Increased Risk of Opioid Overdose Death Following Cold Weather: A Case-Crossover Study.
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ABSTRACT:
SUBMITTER: Goedel WC
PROVIDER: S-EPMC6679791 | biostudies-literature | 2019 Sep
REPOSITORIES: biostudies-literature
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Increased Risk of Opioid Overdose Death Following Cold Weather: A Case-Crossover Study.
Goedel William C WC Marshall Brandon D L BDL Spangler Keith R KR Alexander-Scott Nicole N Green Traci C TC Wellenius Gregory A GA Weinberger Kate R KR
Epidemiology (Cambridge, Mass.) 20190901 5
<h4>Background</h4>The United States is in the midst of an opioid overdose crisis. Little is known about the role of environmental factors in increasing risk of fatal opioid overdose.<h4>Methods</h4>We conducted a case-crossover analysis of 3,275 opioid overdose deaths recorded in Connecticut and Rhode Island in 2014-2017. We compared the mean ambient temperature on the day of death, as well as average temperature up to 14 days before death, to referent periods matched on year, month, and day of ...[more]
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Project description:ImportanceA recent increase in patients presenting with nonfatal opioid overdoses has focused clinical attention on characterizing their risks of premature mortality.ObjectiveTo 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 participantsThis 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.Main outcomes and measuresCrude 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.ResultsThe 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).Conclusions and relevanceIn 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.
| S-EPMC6143082 | biostudies-literature
Project description:ObjectiveTo test a priori hypothesis of an association between season-specific cold spells and sudden cardiac death (SCD).MethodsWe conducted a case-crossover study of 3614 autopsy-verified cases of SCD in the Province of Oulu, Finland (1998-2011). Cold spell was statistically defined by applying an individual frequency distribution of daily temperatures at the home address during the hazard period (7 days preceding death) and 50 reference periods (same calendar days of other years) for each case using the home coordinates. Conditional logistic regression was applied to estimate ORs for the association between the occurrence of cold spells and the risk of SCD after controlling for temporal trends.ResultsThe risk of SCD was associated with a preceding cold spell (OR 1.33; 95%?CI 1.00, 1.78). A greater number of cold days preceding death increased the risk of SCD approximately 19% per day (OR 1.19; 95%?CI 1.07 to 1.32). The association was strongest during autumn (OR 2.51; 95%?CI 1.27 to 4.96) and winter (OR 1.70; 95%?CI 1.13 to 2.55) and lowest during summer (OR 0.42; 95%?CI 0.15 to 1.18) and spring (OR 0.89; 95%?CI 0.45 to 1.79). The association was stronger for ischaemic (OR 1.55; 95%?CI 1.12 to 2.13) than for non-ischaemic SCD (OR 0.68; 95%?CI 0.32 to 1.45) verified by medicolegal autopsy.ConclusionsOur results indicate that there is an association between cold spells and SCD, that this association is strongest during autumn, when the weather event is prolonged, and with cases suffering ischaemic SCD. These findings are subsumed with potential prevention via weather forecasting, medical advice and protective behaviour.
| S-EPMC5695410 | biostudies-literature
Project description:BackgroundLittle is known about risk factors for repeated opioid overdose and fatal opioid overdose in the first year following nonfatal opioid overdose.MethodsWe identified a national retrospective longitudinal cohort of patients aged 18-64 years in the Medicaid program who received a clinical diagnosis of nonfatal opioid overdose. Repeated overdoses and fatal opioid overdoses were measured with the Medicaid record and the National Death Index. Rates of repeat overdose per 1000 person-years and fatal overdose per 100,000 person-years were determined. Hazard ratios of repeated opioid overdose and fatal opioid overdose were estimated by Cox proportional hazards.ResultsNearly two-thirds (64.8%) of the patients with nonfatal overdoses (total n = 75,556) had filled opioid prescriptions in the 180 days before initial overdose. During the 12 months after nonfatal overdose, the rate of repeat overdose was 295.0 per 1000 person-years and that of fatal opioid overdose was 1154 per 100,000 person-years. After controlling for age, sex, race/ethnicity, and region, the hazard of fatal opioid overdose was increased for patients who had filled a benzodiazepine prescription in the 180 days prior to their initial overdose (HR = 1.71, 95%CI: 1.46-1.99), whose initial overdose involved heroin (HR = 1.57, 95%CI:1.30-1.89), or who required mechanical ventilation at the initial overdose (HR = 1.86, 95%CI = 1.50-2.31).ConclusionsAdults treated for opioid overdose frequently have repeated opioid overdoses in the following year. They are also at high risk of fatal opioid overdose throughout this period, which underscores the importance of efforts to engage and maintain patients in evidence-based opioid treatments following nonfatal overdose.
