Injury-Related Mortality Over 12Years in a Cohort of Patients with Alcohol Use Disorders: Higher Mortality Among Young People and Women.

Abstract

The goal of this study was to estimate excess death due to external causes among 18- to 64-year-olds with alcohol use disorder (AUD) who were treated at public outpatient treatment centers, and the time elapsed from treatment initiation to death. We conducted a retrospective longitudinal study among 7,012 outpatients aged 18 to 64years who began treatment for AUD between 1997 and 2007. Deaths due to external causes (intentional and unintentional injuries) were monitored until the end of 2008. Person-years (PY) of follow-up and crude mortality rates (CMRs) were calculated for all study variables, for each sex, and for 2 age groups (18 to 34 and 35 to 64years). Standardized mortality ratios (SMRs) were estimated by age group and sex. Survival was analyzed using the Kaplan-Meier method and Cox regression. We recorded 114 deaths due to external causes. The CMR was 2.7 per 1,000 PY (95% confidence interval [CI]: 2.2 to 3.2), with significant gender differences only among younger individuals (CMR for males=3.9 per 1,000 PY [95% CI: 2.2 to 5.5] and CMR for females=2.8 per 1,000 PY [95% CI: 0.1 to 5.6]). Unintentional injury was the most common cause of death (n=65), of which acute poisoning (n=25; 38.5%) and traffic accidents (n=15; 23.1%) were the most prevalent. Suicide accounted for 91.8% (n=49) of deaths from intentional injuries. The excess of mortality between the AUD group and the general population (SMR) was 9.5 higher than in the general population (95% CI: 7.9 to 11.4), with significant differences between genders (SMR=6.1 [95% CI: 4.9 to 7.5] in males and SMR=20.4 [95% CI: 13.9 to 29.9] in females). Approximately 35% of deaths among individuals aged <35years and 60% among women occurred within a year of initiating treatment. This study highlights the importance of excess of mortality among people with AUD and patients' vulnerability during the initial years of treatment. Preventing premature deaths due to external causes among women and younger patients with AUD is a priority.