Importance Extramedical opioid use has escalated in recent years. A better understanding of cause-specific mortality in this population is needed to inform comprehensive responses. Objective To estimate all-cause and cause-specific crude mortality rates (CMRs) and standardized mortality ratios (SMRs) among people using extramedical opioids, including age- and sex-specific estimates when possible. Data Sources For this systematic review and meta-analysis, MEDLINE, PsycINFO, and Embase were searched for studies published from January 1, 2009, to October 3, 2019, and an earlier systematic review on this topic published in 2011. Study Selection Cohort studies of people using extramedical opioids and reporting mortality outcomes were screened for inclusion independently by 2 team members. Data Extraction and Synthesis Data were extracted by a team member and checked by another team member. Study quality was assessed using a custom set of items that examined risk of bias and quality of reporting. Data were pooled using random-effects meta-analysis models. Heterogeneity was assessed using stratified meta-analyses and meta-regression. Main Outcomes and Measures Outcome measures were all-cause and cause-specific CMRs and SMRs among people using extramedical opioids compared with the general population of the same age and sex. Results Of 8683 identified studies, 124 were included in this analysis (100 primary studies and 24 studies providing additional data for primary studies). The pooled all-cause CMR, based on 99 cohorts of 1 262 592 people, was 1.6 per 100 person-years (95% CI, 1.4-1.8 per 100 person-years), with substantial heterogeneity (I2 = 99.7%). Heterogeneity was associated with the proportion of the study sample that injected opioids or was living with HIV infection or hepatitis C. The pooled all-cause SMR, based on 43 cohorts, was 10.0 (95% CI, 7.6-13.2). Excess mortality was observed across a range of causes, including overdose, injuries, and infectious and noncommunicable diseases. Conclusions and Relevance The findings suggest that people using extramedical opioids experience significant excess mortality, much of which is preventable. The range of causes for which excess mortality was observed highlights the multiplicity of risk exposures experienced by this population and the need for comprehensive responses to address these. Better data on cause-specific mortality in this population in several world regions appear to be needed.

中文翻译：

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使用非医疗类鸦片药物的人群中的全因和特定原因死亡率：系统评价和荟萃分析。

重要性近年来，医学上使用阿片类药物的人数不断上升。需要更好地了解该人群中因特定原因引起的死亡率，以提供全面的对策。目的评估使用非医疗类阿片类药物的人群的全因和因果关系的粗死亡率（CMR）和标准化死亡率（SMR），并在可能的情况下包括针对年龄和性别的估算。数据源为了进行系统的回顾和荟萃分析，搜索了MEDLINE，PsycINFO和Embase在2009年1月1日至2019年10月3日之间发表的研究，并在2011年对该主题进行了较早的系统综述。研究选择队列研究2名团队成员对使用阿片类药物治疗并报告死亡率结果的人群进行了独立筛选。数据提取和综合数据是由一个团队成员提取的，并由另一个团队成员检查的。使用一组定制项目评估研究质量，这些项目检查了偏倚风险和报告质量。使用随机效应荟萃分析模型汇总数据。使用分层荟萃分析和荟萃回归评估异质性。主要结果和措施结果措施是与同年龄和性别的普通人群相比，使用医学类阿片类药物的人群中的全因病因和特定原因的CMR和SMR。结果在8683项确定的研究中，有124项被纳入分析（100项基础研究和24项研究为基础研究提供了额外的数据）。基于99个队列的1,262592人的汇总全因CMR为每100人年1.6（95％CI，每100人年1.4-1.8），具有显着的异质性（I2 = 99.7％）。异质性与注射阿片类药物或患有HIV感染或丙型肝炎的研究样本的比例有关。基于43个队列的汇总全因SMR为10.0（95％CI，7.6-13.2）。在各种原因中都观察到过高的死亡率，包括过量，伤害，传染性和非传染性疾病。结论与相关性研究结果表明，使用药物外阿片类药物的人会出现明显的过高死亡率，其中大部分是可以预防的。观察到超标死亡率的原因范围突出表明，该人群经历了多种风险暴露，需要采取综合应对措施来解决这些问题。似乎需要在几个世界区域中提供有关该人群特定原因死亡率的更好数据。