New York State Psychiatric Institute, Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York.
Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy and Aging Research, Rutgers University, The State University of New Jersey, New Brunswick, New Jersey.
JAMA Psychiatry. 2018 Aug 1;75(8):820-827. doi: 10.1001/jamapsychiatry.2018.1471.
A recent increase in patients presenting with nonfatal opioid overdoses has focused clinical attention on characterizing their risks of premature mortality.
To describe all-cause mortality rates, selected cause-specific mortality rates, and standardized mortality rate ratios (SMRs) of adults during their first year after nonfatal opioid overdose.
DESIGN, SETTING, AND PARTICIPANTS: This US national longitudinal study assesses a cohort of patients aged 18 to 64 years who were Medicaid beneficiaries and experienced nonfatal opioid overdoses. The Medicaid data set included the years 2001 through 2007. Death record information was obtained from the National Death Index. Data analysis occurred from October 2017 to January 2018.
Crude mortality rates per 100 000 person-years were determined in the first year after nonfatal opioid overdose. Standardized mortality rate ratios (SMR) were estimated for all-cause and selected cause-specific mortality standardized to the general population with respect to age, sex, and race/ethnicity.
The primary cohort included 76 325 adults and 66 736 person-years of follow-up. During the first year after nonfatal opioid overdose, there were 5194 deaths, the crude death rate was 778.3 per 10 000 person-years, and the all-cause SMR was 24.2 (95% CI, 23.6-24.9). The most common immediate causes of death were substance use-associated diseases (26.2%), diseases of the circulatory system (13.2%), and cancer (10.3%). For every cause examined, SMRs were significantly elevated, especially with respect to drug use-associated diseases (SMR, 132.1; 95% CI, 125.6-140.0), HIV (SMR, 45.9; 95% CI, 39.5-53.0), chronic respiratory diseases (SMR, 41.1; 95% CI, 36.0-46.8), viral hepatitis (SMR, 30.6; 95% CI, 22.9-40.2), and suicide (SMR, 25.9; 95% CI, 22.6-29.6), particularly including suicide among females (SMR, 47.9; 95% CI, 39.8-52.3).
In a US national cohort of adults who had experienced a nonfatal opioid overdose, a marked excess of deaths was attributable to a wide range of substance use-associated, mental health, and medical conditions, underscoring the importance of closely coordinating the substance use, mental health, and medical care of this patient population.
最近出现了越来越多因非致命性阿片类药物过量而就诊的患者，这引起了临床对患者过早死亡风险特征的关注。
描述非致命性阿片类药物过量后第一年成年人的全因死亡率、特定病因死亡率和标准化死亡率比（SMR）。
设计、地点和参与者：这项美国全国性纵向研究评估了一个年龄在 18 至 64 岁的成年患者队列，他们是医疗补助受益人，经历了非致命性阿片类药物过量。医疗补助数据集中包括 2001 年至 2007 年的数据。死亡记录信息从国家死亡指数中获取。数据分析于 2017 年 10 月至 2018 年 1 月进行。
在非致命性阿片类药物过量后的第一年中，每 100000 人年确定的粗死亡率。对于所有原因和特定病因的死亡率，采用标准化死亡率比（SMR）进行了估计，这些死亡率根据年龄、性别和种族/民族与普通人群进行了标准化。
主要队列包括 76325 名成年人和 66736 人年的随访。在非致命性阿片类药物过量后的第一年中，有 5194 人死亡，粗死亡率为 778.3 人/10000 人年，全因 SMR 为 24.2（95%CI，23.6-24.9）。最常见的直接死因是与物质使用相关的疾病（26.2%）、循环系统疾病（13.2%）和癌症（10.3%）。对于所有检查的原因，SMR 均显著升高，尤其是与物质使用相关的疾病（SMR，132.1；95%CI，125.6-140.0）、HIV（SMR，45.9；95%CI，39.5-53.0）、慢性呼吸道疾病（SMR，41.1；95%CI，36.0-46.8）、病毒性肝炎（SMR，30.6；95%CI，22.9-40.2）和自杀（SMR，25.9；95%CI，22.6-29.6），特别是包括女性自杀（SMR，47.9；95%CI，39.8-52.3）。
在一个经历过非致命性阿片类药物过量的美国全国性成年人群队列中，大量的死亡归因于广泛的与物质使用相关的、心理健康和医疗状况，这突显了密切协调该患者群体的物质使用、心理健康和医疗保健的重要性。
