Opioid-related mortality after occupational injury in Washington State: accounting for preinjury opioid use

Details

• Alternative Title:
  Occup Environ Med
• Personal Author:
  Boden, Leslie I ; Asfaw, Abay ; O’Leary, Paul K ; Tripodis, Yorghos ; Busey, Andrew ; Applebaum, Katie M ; Fox, Matthew P
• Description:
  Objectives
  
  To estimate the impact of occupational injury and illness on opioid-related mortality while accounting for confounding by preinjury opioid use.
  
  Methods
  
  We employed a retrospective cohort study design using Washington State workers’ compensation data for 1994–2000 injuries linked to US Social Security Administration earnings and mortality data and National Death Index (NDI) cause of death data from 1994 to 2018. We categorised injuries as lost-time versus medical-only, where the former involved more than 3 days off work or permanent disability. We determined death status and cause of death from NDI records. We modelled separate Fine and Gray subdistribution hazard ratios (sHRs) and 95% CIs for injured men and women for opioid-related and all drug-related mortality through 2018. We used quantitative bias analysis to account for unmeasured confounding by preinjury opioid use.
  
  Results
  
  The hazard of opioid-related mortality was elevated for workers with lost-time relative to medical-only injuries: sHR for men: 1.53, 95% CI 1.41 to 1.66; for women: 1.31, 95% CI 1.16 to 1.48. Accounting for preinjury opioid use, effect sizes were reduced but remained elevated: sHR for men was 1.43, 95% simulation interval (SI) 1.20 to 1.69; for women: 1.27, 95% SI 1.10 to 1.45.
  
  Conclusions
  
  Occupational injuries and illnesses severe enough to require more than 3 days off work are associated with an increase in the hazard of opioid-related mortality. The estimated increase is reduced when we account for preinjury opioid use, but it remains substantial. Reducing work-related injuries and postinjury opioid prescribing and improving employment and income security may decrease opioid-related mortality.
  
  
• Subjects:
  Adult Analgesics, Opioid Cause Of Death Female Humans Male Middle Aged Occupational Injuries Opioid-Related Disorders Retrospective Studies Washington Workers' Compensation

  More +
• Source:
  Occup Environ Med. 81(10):515-521
• Pubmed ID:
  39327042
• Pubmed Central ID:
  PMC11526225
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; R01 OH011511/OH/NIOSH CDC HHSUnited States/ ; R21 OH010555/OH/NIOSH CDC HHSUnited States/
• Volume:
  81
• Issue:
  10
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:cbd5d571a10d799061805a75205fe560e1186a39f91f54bb7af11e17d782181ecb343a9b34e0dabfa1306a5c9b15457f4fb8153b622410887318b4d8d9f731fd
• Download URL:
  https://stacks.cdc.gov/view/cdc/168896/cdc_168896_DS1.pdf
• File Type:
  [PDF - 296.88 KB ]