Causes of Death After Nonfatal Opioid Overdose
Causes of Death After Nonfatal Opioid Overdose
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DOI：
10.1001/jamapsychiatry.2018.1471
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发表时间：
2018-08-01
期刊：
影响因子：
25.8
通讯作者：
Blanco, Carlos
中科院分区：
文献类型：
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作者：
Olfson, Mark;Crystal, Stephen;Blanco, Carlos
重要性最近增加的病人提出与非致命性阿片类药物过量已集中临床注意力的特点，他们的风险过早mortals.OBJECTIVE描述全因死亡率，选定的原因特异性死亡率，和标准化死亡率比（SMR）的成年人在他们的第一年后，非致命性阿片类药物过量。这项美国国家纵向研究评估了一组年龄在18至64岁之间的患者，他们是医疗补助受益人，并经历了非致命的阿片类药物过量。医疗补助数据集包括2001年至2007年。死亡记录信息来自国家死亡指数。数据分析时间为2017年10月至2018年1月。主要结局和指标在非致死性阿片类药物过量后第一年确定每10万人年的粗死亡率。标准化死亡率比（SMR）估计全因和选定的原因特异性死亡率标准化的一般人群的年龄，性别和种族/ethnication.RESULTS的主要队列包括76 325成人和66 736人年的后续行动。在非致死性阿片类药物过量后的第一年，有5194例死亡，粗死亡率为778.3/10000人-年，全因SMR为24.2（95% CI，23.6-24.9）。最常见的直接死亡原因是与药物使用有关的疾病（26.2%）、循环系统疾病（13.2%）和癌症（10.3%）。对于检查的每一个原因，SMR都显著升高，特别是与药物使用相关的疾病（SMR，132.1; 95% CI，125.6-140.0），HIV（SMR，45.9; 95%CI，39.5-53.0），慢性呼吸道疾病（SMR，41.1; 95% CI，36.0-46.8），病毒性肝炎（SMR，30.6; 95% CI，22.9-40.2）和自杀（SMR，25.9; 95% CI，22.6-29.6），尤其包括女性自杀（SMR，47.9; 95%CI，39.8-52.3）。结论和相关性在经历过非致命性阿片类药物过量的美国国家成人队列中，大量死亡可归因于各种与药物使用相关的精神健康和医疗状况，这突出了密切协调这一患者群体的药物使用、精神健康和医疗护理的重要性。
IMPORTANCE A recent increase in patients presenting with nonfatal opioid overdoses has focused clinical attention on characterizing their risks of premature mortality.OBJECTIVE To describe all-cause mortality rates, selected cause-specific mortality rates, and standardized mortality rate ratios (SMRs) of adults during their first year after nonfatal opioid overdose.DESIGN, SETTING, AND PARTICIPANTS This US national longitudinal study assesses a cohort of patients aged 18 to 64 years who were Medicaid beneficiaries and experienced nonfatal opioid overdoses. The Medicaid data set included the years 2001 through 2007. Death record information was obtained from the National Death Index. Data analysis occurred from October 2017 to January 2018.MAIN OUTCOMES AND MEASURES Crude mortality rates per 100 000 person-years were determined in the first year after nonfatal opioid overdose. Standardized mortality rate ratios (SMR) were estimated for all-cause and selected cause-specific mortality standardized to the general population with respect to age, sex, and race/ethnicity.RESULTS The primary cohort included 76 325 adults and 66 736 person-years of follow-up. During the first year after nonfatal opioid overdose, there were 5194 deaths, the crude death rate was 778.3 per 10 000 person-years, and the all-cause SMR was 24.2 (95% CI, 23.6-24.9). The most common immediate causes of death were substance use-associated diseases (26.2%), diseases of the circulatory system (13.2%), and cancer (10.3%). For every cause examined, SMRs were significantly elevated, especially with respect to drug use-associated diseases (SMR, 132.1; 95% CI, 125.6-140.0), HIV (SMR, 45.9; 95% CI, 39.5-53.0), chronic respiratory diseases (SMR, 41.1; 95% CI, 36.0-46.8), viral hepatitis (SMR, 30.6; 95% CI, 22.9-40.2), and suicide (SMR, 25.9; 95% CI, 22.6-29.6), particularly including suicide among females (SMR, 47.9; 95% CI, 39.8-52.3).CONCLUSIONS AND RELEVANCE In a US national cohort of adults who had experienced a nonfatal opioid overdose, a marked excess of deaths was attributable to a wide range of substance use-associated, mental health, and medical conditions, underscoring the importance of closely coordinating the substance use, mental health, and medical care of this patient population.