Population-Based Study on the All-Cause and Cause-Specific Risks of Mortality among Long-Term Opioid Analgesics Users without Cancer in Taiwan
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources
2.2. Study Cohort and End Points
2.3. Study Design
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Pan, H.H.; Ho, S.T.; Lu, C.C.; Wang, J.O.; Lin, T.C.; Wang, K.Y. Trends in the consumption of opioid analgesics in Taiwan from 2002 to 2007: A population-based study. J. Pain Symptom Manag. 2013, 45, 272–278. [Google Scholar] [CrossRef]
- Kang, K.H.; Kuo, L.F.; Cheng, I.C.; Chang, C.S.; Tsay, W.I. Trends in major opioid analgesic consumption in Taiwan, 2002–2014. J. Formos. Med. Assoc. 2017, 116, 529–535. [Google Scholar] [CrossRef]
- Garcia del Pozo, J.; Carvajal, A.; Viloria, J.M.; Velasco, A.; Garcia del Pozo, V. Trends in the consumption of opioid analgesics in Spain. Higher increases as fentanyl replaces morphine. Eur. J. Clin. Pharmacol. 2008, 64, 411–415. [Google Scholar] [CrossRef]
- Hamunen, K.; Paakkari, P.; Kalso, E. Trends in opioid consumption in the Nordic countries 2002–2006. Eur. J. Pain 2009, 13, 954–962. [Google Scholar] [CrossRef]
- Roxburgh, A.; Hall, W.D.; Dobbins, T.; Gisev, N.; Burns, L.; Pearson, S.; Degenhardt, L. Trends in heroin and pharmaceutical opioid overdose deaths in Australia. Drug Alcohol Depend. 2017, 179, 291–298. [Google Scholar] [CrossRef]
- Ekholm, O.; Kurita, G.P.; Hojsted, J.; Juel, K.; Sjogren, P. Chronic pain, opioid prescriptions, and mortality in Denmark: A population-based cohort study. Pain 2014, 155, 2486–2490. [Google Scholar] [CrossRef]
- Kiang, M.V.; Basu, S.; Chen, J.; Alexander, M.J. Assessment of changes in the geographical distribution of opioid-related mortality across the United States by opioid type, 1999–2016. JAMA Netw. Open 2019, 2, e190040. [Google Scholar] [CrossRef] [Green Version]
- Rose, A.J.; Bernson, D.; Chui, K.K.H.; Land, T.; Walley, A.Y.; LaRochelle, M.R.; Stein, B.D.; Stopka, T.J. Potentially inappropriate opioid prescribing, overdose, and mortality in Massachusetts, 2011–2015. J. Gen. Intern. Med. 2018, 33, 1512–1519. [Google Scholar] [CrossRef] [Green Version]
- Ruhm, C.J. Corrected US opioid-involved drug poisoning deaths and mortality rates, 1999–2015. Addiction 2018, 113, 1339–1344. [Google Scholar] [CrossRef]
- Bahji, A.; Cheng, B.; Gray, S.; Stuart, H. Reduction in mortality risk with opioid agonist therapy: A systematic review and meta-analysis. Acta Psychiatr. Scand. 2019, 140, 313–339. [Google Scholar] [CrossRef]
- Degenhardt, L.; Bucello, C.; Mathers, B.; Briegleb, C.; Ali, H.; Hickman, M.; McLaren, J. Mortality among regular or dependent users of heroin and other opioids: A systematic review and meta-analysis of cohort studies. Addiction 2011, 106, 32–51. [Google Scholar] [CrossRef]
- Ma, J.; Bao, Y.-P.; Wang, R.-J.; Su, M.-F.; Liu, M.-X.; Li, J.-Q.; Degenhardt, L.; Farrell, M.; Blow, F.C.; Ilgen, M.; et al. Effects of medication-assisted treatment on mortality among opioids users: A systematic review and meta-analysis. Mol. Psychiatry 2019, 24, 1868–1883. [Google Scholar] [CrossRef]
