Table 4. Factors associated with mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006-2010.
(n=90,509 episodes as experienced by 32,222 individuals, of whom 1,031 died)
| All-cause (n=1,031) | Cause-specific | |||
|---|---|---|---|---|
| Drug-related (n=450) | HCV/HIV (n=57) | Other causes (n=524) | ||
| Model | 1a | 2ai | 2bi | 2ci |
| HR (95% CI) | HR (95% CI) | HR (95% CI) | HR (95% CI) | |
| Episode type (ref. out-of-treatment)ˆ | ||||
| Detoxification | 0.22 (0.13, 0.36) | 0.12 (0.05, 0.28) | 0.28 (0.04, 2.24) | 0.34 (0.18, 0.64) |
| Maintenance treatment | 0.27 (0.23, 0.32) | 0.24 (0.18, 0.33) | 0.19 (0.09, 0.40) | 0.30 (0.23, 0.37) |
| Primary drug (ref. daily heroin)ˆ | ||||
| Daily prescription opioids | 1.02 (0.86, 1.22) | 0.84 (0.65, 1.09) | 1.11 (0.48, 2.56) | 1.23 (0.96, 1.58) |
| Non-daily prescription opioids | 0.78 (0.62, 0.99) | 0.57 (0.39, 0.82) | na | 1.13 (0.82, 1.55) |
| Non-daily heroin | 1.14 (0.97, 1.35) | 0.95 (0.74, 1.22) | 1.28 (0.68, 2.39) | 1.34 (1.07, 1.67) |
| Model | 1b | 2aii | 2bii | 2cii |
| HR (95% CI) | HR (95% CI) | HR (95% CI) | HR (95% CI) | |
| Episode type (ref. out-of-treatment)ˆ | ||||
| Detoxification with no prior maintenance treatment | 0.21 (0.13, 0.35) | 0.11 (0.05, 0.27) | 0.28# (0.03, 2.22) | 0.33 (0.17, 0.65) |
| Detoxification with prior maintenance treatment | 0.63 (0.16, 2.53) | 0.62 (0.09, 4.45) | 0.69 (0.10, 4.91) | |
| Maintenance treatment with no prior detoxification | 0.30 (0.25, 0.37) | 0.26 (0.18, 0.36) | 0.17 (0.07, 0.41) | 0.34 (0.26, 0.44) |
| Maintenance treatment with prior detoxification | 0.20 (0.14, 0.28) | 0.21 (0.12, 0.35) | 0.25 (0.08, 0.82) | 0.19 (0.11, 0.31) |
| Primary drug (ref. daily heroin)ˆ | ||||
| Daily prescription opioids | 1.02 (0.86, 1.22) | 0.84 (0.65, 1.09) | 1.11 (0.48, 2.56) | 1.24 (0.96, 1.58) |
| Non-daily prescription opioids | 0.79 (0.62, 1.01) | 0.57 (0.39, 0.83) | na | 1.15 (0.84, 1.59) |
| Non-daily heroin | 1.15 (0.98, 1.35) | 0.95 (0.74, 1.23) | 1.28 (0.68, 2.38) | 1.34 (1.07, 1.68) |
time-varying variable. HR= Hazard Ratio; 95% CI = 95% confidence interval. Bolded values are statistically significant.
24 observations were deleted due to missingness.
Other variables included in each model and statistically significant but not shown above include: age, gender, race/ethnicity, has a disability,ˆ labor force status,ˆ Medi-Cal beneficiary,ˆ mentally ill,ˆ has hepatitis C,ˆ has tuberculosis,ˆ hospital stay in past 30 days,ˆ been tested for HIV.ˆ
Other variables included in each model but not statistically significant and not shown above include: educational attainment, years from 1st primary drug use to 1st treatment episode,ˆ criminal justice system involved,ˆ and secondary drug type.ˆ
Due to the relatively few HCV/HIV-related deaths, detoxification with and without prior MMT were collapsed into one category when treatment experiences were examined (Model 2bii).