Table 4. Cause-Specific Mortality Within 1 Year Among Patients Initiating Tramadol Prescription Compared With Propensity Score–Matched Other Analgesics.
| Cause of Death, No. | Nonselective NSAIDs | COX-2 Inhibitors | Weak Opioid | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Tramadol vs Naproxen | Tramadol vs Diclofenac | Tramadol vs Celecoxib | Tramadol vs Etoricoxib | |||||||||
| Tramadol (n = 12 397) | Naproxen (n = 12 397) | Tramadol (n = 6512) | Diclofenac (n = 6512) | Tramadol (n = 5674) | Celecoxib (n = 5674) | Tramadol (n = 2946) | Etoricoxib (n = 2946) | Tramadol (n = 16 922) | Codeine (n = 16 922) | |||
| Cardiovascular | 40 | 33 | 39 | 26 | 47 | 42 | 27 | 4 | 111 | 126 | ||
| HR (95% CI)a | 1.22 (0.77-1.94) | 1 [Ref] | 1.49 (0.90-2.44) | 1 [Ref] | 1.13 (0.74-1.70) | 1 [Ref] | 6.85 (2.43-19.30) | 1 [Ref] | 0.88 (0.68-1.13) | 1 [Ref] | ||
| Gastrointestinal | 20 | 10 | 20 | 10 | 11 | 6 | 3 | 4 | 38 | 49 | ||
| HR (95% CI)a | 1.99 (0.94-4.23) | 2.00 (0.94-4.28) | 1.82 (0.68-4.93) | 0.87 (0.18-4.20) | 0.77 (0.51-1.18) | |||||||
| Infection | 47 | 20 | 31 | 18 | 26 | 10 | 9 | 6 | 70 | 101 | ||
| HR (95% CI)a | 2.35 (1.38-3.98) | 1.73 (0.97-3.10) | 2.61 (1.27-5.38) | 1.64 (0.57-4.73) | 0.69 (0.51-0.93) | |||||||
| Cancer | 65 | 35 | 56 | 26 | 38 | 13 | 15 | 7 | 113 | 107 | ||
| HR (95% CI)a | 1.86 (1.24-2.81) | 2.10 (1.33-3.34) | 2.93 (1.57-5.47) | 2.16 (0.89-5.28) | 1.04 (0.8-1.36) | |||||||
| Respiratory | 23 | 19 | 23 | 8 | 25 | 11 | 13 | 3 | 63 | 75 | ||
| HR (95% CI)a | 1.22 (0.67-2.24) | 2.86 (1.28-6.41) | 2.27 (1.13-4.56) | 4.44 (1.30-15.17) | 0.84 (0.60-1.17) | |||||||
| Renal | 12 | 8 | 9 | 9 | 5 | 7 | 4 | 1 | 25 | 36 | ||
| HR (95% CI)a | 1.02 (0.40-2.58) | 0.69 (0.41-1.14) | ||||||||||
| Musculoskeletal | 12 | 12 | 6 | 5 | 10 | 1 | 4 | 1 | 21 | 21 | ||
| HR (95% CI)a | 1.02 (0.46-2.26) | |||||||||||
| Blood | 7 | 9 | 5 | 7 | 6 | 1 | 2 | 2 | 18 | 14 | ||
| Endocrine | 6 | 6 | 8 | 3 | 7 | 4 | 2 | 2 | 19 | 18 | ||
| Mental | 6 | 4 | 8 | 2 | 6 | 4 | 2 | 1 | 13 | 22 | ||
| Nervous system | 4 | 4 | 3 | 5 | 5 | 3 | 1 | 0 | 6 | 10 | ||
| Accidents | 6 | 3 | 5 | 2 | 2 | 0 | 0 | 0 | 8 | 5 | ||
| Sudden death | 4 | 4 | 5 | 0 | 5 | 3 | 4 | 2 | 14 | 7 | ||
| Unknown | 81 | 39 | 57 | 33 | 31 | 20 | 12 | 11 | 130 | 128 | ||
Abbreviations: COX-2, cyclooxygenase 2; HR, hazard ratio; NSAIDs, nonsteroidal anti-inflammatory drugs.
a
The HR (95% CI) was only estimated for the cause-specific death that contributed >5% of deaths to the total number of deaths within each matched-cohort except for unknown cause of death. The reference group is the second of the pair in each comparison.