95% CI
229-312) per 100,000 person-years, accounting for 60% of deaths, while non-communicable diseases together caused 31 (95% CI 16-45) per 100,000 person-years, accounting for 7% of deaths. The rate of fatal drug poisonings increased steadily with age, reaching 507 (95% CI 452-562) per 100,000 person-years at age 50, accounting for 23% of deaths. Deaths due to non-communicable diseases increased more rapidly with age to 1,155 (95% CI 880-1431) per
100,000 person-years at age 50, accounting for 52% of deaths. Mirroring national surveillance data, the rate of fatal drug poisonings in the cohort increased by 55% between 2010-12 and 2016-18, and this increase was not sensitive to adjustment for age.
Interpretation: People who use illicit opioids have excess mortality risk across all causes of death. Population ageing is unlikely to explain the increasing number of fatal drug poisonings seen in surveillance data, but is associated with many more deaths due to non-communicablediseases.
Funding: National Institute for Health Research
Original languageEnglish
JournalThe Lancet Public Health
Publication statusAccepted/In press - 1 Nov 2021

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