Opioid-Related Mortality After Occupational Injury in Washington State: Accounting for Preinjury Opioid Use

Details

• Personal Author:
  Applebaum KM ; Asfaw A ; Boden LI ; Busey A ; Fox MP ; O'Leary PK ; Tripodis Y
• 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. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Epidemiology Mortality Occupational Health Safety
• Keywords:
  Cohort Studies Drug Overdose Injuries Lost Work Days Mortality Rates Opioids Substance Use
• ISSN:
  1351-0711
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Boston Region [OSHA] ; District of Columbia ; Massachusetts ; Philadelphia Region [OSHA] ; San Francisco Region [OSHA] ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OD - Office of the Director
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  81
• Issue:
  10
• NIOSHTIC Number:
  nn:20070179
• Citation:
  Occup Environ Med 2024 Oct; 81(10):515-521
• Email:
  lboden@bu.edu
• Federal Fiscal Year:
  2025
• Performing Organization:
  Boston University Medical Campus
• Peer Reviewed:
  True
• Start Date:
  20140701
• Source Full Name:
  Occupational and Environmental Medicine
• End Date:
  20170630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:50a4a7e1c8a932e55f855fe67c5179c2ce95a3ea0b6dcfd81f56dd5d3c69c88bf3660f6ea6b8db5f3cf583443c7ad911bf0b52b9d69b5bec9786faee39b6fc60
• Download URL:
  https://stacks.cdc.gov/view/cdc/208443/cdc_208443_DS1.pdf
• File Type:
  [PDF - 605.51 KB ]