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

Autor:	Boden LI; Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA lboden@bu.edu., Asfaw A; National Institute for Occupational Safety and Health, Washington, District of Columbia, USA., O'Leary PK; Office of Retirement and Disability Policy, U.S. Social Security Administration, Washington, District of Columbia, USA., Tripodis Y; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA., Busey A; NERA Economic Consulting, Boston, Massachusetts, USA., Applebaum KM; Department of Environmental and Occupational Health, The George Washington University, Washington, District of Columbia, USA., Fox MP; Departments of Epidemiology and Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	Occupational and environmental medicine [Occup Environ Med] 2024 Oct 23; Vol. 81 (10), pp. 515-521. Date of Electronic Publication: 2024 Oct 23.
DOI:	10.1136/oemed-2024-109606
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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