| S-EPMC10398609 | biostudies-literature
Project description:BackgroundNonfatal opioid overdose (OD) is an opportunity to identify patients who may benefit from interventions to reduce repeated overdose (rOD). In this study, we sought to determine risk and protective factors associated with rOD.MethodsIn this retrospective cohort study of 4,155 patients aged 18-64 who presented to one of 16 emergency departments in a single Western Pennsylvania health system between July 2015 and January 2018 for index opioid overdose (iOD) and survived to discharge, we identified demographic and clinical factors association with rOD within one-year. Relative risk of repeated opioid overdose was estimated using adjusted Cox proportional hazard ratios (aHRs).Results14.9 % of patients (95 % CI 13.9-16.1) had a rOD, with 29 % occurring within 30 days from iOD. The adjusted hazard of opioid overdose was increased for male patients (aHR = 1.19; 95 % CI 1.01, 1.41), those with pre-iOD diagnoses of anxiety (aHR = 1.41; 95 % CI1.13, 1.77), depression (aHR = 1.44; 95 % CI 1.17, 1.78), substance use disorders (aHR = 1.30; 95 % CI 1.09, 1.55), and alcohol use disorder (aHR = 1.52; 95 % CI 1.02, 2.25). The hazard was lower for individuals prescribed an opioid in the 90 days prior to iOD (aHR = 0.59; 95 % CI 0.37, 0.97) and those admitted to the hospital for iOD (aHR = 0.56; 95 % CI 0.37, 0.86).ConclusionWe found that, among ED patients who survive an initial OD, mental health and substance use diagnoses are associated with a higher hazard of repeated overdoses whereas opioids prescriptions and admission are associated with lower hazards.
| S-EPMC7127977 | biostudies-literature
Project description:IntroductionOpioid and sedative/hypnotic drug overdoses are major causes of morbidity in the U.S. This study compares 12-month incidence of fatal unintentional drug overdose, suicide, and other mortality among emergency department patients presenting with nonfatal opioid or sedative/hypnotic overdose.MethodsThis is a retrospective cohort study using statewide, longitudinally linked emergency department patient record and mortality data from California. Participants comprised all residents presenting to a licensed emergency department at least once in 2009-2011 with nonfatal unintentional opioid overdose, sedative/hypnotic overdose, or neither (a 5% random sample). Participants were followed for 1 year after index emergency department presentation to assess death from unintentional overdose, suicide, or other causes, ascertained using ICD-10 codes. Absolute death rates per 100,000 person years and standardized mortality ratios relative to the general population were calculated. Data were analyzed February-August 2019.ResultsFollowing the index emergency department visit, unintentional overdose death rates per 100,000 person years were 1,863 following opioid overdose, 342 following sedative/hypnotic overdose, and 31 for reference patients without an index overdose (respective standardized mortality ratios of 106.1, 95% CI=95.2, 116.9; 24.5, 95% CI=21.3, 27.6; and 2.6, 95% CI=2.2, 3.0). Suicide mortality rates per 100,000 were 319, 174, and 32 following opioid overdose, sedative/hypnotic overdose, and reference visits, respectively. Natural causes mortality rates per 100,000 were 8,058 (opioid overdose patients), 17,301 (sedative/hypnotic overdose patients), and 3,097 (reference patients).ConclusionsEmergency department patients with nonfatal opioid or sedative/hypnotic drug overdose have exceptionally high risks of death from unintentional overdose, suicide, and other causes. Emergency department-based interventions offer potential for reducing these patients' overdose and other mortality risks.
| S-EPMC7311279 | biostudies-literature
Project description:IntroductionIn the context of an opioid public health crisis, U.S. medical schools have been called upon to strengthen curricula on the appropriate use of opioids, with an emphasis on maximizing benefits while utilizing risk-mitigation strategies to prevent addiction and overdose.MethodsThis self-contained module provides an overview of the opioid crisis and presents recent clinical guidelines on opioid risk mitigation, as well as information regarding prevention and treatment of opioid overdose. This module then gives learners the opportunity to practice these skills by solving an evolving case of back pain.ResultsVerbal and written feedback on the module from students revealed that the majority strongly agreed that, overall, the module was valuable as an educational tool.DiscussionThis module was created to help medical educators update the training of students in risk mitigation strategies and the steps of opioid overdose resuscitation. The feedback to date from students and faculty has been positive and supports its use in undergraduate medical education.
| S-EPMC6338191 | biostudies-literature
Project description:Opioid overdose deaths in the U.S. rose dramatically after 1999, but also exhibited substantial geographic variation. This has largely been explained by differential availability of prescription and non-prescription opioids, including heroin and fentanyl. Recent studies explore the underlying role of socioeconomic factors, but overlook the influence of job loss due to international trade, an economic phenomenon that disproportionately harms the same regions and demographic groups at the heart of the opioid epidemic. We used OLS regression and county-year level data from the Centers for Disease Controls and the Department of Labor to test the association between trade-related job loss and opioid-related overdose death between 1999 and 2015. We find that the loss of 1000 trade-related jobs was associated with a 2.7 percent increase in opioid-related deaths. When fentanyl was present in the heroin supply, the same number of job losses was associated with a 11.3 percent increase in opioid-related deaths.
