Socioeconomic correlates of incident and fatal opioid overdose among Swedish people with opioid use disorder

Disa Dahlman,Alexis C Edwards,Jan Sundquist,Henrik Ohlsson,Anders Håkansson,Kristina Sundquist

doi:10.1186/s13011-021-00409-3

Abstract

BackgroundOpioid overdose (OD) and opioid OD death are major health threats to people with opioid use disorder (OUD). Socioeconomic factors are underexplored potential determinants of opioid OD. In this study, we assessed socioeconomic and other factors and their associations with incident and fatal opioid OD, in a cohort consisting of 22,079 individuals with OUD.MethodsWe performed a retrospective, longitudinal study based on Swedish national register data for the period January 2005–December 2017. We used Cox proportional hazard models to investigate the risk of incident and fatal opioid OD as a function of several individual, parental and neighborhood covariates.ResultsUnivariate analysis showed that several covariates were associated with incident and fatal opioid OD. In the multivariate analysis, incident opioid OD was associated with educational attainment (Hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.94–0.97), having received social welfare (HR 1.31; 95% CI 1.22–1.39), and criminal conviction (HR 1.53; 95% CI 1.42–1.65). Fatal opioid OD was also associated with criminal conviction (HR 1.93; 95% CI 1.61–2.32).ConclusionIndividuals with low education and receipt of social welfare had higher risks of incident opioid OD and individuals with criminal conviction were identified as a risk group for both incident and fatal opioid OD. Our findings should raise attention among health prevention policy makers in general, and among decision-makers within the criminal justice system and social services in particular.

Highlights

Drug overdoses (OD) are highly prevalent among people who use drugs; experienced by 17–68% and witnessed by 50–96% [1]
Correlates of incident opioid OD In the univariate analysis, incident opioid OD was positively associated with male sex, year of birth, criminal conviction, social welfare, neighborhood deprivation, living 10–50 km or 50+ km from the mother, and living 10–50 km or 50+ km from the father
We found that criminal conviction, educational attainment and social welfare receipt were associated with incident opioid OD in the multivariate analysis

Summary

Introduction

Drug overdoses (OD) are highly prevalent among people who use drugs; experienced by 17–68% and witnessed by 50–96% [1]. A recent systematic review from 2020 stated that socio-economic marginalization (SEM) is “an important but under-explored determinant of opioid overdose with important implications for health equity and associated public policy initiatives”, and that “There is a critical need for well-designed studies that explicitly and comprehensively examine the association between SEM variables and overdose as their primary purpose” [26]. This is because many previous studies have small sample sizes, compare OD descendants with the general population rather than with people with OUD, or have insufficient adjustment for confounding factors. We assessed socioeconomic and other factors and their associations with incident and fatal opioid OD, in a cohort consisting of 22,079 individuals with OUD

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