VA Connecticut Healthcare System, 950 Campbell Avenue, Mail Stop 151B, West Haven, CT 06516, USA; Yale School of Medicine, 367 Cedar Street, New Haven, CT 06510, USA.
VA Connecticut Healthcare System, 950 Campbell Avenue, Mail Stop 151B, West Haven, CT 06516, USA; Yale School of Medicine, 367 Cedar Street, New Haven, CT 06510, USA.
Drug Alcohol Depend. 2020 Jul 1;212:108003. doi: 10.1016/j.drugalcdep.2020.108003. Epub 2020 Apr 25.
Ascertainment of unnatural and overdose death may be unreliable among individuals with life-limiting conditions such as HIV infection. We sought to determine whether the relationship between opioid use and unnatural death differs among decedents with HIV (DWH) and those without.
Decedents in the Veterans Aging Cohort Study (VACS) from 2002 to 14 were linked to the National Death Index cause of death file. Deaths were classified as unnatural, overdose (a subset of unnatural), or other. We defined opioid use as self-reported illicit use or receipt of prescribed opioids. Treating unnatural and overdose deaths as outcomes, we calculated odds ratios for opioid exposure by HIV status, with and without adjustment for disease severity using VACS Index.
Among 561 decedents without HIV (DWOH) and 884 DWH, 11 % and 8 % respectively were classified as unnatural deaths and 4 % and 2 % were classified as overdose deaths. Among DWOH, opioid use was associated with 2-fold greater odds of unnatural (OR 2.3; 95 % CI 1.3-4.0) and 4-fold greater odds of overdose death (OR 4.5; 95 % CI 1.5-13.7); in adjusted analyses, opioid use was associated with unnatural death (OR 2.6; 95 % CI 1.3-4.9) and with overdose (OR 4.2; 95 % CI 1.4-12.7). Opioid use was not associated with unnatural or overdose death among DWH.
Opioid use was strongly associated with unnatural and overdose death among DWOH but not among DWH suggesting potential differential misclassification. Caution should be used in interpreting prevalence, incidence and risk factors for unnatural and overdose cause of death among patients with life-limiting conditions such as HIV.
在感染艾滋病毒等生命受限条件的个体中，非自然和过量死亡的确定可能不可靠。我们试图确定阿片类药物使用与艾滋病毒死亡者（DWH）和非艾滋病毒死亡者之间的非自然死亡之间的关系是否不同。
2002 年至 2014 年期间，退伍军人老龄化队列研究（VACS）中的死者与国家死亡指数死因档案相关联。死亡被分类为非自然、过量（非自然的一个子集）或其他。我们将阿片类药物使用定义为自我报告的非法使用或收到处方阿片类药物。将非自然和过量死亡视为结局，我们计算了 HIV 状态下阿片类药物暴露的比值比，包括和不包括 VACS 指数调整的疾病严重程度。
在 561 名无 HIV（DWOH）和 884 名 DWH 死亡者中，分别有 11%和 8%被归类为非自然死亡，4%和 2%被归类为过量死亡。在 DWOH 中，阿片类药物使用与非自然死亡的几率增加 2 倍（OR 2.3；95%CI 1.3-4.0）和过量死亡的几率增加 4 倍（OR 4.5；95%CI 1.5-13.7）；在调整后的分析中，阿片类药物使用与非自然死亡（OR 2.6；95%CI 1.3-4.9）和过量（OR 4.2；95%CI 1.4-12.7）相关。阿片类药物使用与 DWH 中的非自然或过量死亡无关。
阿片类药物使用与 DWOH 中的非自然和过量死亡密切相关，但与 DWH 无关，这表明可能存在差异分类。在解释生命受限条件（如艾滋病毒）患者的非自然和过量死因的流行率、发生率和危险因素时应谨慎。