| S-EPMC6606896 | biostudies-literature
Project description:Background"Lock-in" programs (LIPs) identify beneficiaries demonstrating potential overutilization of opioids, and other controlled substances, and restrict their access to these medications. LIPs are expanding to address the opioid crisis and could be an effective tool for connecting people to opioid use disorder treatment. We examined the immediate and sustained effects of a Medicaid LIP on overdose risk and use of medication-assisted treatment (MAT) for opioid use disorder.MethodsWe analyzed North Carolina Medicaid claims from July 2009 through June 2013. We estimated daily risk differences and ratios of MAT use and overdose during lock-in and following release from the program, compared with periods before program enrollment.ResultsThe daily probability of MAT use during lock-in and following release was greater, when compared with a period just before LIP enrollment [daily risk ratios: 1.50, 95% confidence interval (CI): 1.18-1.91; 2.27, 95% CI: 1.07-4.80; respectively]. Beneficiaries' average overdose risk while enrolled in the program and following release was similar to their risk just before enrollment (daily risk ratios: 1.01, 95% CI: 0.79-1.28; 1.12, 95% CI: 0.82-1.54; respectively).DiscussionNorth Carolina's Medicaid LIP was associated with increased use of MAT during enrollment, and this increase was sustained in the year following release from the program. However, we did not observe parallel reductions in overdose risk during lock-in and following release. Identifying facilitators of MAT access and use among this population, as well as potential barriers to overdose reduction are important next steps to ensuring effective LIP design.
| S-EPMC7083172 | biostudies-literature
Project description:BACKGROUND:The first evidence that the hazard ratio (HR) for methadone-specific death rises more steeply with age-group than for all drug-related deaths (DRDs) came from Scotland's cohort of 33,000 methadone-prescription clients. We aim to examine, for England, whether illicit opioid users' risk of methadone-specific death increases with age; and to pool age-related HRs for methadone-specific deaths with those for Scotland's methadone-prescription clients. METHODS:The setting is all services in England that provide publicly-funded, structured treatment for illicit opioid users, the methodology linkage of the English National Drug Treatment Monitoring System and mortality database, and key measurements are DRDs, methadone-specific DRDs, or heroin-specific DRDs, by age-group and gender, with proportional hazards adjustment for substances used, injecting status and periods in/out of treatment. RESULTS:Linkage was achieved for 129,979 adults receiving prescribing treatment modalities for opioid dependence during April 2005 to March 2009 and followed-up for 378,009 person-years (pys). There were 1,266 DRDs: 271 methadone-specific (7 per 10,000 pys: irrespective of gender) and 473 heroin-specific (15 per 10,000 pys for males, 7 for females). Methadone-specific DRD-rate per 10,000 person-years was 3.5 (95% CI: 2.7-4.4) at 18-34 years, 8.9 (CI: 7.3-10.5) at 35-44 years and 18 (CI: 13.8-21.2) at 45+ years; heroin-specific DRD-rate was unchanged with age. Relative to 25-34 years, pooled HRs for UK clients' methadone-specific deaths were: 0.87 at <25 years (95% CI: 0.56-1.35); 2.14 at 35-44 years (95% CI: 1.76-2.60); 3.75 at 45+ years (95% CI: 2.99-4.70). CONCLUSION:International testing and explanation are needed of UK's sharp age-related increase in the risk of methadone-specific death. Clients should be alerted that their risk of methadone-specific death increases as they age.
| S-EPMC6004035 | biostudies-literature
Project description:The spatial synoptic classification (SSC) is a holistic categorical assessment of the daily weather conditions at specific locations; it is a useful tool for assessing weather effects on health. In this study, we assessed (a) the effect of hot weather types and the duration of heat events on cardiovascular and respiratory mortality in summer and (b) the effect of cold weather types and the duration of cold events on cardiovascular and respiratory mortality in winter. A time-stratified case-crossover design combined with a distributed lag nonlinear model was carried out to investigate the association of weather types with cause-specific mortality in two southern (Skåne and Stockholm) and two northern (Jämtland and Västerbotten) locations in Sweden. During summer, in the southern locations, the Moist Tropical (MT) and Dry Tropical (DT) weather types increased cardiovascular and respiratory mortality at shorter lags; both hot weather types substantially increased respiratory mortality mainly in Skåne. The impact of heat events on mortality by cardiovascular and respiratory diseases was more important in the southern than in the northern locations at lag 0. The cumulative effect of MT, DT and heat events lagged over 14 days was particularly high for respiratory mortality in all locations except in Jämtland, though these did not show a clear effect on cardiovascular mortality. During winter, the dry polar and moist polar weather types and cold events showed a negligible effect on cardiovascular and respiratory mortality. This study provides valuable information about the relationship between hot oppressive weather types with cause-specific mortality; however, the cold weather types may not capture sufficiently effects on cause-specific mortality in this sub-Arctic region.
| S-EPMC7445203 | biostudies-literature