- Larney, S.; Peacock, A.; Tran, L.T.; Stockings, E.; Santomauro, D.; Santo, T.; Degenhardt, L. All-cause and overdose mortality risk among people prescribed opioids: A systematic review and meta-analysis. Pain Med. 2020, 21, 3700–3711. [Google Scholar] [CrossRef]
- Peacock, A.; Tran, L.T.; Larney, S.; Stockings, E.; Santo, T., Jr.; Jones, H.; Santomauro, D.; Degenhardt, L. All-cause and cause-specific mortality among people with regular or problematic cocaine use: A systematic review and meta-analysis. Addiction 2021, 116, 725–742. [Google Scholar] [CrossRef]
- Chen, H.F.; Ho, C.A.; Li, C.Y. Risk of heart failure in a population with type 2 diabetes versus a population without diabetes with and without coronary heart disease. Diabetes Obes. Metab. 2019, 21, 112–119. [Google Scholar] [CrossRef] [Green Version]
- Lu, T.H.; Lee, M.C.; Chou, M.C. Accuracy of cause-of-death coding in Taiwan: Types of miscoding and effects on mortality statistics. Int. J. Epidemiol. 2000, 29, 336–343. [Google Scholar] [CrossRef]
- Dobson, A.J.; Kuulasmaa, K.; Eberle, E.; Scherer, J. Confidence intervals for weighted sums of Poisson parameters. Stat. Med. 1991, 10, 457–462. [Google Scholar] [CrossRef]
- Maia, L.O.; Daldegan-Bueno, D.; Fischer, B. Opioid use, regulation, and harms in Brazil: A comprehensive narrative overview of available data and indicators. Subst. Abuse Treat. Prev. Policy 2021, 16, 12. [Google Scholar] [CrossRef]
- Foster, D.; Udayachalerm, S.; Wang, J.; Murray, M. Characterization of opioid use and adverse outcomes using longitudinal data from a statewide health information exchange. Pharmacotherapy 2017, 37, e189. [Google Scholar]
- Du, Y.; Wolf, I.K.; Busch, M.A.; Knopf, H. Associations between the use of specific psychotropic drugs and all-cause mortality among older adults in Germany: Results of the mortality follow-up of the German National Health Interview and Examination Survey 1998. PLoS ONE 2019, 14, e0210695. [Google Scholar] [CrossRef] [Green Version]
- Bahji, A.; Cheng, B.; Gray, S.; Stuart, H. Mortality among people with opioid use disorder: A systematic review and meta-analysis. J. Addict. Med. 2020, 14, e118–e132. [Google Scholar] [CrossRef]
- Larney, S.; Tran, L.T.; Leung, J.; Santo, T., Jr.; Santomauro, D.; Hickman, M.; Peacock, A.; Stockings, E.; Degenhardt, L. All-cause and cause-specific mortality among people using extramedical opioids: A systematic review and meta-analysis. JAMA Psychiatry 2020, 77, 493–502. [Google Scholar] [CrossRef]
- Dart, R.C.; Surratt, H.L.; Cicero, T.J.; Parrino, M.W.; Severtson, S.G.; Bucher-Bartelson, B.; Green, J.L. Trends in opioid analgesic abuse and mortality in the United States. N. Engl. J. Med. 2015, 372, 241–248. [Google Scholar] [CrossRef] [Green Version]
- Tölle, T.; Fitzcharles, M.A.; Häuser, W. Is opioid therapy for chronic non-cancer pain associated with a greater risk of all-cause mortality compared to non-opioid analgesics? A systematic review of propensity score matched observational studies. Eur. J. Pain 2021, 25, 1195–1208. [Google Scholar] [CrossRef]
