Chang Kun-Chia, Wang Jung-Der, Saxon Andrew, Matthews Abigail G, Woody George, Hser Yih-Ing
Jianan Psychiatric Center, Taiwan; National Cheng Kung University, Taiwan.
National Cheng Kung University, Taiwan; National Cheng Kung University Hospital, Taiwan.
Int J Drug Policy. 2017 May;43:1-6. doi: 10.1016/j.drugpo.2016.12.003. Epub 2017 Feb 1.
This study compared the cause-specific standardized mortality ratios (SMRs) and expected years of life lost (EYLL) among opioid-dependent individuals in the United States and Taiwan.
Survival data came from two cohorts followed until 2014: The U.S. data were based on a randomized trial of 1267 opioid-dependent participants enrolled between 2006 and 2009; the Taiwan data were from a study of 983 individuals that began in 2006, when opioid agonist treatment (OAT) was implemented in Taiwan. SMRs were calculated for each national cohort and compared. Kaplan-Meier estimation was performed on the survival data, then lifespans were extrapolated to 70 years (840 months) to estimate life expectancy using a semi-parametric method. EYLLs for both cohorts were estimated by subtracting their life expectancies from the age- and gender-matched referents within the general population of their respective country.
Compared with age- and gender-matched referents, the SMRs were 3.2 for the U.S. sample and 7.8 for the Taiwan sample; the EYLLs were 7.7 and 16.4 years, respectively. Half of decedents died of unnatural causes in both cohorts; overdose deaths predominated in the U.S. and suicide in Taiwan.
Our study identified differences by country in EYLL and causes of deaths. These findings suggest that intervention strategies to reduce mortality risk by overdose (particularly in the U.S.) and suicide (particularly in Taiwan) are urgently needed in these countries.
本研究比较了美国和台湾地区阿片类药物依赖者的特定病因标准化死亡率（SMR）和预期寿命损失年数（EYLL）。
生存数据来自两个随访至2014年的队列：美国的数据基于2006年至2009年招募的1267名阿片类药物依赖参与者的随机试验；台湾的数据来自一项始于2006年的983人的研究，当时台湾开始实施阿片类激动剂治疗（OAT）。计算每个国家队列的SMR并进行比较。对生存数据进行Kaplan-Meier估计，然后使用半参数方法将寿命外推至70岁（840个月）以估计预期寿命。通过从各自国家一般人群中年龄和性别匹配的参照对象的预期寿命中减去两个队列的预期寿命来估计EYLL。
与年龄和性别匹配的参照对象相比，美国样本的SMR为3.2，台湾样本的SMR为7.8；EYLL分别为7.7年和16.4年。两个队列中一半的死者死于非自然原因；美国以过量用药死亡为主，台湾以自杀为主。
我们的研究确定了不同国家在EYLL和死亡原因方面的差异。这些发现表明，在这些国家迫切需要采取干预策略来降低过量用药（特别是在美国）和自杀（特别是在台湾）导致的死亡风险。
