Mortality and Causes of Death among Individuals in a National Opioid Agonist Treatment Cohort.
5 affiliations
- 1Austrian National Public Health Institute (Gesundheit Österreich GmbH, GOEG), Vienna, Austria, [email protected].
- 2Doctoral Program Meduni Vienna, Medical University of Vienna, Vienna, Austria, [email protected].
- 3Austrian National Public Health Institute (Gesundheit Österreich GmbH, GOEG), Vienna, Austria.
- 4Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria.
- 5Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, USA.
Abstract
Introduction
People with opioid use disorder experience markedly elevated all-cause and cause-specific mortality. Opioid-agonist treatment (OAT) reduces mortality risk, and OAT populations across Europe are ageing, with cardiovascular, respiratory, and liver diseases accounting for a growing proportion of deaths. However, cause-specific mortality beyond overdose remains poorly characterized in large national cohorts.Methods
We conducted a retrospective cohort study including all 26,031 individuals (76% men) recorded in the Austrian national OAT registry between January 1, 2002, and December 31, 2019, linked to the national causes of death registry with follow-up through December 31, 2021. We calculated sex-specific age-standardized mortality rates per 100,000 person-years (2013 European Standard Population), standardized rate ratios (SRRs), and cause-specific standardized mortality ratios (SMRs) compared with the Austrian general population.Results
Across 278,959 person-years of follow-up, 2,358 deaths occurred. Cohort members had substantially higher mortality across all causes, with greater excess among women (SRR 7.06, 95% CI 6.45-7.72) than men (3.86; 3.69-4.04). Beyond substance use-related causes (SMR 33.2, 95% CI 31.4-35.2), the highest SMRs were found for viral hepatitis (63.8, 52.3-77.8), HIV (48.6, 39.0-60.6), and valvular heart diseases and endocarditis (28.4, 18.6-43.6). By the early to mid-40s, deaths from non-communicable diseases collectively exceeded those from substance use-related causes.Conclusion
Austria's national OAT cohort experiences substantial excess mortality across all major causes, with high relative excess for substance use-related, infectious, and liver-related conditions. As OAT populations age, non-communicable diseases account for an increasing share of deaths. Future analyses linking the cohort to additional data sources will be needed to disentangle the underlying contributions to this excess mortality.
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BibTeX
@article{schwarz2026mortality,
title = {{Mortality and Causes of Death among Individuals in a National Opioid Agonist Treatment Cohort.}},
author = {Tanja Schwarz and Judith Anzenberger and Martin Busch and Eva S Schernhammer and Susanne Strohmaier},
journal = {European addiction research},
year = {2026},
month = oct,
doi = {10.1159/ear/acrag005},
url = {https://europepmc.org/article/MED/42879347},
note = {CC BY},
}
RIS
TY - JOUR
TI - Mortality and Causes of Death among Individuals in a National Opioid Agonist Treatment Cohort.
AU - Tanja Schwarz
AU - Judith Anzenberger
AU - Martin Busch
AU - Eva S Schernhammer
AU - Susanne Strohmaier
PY - 2026
DA - 2026/10/15
JO - European addiction research
DO - 10.1159/ear/acrag005
UR - https://europepmc.org/article/MED/42879347
AB - Introduction People with opioid use disorder experience markedly elevated all-cause and cause-specific mortality. Opioid-agonist treatment (OAT) reduces mortality risk, and OAT populations across Europe are ageing, with cardiovascular, respiratory, and liver diseases accounting for a growing proportion of deaths. However, cause-specific mortality beyond overdose remains poorly characterized in large national cohorts.Methods We conducted a retrospective cohort study including all 26,031 individuals (76% men) recorded in the Austrian national OAT registry between January 1, 2002, and December 31, 2019, linked to the national causes of death registry with follow-up through December 31, 2021. We calculated sex-specific age-standardized mortality rates per 100,000 person-years (2013 European Standard Population), standardized rate ratios (SRRs), and cause-specific standardized mortality ratios (SMRs) compared with the Austrian general population.Results Across 278,959 person-years of follow-up, 2,358 deaths occurred. Cohort members had substantially higher mortality across all causes, with greater excess among women (SRR 7.06, 95% CI 6.45-7.72) than men (3.86; 3.69-4.04). Beyond substance use-related causes (SMR 33.2, 95% CI 31.4-35.2), the highest SMRs were found for viral hepatitis (63.8, 52.3-77.8), HIV (48.6, 39.0-60.6), and valvular heart diseases and endocarditis (28.4, 18.6-43.6). By the early to mid-40s, deaths from non-communicable diseases collectively exceeded those from substance use-related causes.Conclusion Austria's national OAT cohort experiences substantial excess mortality across all major causes, with high relative excess for substance use-related, infectious, and liver-related conditions. As OAT populations age, non-communicable diseases account for an increasing share of deaths. Future analyses linking the cohort to additional data sources will be needed to disentangle the underlying contributions to this excess mortality.
SN - 1022-6877
SN - 1421-9891
ER -