- Armstrong, B.G. Comparing standardized mortality ratios. Ann. Epidemiol. 1995, 5, 60–64. [Google Scholar] [CrossRef]
- Dydyk, A.M.; Yarrarapu, S.N.S.; Conermann, T. Chronic Pain. In StatPearls; StatPearls Publishing: Treasure Island, FL, USA, 2021. [Google Scholar]
- Thompson, B.L.; Oscar-Berman, M.; Kaplan, G.B. Opioid-induced structural and functional plasticity of medium-spiny neurons in the nucleus accumbens. Neurosci. Biobehav. Rev. 2021, 120, 417–430. [Google Scholar] [CrossRef]
- Gill, H.; Perez, C.D.; Gill, B.; El-Halabi, S.; Lee, Y.; Lipsitz, O.; Park, C.; Mansur, R.B.; Rodrigues, N.B.; McIntyre, R.S.; et al. The Prevalence of suicidal behaviour in fibromyalgia patients. Prog. Neuropsychopharmacol. Biol. Psychiatry 2021, 108, 110078. [Google Scholar] [CrossRef]
- Kirtley, O.J.; Rodham, K.; Crane, C. Understanding suicidal ideation and behaviour in individuals with chronic pain: A review of the role of novel transdiagnostic psychological factors. Lancet Psychiatry 2020, 7, 282–290. [Google Scholar] [CrossRef]
- Bohnert, A.S.B.; Ilgen, M.A. Understanding links among opioid use, overdose, and suicide. N. Engl. J. Med. 2019, 380, 71–79. [Google Scholar] [CrossRef]
- Dydyk, A.M.; Jain, N.K.; Gupta, M. Opioid Use Disorder. In StatPearls; StatPearls Publishing: Treasure Island, FL, USA, 2021. [Google Scholar]
- Chan, W.L.; Wood, D.M.; Dargan, P.I. Prescription medicine misuse in the Asia-Pacific region: An evolving issue? Br. J. Clin. Pharmacol. 2021, 87, 1660–1667. [Google Scholar] [CrossRef]
- Ansari, B.; Tote, K.M.; Rosenberg, E.S.; Martin, E.G. A rapid review of the impact of systems-level policies and interventions on population-level outcomes related to the opioid epidemic, United States and Canada, 2014–2018. Public Health Rep. 2020, 135, 100S–127S. [Google Scholar] [CrossRef] [PubMed]
- Lewiecki, E.M. Risk communication and shared decision making in the care of patients with osteoporosis. J. Clin. Densitom. 2010, 13, 335–345. [Google Scholar] [CrossRef] [PubMed]
Characteristics | n | % |
---|---|---|
Total | 12,990 | 100.00 |
Calendar year of enrollment a | ||
2001–2003 | 360 | 2.77 |
2004–2006 | 789 | 6.07 |
2007–2009 | 3798 | 29.24 |
2010–2012 | 7843 | 60.38 |
Age at cohort enrollment (years) | ||
18–24 | 474 | 3.65 |
25–34 | 1499 | 11.54 |
35–44 | 2302 | 17.72 |
45–54 | 3682 | 28.34 |
55–64 | 5033 | 38.75 |
Mean ± SD | 48.52 ± 11.63 | |
Sex | ||
Male | 7826 | 60.25 |
Female | 5164 | 39.75 |
Years of follow-up | ||
<2 | 5445 | 41.92 |
2–3 | 3878 | 29.85 |
4–5 | 2301 | 17.71 |
6–7 | 713 | 5.49 |
8–9 | 300 | 2.31 |
10–14 | 353 | 2.72 |
Mean ± SD | 2.81 ± 2.14 | |
Survival status at the end of 2013 | ||
Survivors | 12,432 | 71.42 |
Nonsurvivors | 558 | 28.58 |
All-Cause Mortality | Obs. | Mortality Rate (per 103 Person-Years) | Exp. | Standardized Mortality Ratio a | ||
---|---|---|---|---|---|---|
Estimate | 95% CI | |||||
Overall | 558 | 11.62 | 129.77 | 4.30 | 3.95 | 4.66 |
By calendar year of enrollment | ||||||
2001–2003 | 23 | 16.74 | 1.96 | 11.73 | 7.44 | 17.61 |
2004–2006 | 67 | 14.31 | 8.17 | 8.20 | 6.36 | 10.41 |
