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Drug abuse-associated mortality across the lifespan: a population-based longitudinal cohort and co-relative analysis

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Abstract

Purpose

Nationwide data have been lacking on drug abuse (DA)-associated mortality. We do not know the degree to which this excess mortality results from the characteristics of drug-abusing individuals or from the effects of DA itself.

Method

DA was assessed from medical, criminal, and prescribed drug registries. Relative pairs discordant for DA were obtained from the Multi-Generation and Twin Registers. Mortality was obtained from the Swedish Mortality registry.

Results

We examined all individuals born in Sweden 1955–1980 (n = 2,696,253), 75,061 of whom developed DA. The mortality hazard ratio (mHR) (95% CIs) for DA was 11.36 (95% CIs, 11.07–11.66), substantially higher in non-medical (18.15, 17.51–18.82) than medical causes (8.05, 7.77–8.35) and stronger in women (12.13, 11.52–12.77) than in men (11.14, 10.82–11.47). Comorbid smoking and alcohol use disorder explained only a small proportion of the excess DA-associated mortality. Co-relative analyses demonstrated substantial familial confounding in the DA–mortality association with the strongest direct effects seen in middle and late-middle ages. The mHR was highest for opiate abusers (24.57, 23.46–25.73), followed by sedatives (14.19, 13.11–15.36), cocaine/stimulants (12.01, 11.36–12.69), and cannabis (10.93, 9.94–12.03).

Conclusion

The association between registry-ascertained DA and premature mortality is very strong and results from both non-medical and medical causes. This excess mortality arises both indirectly—from characteristics of drug-abusing persons—and directly from the effects of DA. Excess mortality of opiate abuse was substantially higher than that observed for all other drug classes. These results have implications for interventions seeking to reduce the large burden of DA-associated premature mortality.

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Acknowledgements

This Project was supported by Grant R01DA030005 from the National Institutes of Health, the Swedish Research Council (K2012-70X-15428-08-3), the Swedish Research Council for Health, Working Life and Welfare (In Swedish: Forte; Reg. no.: 2013-1836), the Swedish Research Council (2012-2378; 2014-10134) and FORTE (2014-0804) as well as ALF funding from Region Skåne awarded.

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Authors and Affiliations

  1. Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Box 980126, Richmond, VA, 23298-0126, USA

    Kenneth S. Kendler

  2. Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA

    Kenneth S. Kendler

  3. Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA

    Kenneth S. Kendler

  4. Center for Primary Health Care Research, Lund University, Malmö, Sweden

    Henrik Ohlsson, Kristina Sundquist & Jan Sundquist

Authors
  1. Kenneth S. Kendler
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  2. Henrik Ohlsson
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Correspondence to Kenneth S. Kendler.

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Conflict of interest

The authors have no conflicts of interest to declare.

Ethical standards

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. We secured ethical approval for this study from the Regional Ethical Review Board of Lund University (No. 2008/409).

Appendix

Appendix

See Tables 3 and 4.

Table 3 Exact values of mortality hazard ratios for Fig. 2—results of genetic model fitting for co-relative design for drug abuse—cohort born 1955–1980
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Table 4 Exact values of mortality hazard ratios for Fig. 3—results of genetic model fitting for co-relative design for drug abuse—cohort born 1940–1980
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Kendler, K.S., Ohlsson, H., Sundquist, K. et al. Drug abuse-associated mortality across the lifespan: a population-based longitudinal cohort and co-relative analysis. Soc Psychiatry Psychiatr Epidemiol 52, 877–886 (2017). https://doi.org/10.1007/s00127-017-1398-5

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  • DOI: https://doi.org/10.1007/s00127-017-1398-5

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