Abstract
ObjectiveThe objective of this study was to evaluate age-sex standardized death rates (ASDR) from all causes from 2011 to 2015 among people who have accessed opioid agonist treatment (OAT) and compare rates living in the Northern and Southern areas of Ontario.MethodsRoutinely collected administrative health data was used to calculate crude death rates and age-sex standardized death rates (ASDRs) per 1,000,000 population of individuals who accessed OAT and compared the rates geographically from 2011 to 2015. The weighted ASDRs for each year were calculated by using the mid-year population of these regions. The rate ratios were calculated considering the base year as 2011. ResultsA total of 55,924 adults who accessed OAT were included between January 1, 2011, and December 31, 2015. The majority of patients in the cohort - 52.3% - were between 15 and 34 years old, 32.5% were female, 11.3% were in the lowest income group, 71.1% lived in Southern areas. Overall, the ASDR steadily increased during the study period and spiked in 2015. We found that among individuals who had accessed OAT, living in Southern Ontario was associated with a lower risk of all-cause mortality than those living in Northern Ontario. ASDR for Northern Ontario was 20.0 (95% confidence interval (CI)= 10.2-34.2) in 2011, and 103.5(95%CI=78.5-133.5) in 2015, which was a five-fold increase from 2011. Whereas in Southern Ontario, ASDR in 2011 was 13.8 (95% CI= 11.5-16.5), and in 2015 ASDR was 60.8 (95%CI=55.8-66.1), which was only a 4-fold increase from 2011ConclusionOur findings demonstrate evidence of a steadily increasing ASDR among individuals who accessed OAT with higher rates in Northern areas of the province before the era of synthetic opioids in Ontario, Canada.
Highlights
Opioid use disorder (OUD) continues to devastate communities across North America with increasing opioid-related death rates
We found that among individuals who had accessed opioid agonist treatment (OAT), living in Southern Ontario was associated with a lower risk of all-cause mortality than those living in Northern Ontario
Drawing on a population-based cohort of 55,924 individuals, we identified that the crude death rate and age-sex standardized death rates (ASDR) in individuals who accessed OAT were consistently higher than the death rate in the Ontario population
Summary
Opioid use disorder (OUD) continues to devastate communities across North America with increasing opioid-related death rates. In Canada, as of September 2020, reports show that opioid toxicity deaths have reached their highest count since national surveillance began in 2016. By 2018, three-quarters of deaths among people who use opioids were due to synthetic opioids [1]. In Ontario, the most populated province in Canada, Northern areas with limited access to health care services have death rates among people with OUD two times higher than urban areas [1]. Research focusing on mortality within the OUD population has often focused on crude death rates specific to opioid-related poisonings [2]. Opioid poisoning only accounts for 21% of deaths related to opioids [2]. There is a growing body of evidence suggesting that misclassification of opioid-related deaths is common because of the ambiguous circumstantial information on death certificates [3] making drawing conclusions from this
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
