Causes of death and expected years of life lost among treated opioid-dependent individuals in the United States and Taiwan.

Publication Type
Journal Article
Year of Publication
Chang, Kun-Chia; Wang, Jung-Der; Saxon, Andrew; Matthews, Abigail G; Woody, George; Hser, Yih-Ing
Int J Drug Policy
Date Published
2017 05
Adolescent; Adult; Aged; Analgesics, Opioid; Cause of Death; Cohort Studies; Drug Overdose; Female; Humans; Kaplan-Meier Estimate; Life Expectancy; Male; Middle Aged; Opiate Substitution Treatment; Opioid-Related Disorders; Randomized Controlled Trials as Topic; Suicide; Taiwan; United States; Young Adult

AIMS: This study compared the cause-specific standardized mortality ratios (SMRs) and expected years of life lost (EYLL) among opioid-dependent individuals in the United States and Taiwan.

METHODS: Survival data came from two cohorts followed until 2014: The U.S. data were based on a randomized trial of 1267 opioid-dependent participants enrolled between 2006 and 2009; the Taiwan data were from a study of 983 individuals that began in 2006, when opioid agonist treatment (OAT) was implemented in Taiwan. SMRs were calculated for each national cohort and compared. Kaplan-Meier estimation was performed on the survival data, then lifespans were extrapolated to 70 years (840 months) to estimate life expectancy using a semi-parametric method. EYLLs for both cohorts were estimated by subtracting their life expectancies from the age- and gender-matched referents within the general population of their respective country.

RESULTS: Compared with age- and gender-matched referents, the SMRs were 3.2 for the U.S. sample and 7.8 for the Taiwan sample; the EYLLs were 7.7 and 16.4 years, respectively. Half of decedents died of unnatural causes in both cohorts; overdose deaths predominated in the U.S. and suicide in Taiwan.

CONCLUSIONS: Our study identified differences by country in EYLL and causes of deaths. These findings suggest that intervention strategies to reduce mortality risk by overdose (particularly in the U.S.) and suicide (particularly in Taiwan) are urgently needed in these countries.