2007–2009 | 132 | 9.84 | 23.54 | 5.61 | 4.69 | 6.65 |
2010–2012 | 336 | 10.90 | 96.10 | 3.50 | 3.13 | 3.89 |
By age at cohort enrollment (years) | ||||||
18–24 | 27 | 1.77 | 2.05 | 13.17 | 8.68 | 18.58 |
25–34 | 94 | 6.16 | 14.33 | 6.56 | 5.30 | 7.95 |
35–44 | 93 | 8.31 | 18.36 | 5.07 | 4.09 | 6.15 |
45–54 | 144 | 11.56 | 31.07 | 4.63 | 3.91 | 5.42 |
55–64 | 200 | 15.92 | 63.96 | 3.13 | 2.71 | 3.57 |
By sex | ||||||
Men | 362 | 13.40 | 79.85 | 4.56 | 4.10 | 5.04 |
Women | 196 | 9.14 | 49.92 | 3.89 | 3.36 | 4.45 |
Underlying Cause of Death | Obs. | Mortality Rate (103 Person-Years) | Exp. | Standardized Mortality Ratio a | ||
---|---|---|---|---|---|---|
Estimate | 95% CI | |||||
Natural causes of death | 481 | 10.02 | 116.30 | 4.15 | 3.78 | 4.53 |
Infection and parasitic diseases | 29 | 0.60 | 2.24 | 12.93 | 8.66 | 18.05 |
Neoplasms b | 13 | 0.27 | 44.27 | 0.29 | 0.16 | 0.47 |
Metabolic and immunity diseases | 79 | 1.65 | 10.27 | 7.69 | 6.09 | 9.48 |
Hematological diseases | 3 | 0.06 | 0.29 | 10.26 | 2.06 | 24.70 |
Mental disorders | 2 | 0.04 | 0.64 | 3.14 | 0.35 | 8.74 |
Diseases of the nervous system and sensory organs | 16 | 0.33 | 1.34 | 11.93 | 6.81 | 18.45 |
Circulatory diseases | 127 | 2.65 | 26.62 | 4.77 | 3.98 | 5.64 |
Respiratory disease | 42 | 0.87 | 9.52 | 4.41 | 3.18 | 5.84 |
Digestive diseases | 88 | 1.83 | 10.67 | 8.25 | 6.61 | 10.06 |
Genitourinary disease | 47 | 0.98 | 5.98 | 7.85 | 5.77 | 10.25 |
Complications of pregnancy, childbirth, and the puerperium | 0 | 0.00 | 0.00 | NA | ||
Skin and subcutaneous disease | 3 | 0.06 | 0.67 | 4.45 | 0.89 | 10.71 |
Musculoskeletal and connective tissue diseases | 13 | 0.27 | 0.62 | 20.88 | 11.11 | 33.68 |
Congenital anomalies | 3 | 0.06 | 0.05 | 58.15 | 11.69 | 139.97 |
Conditions originating in the perinatal period | 0 | 0.00 | 0.00 | NA | ||
Symptoms/signs not classified elsewhere | 16 | 0.33 | 3.12 | 5.12 | 2.93 | 7.92 |
Unnatural causes of death | 63 | 1.31 | 12.49 | 5.04 | 3.88 | 6.45 |
Accidents and violence | 35 | 0.73 | 7.73 | 4.52 | 3.15 | 6.14 |
Suicide | 28 | 0.58 | 4.76 | 5.88 | 3.91 | 8.25 |
Homicide | 0 | 0.00 | 0.18 | NA | ||
Unspecified causes of death | 14 | 0.29 | 0.77 | 18.25 | 9.97 | 28.99 |
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Lee, P.-F.; Li, C.-Y.; Liu, Y.-C.; Chiu, C.-T.; Hou, W.-H. Population-Based Study on the All-Cause and Cause-Specific Risks of Mortality among Long-Term Opioid Analgesics Users without Cancer in Taiwan. Healthcare 2021, 9, 1402. https://doi.org/10.3390/healthcare9111402
Lee P-F, Li C-Y, Liu Y-C, Chiu C-T, Hou W-H. Population-Based Study on the All-Cause and Cause-Specific Risks of Mortality among Long-Term Opioid Analgesics Users without Cancer in Taiwan. Healthcare. 2021; 9(11):1402. https://doi.org/10.3390/healthcare9111402
Chicago/Turabian StyleLee, Po-Feng, Chung-Yi Li, Yen-Chin Liu, Chang-Ta Chiu, and Wen-Hsuan Hou. 2021. "Population-Based Study on the All-Cause and Cause-Specific Risks of Mortality among Long-Term Opioid Analgesics Users without Cancer in Taiwan" Healthcare 9, no. 11: 1402. https://doi.org/10.3390/healthcare9111402