Background: Mortality is increased among people with opioid use disorder but reduced while on opioid agonist treatment (OAT). However, the impact of patient and treatment characteristics on mortality and causes of death is insufficiently studied. Objectives: The objective of this study was to explore mortality and causes of death and examine the impact of patient and treatment characteristics on mortality in an OAT cohort with high retention in treatment. Methods: Design: longitudinal cohort study. Setting: Norway. Observation period: time from OAT start as of 1998 until death or end of 2016, 2,508 person-years (PY) in total. Sample: 200 persons starting OAT 1998–2007. Data sources: hospital records, interviews, the Norwegian Cause of Death Registry, Statistics Norway. Results: Retention: 86.4% of the observation period was on OAT, 9.0% off, 4.6% unknown OAT status. All-cause crude mortality rate per 100 PY during the whole observation period was 1.64 (95% CI: 1.19–2.20), for deaths of somatic cause 0.88 (0.56–1.31), for drug-induced deaths 0.44 (0.23–0.76), and traumatic deaths 0.24 (0.10–0.50). Off-versus-on-OAT all-cause mortality ratio was 2.31 (1.00–4.85). On OAT, 58% of the deaths were of somatic cause and 21% drug-induced; off OAT, 38% of somatic cause and 50% drug-induced. Increasing baseline age and rate of somatic hospital treatment episodes were independently associated with increased all-cause mortality risk, while increasing rate of in-patient psychiatric treatment episodes was associated with reduced risk. Increasing duration of nicotine and cannabis use and alcohol dependence as well as increasing severity of polydrug use were associated with increased all-cause and somatic mortality adjusted for age and sex. Conclusion: The long observation period made it possible to demonstrate the importance of long-term retention in OAT to reduce mortality. Further, the preponderance of somatic and reduction of drug-induced causes of death during OAT underlines the need for follow-up of chronic diseases and health-promoting lifestyle changes. These findings add to the knowledge about long-term OAT effects, not least in ageing OAT populations.
Eur Addict Res

中文翻译：

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接受和停止阿片受体激动剂治疗的患者的死亡率、死亡原因和死亡预测因素：一项 19 年队列研究的结果

背景：阿片类药物使用障碍患者的死亡率增加，但在接受阿片类药物激动剂治疗 (OAT) 时死亡率降低。然而，患者和治疗特征对死亡率和死因的影响尚未得到充分研究。目的：本研究的目的是探讨死亡率和死亡原因，并检查患者和治疗特征对具有高治疗保留率的 OAT 队列中的死亡率的影响。方法： 设计：纵向队列研究。环境: 挪威。观察期：OAT 从 1998 年开始到死亡或 2016 年底，共 2,508 人年（PY）。样本：200 人，从 1998-2007 年开始 OAT。数据来源：医院记录、访谈、挪威死因登记处、挪威统计局。结果：保留：86.4% 的观察期处于 OAT 状态，9.0% 关闭，4.6% 未知 OAT 状态。整个观察期内每 100 年的全因粗死亡率为 1.64（95% CI：1.19-2.20），躯体原因死亡 0.88（0.56-1.31），药物性死亡 0.44（0.23-0.76），和创伤性死亡 0.24 (0.10–0.50)。OAT 非与非 OAT 全因死亡率为 2.31 (1.00–4.85)。在 OAT 中，58% 的死亡是躯体原因，21% 是药物引起的；OAT，38% 的躯体原因和 50% 的药物引起的。基线年龄的增加和躯体住院治疗的发生率与增加的独立相关全因死亡风险，而住院精神科治疗次数的增加与风险降低有关。尼古丁和大麻使用持续时间延长和酒精依赖以及多种药物使用严重程度的增加与根据年龄和性别调整后的全因和躯体死亡率增加有关。结论：长期观察期可以证明长期保留在 OAT 中以降低死亡率的重要性。此外，OAT 期间躯体的优势和药物引起的死亡原因的减少强调了对慢性疾病和促进健康的生活方式改变的随访的必要性。这些发现增加了关于长期 OAT 影响的知识，尤其是在老龄化 OAT 人群中。
欧洲瘾君子水库