Patients hospitalized for substance use disorder (SUD) are significantly more likely to die from other medical conditions later in life, a new study suggests.
Researchers looked at mortality following a diagnosis of 28 different medical conditions, including heart failure, cancer, diabetes, multiple sclerosis, and stroke, and found patients with a history of alcohol or drug misuse had a significantly increased risk of death following diagnosis with those conditions. For seven of the medical conditions studied, prior SUD was associated with a doubling of mortality risk.
“Our study highlights in detail the scope of the problem of elevated mortality among people with substance use disorders. The study provides evidence that should, ideally, motivate immediate and comprehensive action,” lead investigator Tomáš Formánek, MSc, a doctoral student in psychiatry at the University of Cambridge in Cambridge, England, and the National Institute of Mental Health in Klecany, Czechia, told Medscape Medical News.
The findings were published online November 3 in The Lancet Psychiatry.
Treatment as Usual Not Enough
The retrospective cohort study drew on hospitalization data in the national registries in Czechia between 1994 and 2017. Studies in other countries have yielded similar results, suggesting the findings aren’t limited to people in Czechia.
Included in the analysis were 121,153 individuals who had been hospitalized for SUDs and 6,742,134 who had not. Of those, 24.2% of those with SUD and 21.2% of those without were subsequently hospitalized with at least one of the 28 medical conditions researchers examined.
Those with a preexisting SUD had an increased risk of all-cause mortality after the onset of 26 out of 28 physical health conditions compared with those with no SUD history. Adjusted odds ratios ranged from 1.15 (95% CI, 1.09 – 1.21) for chronic liver disease to 3.86 (95% CI, 2.62 – 5.67) for thyroid disorder.
Individuals with a history of SUD were more than twice as likely to die from seven of the conditions studied — atrial fibrillation, circulatory system diseases, diverticular disease of the intestine, hypertension, ischemic heart disease, prostate disorders, and thyroid disorder.
In men with prior SUD, the largest losses in life-years were found in people with heart failure with disease onset at age 30 years (37.17 lost life-years; 95% CI, 32.26 – 41.88) and cancer with disease onset at age 45 (24.27 lost life-years; 95% CI, 23.82 – 24.72).
For women with prior SUD, the largest losses in life-years were found in people with heart failure with disease onset at age 30 years (41.49 lost life-years; 95% CI, 35.72 – 46.06) and heart failure with disease onset at age 45 years (25.20 lost life-years; 95% CI, 21.15 – 29.41).
Researchers found no increased risk of death in just two conditions studied — multiple sclerosis and Parkinson’s disease.
There was no data on the type or frequency of SUD treatment patients received or whether they continued that treatment after discharge. There was also no data on subsequent SUD-related hospitalizations.
Worldwide estimates suggest that more than 283 million people aged 15 years or older have alcohol use disorders. About 35.6 million have a drug use disorder.
World Mental Health Survey data show only 10 in 100 people with substance use disorders in high income countries and 1 in 100 people with substance use disorders in low-income countries have access to even minimally adequate treatment.
“However, the results of our paper suggest that the problem might be deeper; even when people receive some treatment for substance use disorders, there is still a huge mortality gap following the development of physical health conditions,” Formánek said.
Although the study was not designed to reveal reasons for the elevated mortality risk, researchers say that the negative physical impact of SUD and low health screening rates among people with SUD could be factors.
The findings offer several clinical and public health policy implications, the researchers note.
For clinicians, being more proactive with patients with SUD is critical, including helping patients access health screenings and prevention programs and treatment for both SUD and other medical conditions.
“It seems that ‘treatment as usual’ is not sufficient with this population and special attention is needed,” Formánek said.
“Compelling and Concerning”
In an accompanying editorial Carsten Hjorthøj, Anne Emilie Stürup, and Marie Starzer of the Copenhagen Research Center for Mental Health at the University of Copenhagen, Denmark, note that while the results of the study aren’t surprising, “the magnitude of 10–40 life-years lost for most of the physical health conditions they investigated is both compelling and concerning.”
While the study demonstrates that a public health response is needed, the commentary authors note that a successful response would need to be comprehensive, including legislative approaches, early detection, harm reduction, and broad efforts to destigmatize SUD.
“Formánek and colleagues have clearly demonstrated the problem,” they write. “The international community must show the way forward by providing the required solutions.”
The study was funded by National Institute for Health and Care Research Applied Research Collaboration East of England at Cambridge and Peterborough National Health Service Foundation Trust. Study authors and editorialists reported no relevant financial relationships.
Kelli Whitlock Burton is a reporter for Medscape Medical News covering psychiatry and neurology.