Gender differences in mortality among treated opioid dependent patients

Abstract

Aims To assess gender differences in characteristics, mortality rates, and the causes and predictors of death among treated opioid-dependent individuals. Methods Linked vital statistics data were obtained for all individuals first enrolled in publicly-funded pharmacological treatment for opioid dependence in California from 2006–2010. Standardized mortality ratios (SMR) were calculated by gender. Cox proportional hazards models with time-varying covariates were fitted to determine the effect of gender on the hazard of all-cause mortality, controlling for covariates. Results Over a median 2.6 years (interquartile range: 1.4 – 3.7), 1,031 deaths were observed, including 2.2% (259/11,564) of women and 3.7% (772/20,758) of men. Women had a greater increased risk of mortality compared to the general population (SMR 5.1 95% CI: 4.5, 5.7) than men (SMR 4.3 95% CI: 4.0, 4.6). The relative risk of death for women compared with men was 1.18 (95% CI: 1.02, 1.36). Women had a lower instantaneous hazard of all-cause mortality than men (HR 0.58, 95% CI 0.50, 0.68), controlling for other factors. Significant interaction effects indicated that among men, mortality risk was decreased by full-time employment and increased by non-daily heroin use (relative to daily use) and medical problems. Concurrent opioid and methamphetamine/cocaine use increased mortality risk among women and decreased it among men. Conclusions Treatment for opioid dependence is likely to reduce mortality risk among men by addressing employment and medical problems, and via interventions to reduce overdose risk after heroin abstinence, and among women by attending to the concurrent use of methamphetamine/cocaine and opioids.

Adverse childhood experience effects on opioid use initiation, injection drug use, and overdose among persons with opioid use disorder

“…As has been documented in existing research, men in this sample reported earlier age of onset (Evans et al, 2015; Kelly et al, 2009) and were more likely to report recent IDU (Tetrault et al, 2008; Trenz et al, 2012) and lifetime overdose (Clausen et al, 2008) than women. However, women reported more ACEs overall and were nearly four times more likely to report childhood sexual abuse than men, consistent with prior research (Cavanaugh et al, 2015; Finkelhor et al, 2014).…”

Causes of death and expected years of life lost among treated opioid-dependent individuals in the United States and Taiwan

“…Despite the coincidental timing of the U.S. and Taiwan cohorts with similar inclusion and exclusion criteria, it is difficult to compare all the variables specifically relevant to each of the two different societies. Because similar mortality outcomes were found when we compared findings based on samples from Taiwan with those from the U.S. (Evans, Li et al, 2015; Lee et al, 2013; Evans, Kelleghan et al, 2015) using the SMRs to demonstrate the important mortality issues and EYLL to estimate the health burden in both of our cohorts could be representative of opioid-dependent individuals in their areas. Also, both EYLL estimates of these two cohorts could be conservative because of the selection bias (associated with the clinical trial model in the U.S. START study or with the design of including the first admitted cases to Taiwan OAT treatment) and uncertainty would be inevitable over lifetime extrapolation.…”

Association between cannabis use and methadone maintenance treatment outcomes: an investigation into sex differences

“…Women in MMT tend to show a higher prevalence of comorbid psychiatric and physical illnesses [16, 43, 44], as well as more severe opioid craving upon treatment entry [45] which may represent confounding factors that serve to increase rates of both cannabis and opioid use during MMT. As such, these patients may have motivation to use both drugs for purposes of self-medication.…”