Estimating the Burden of Early Loss of Life Due to Opioid Overdose

A recent study sought to quantify the burden of opioid-related deaths in the United States and compare this burden over time and by age and sex.

According to the Centers for Disease Control and Prevention (CDC), prescription opioid overdoses in the U.S. contributed to 830,652 years of life lost among people younger than 65 years in 2008. The authors of this current study state that more recent estimates of the burden of opioid-related harm are required, particularly since there is the rapid rise of opioid-related deaths across the United States, along with the increasing role of fentanyl and other illicit opioids in opioid-induced deaths.

See the full study at: Gomes T, et al. “The burden of opioid-related mortality in the United States.” JAMA Network Open 2018; 1(2): e180217.
The Meaning behind YLL

The Gomes study authors were from St Michael’s Hospital, the Institute for Clinical Evaluative Sciences, and Sunnybrook Research Institute, all located in Toronto, Canada. They noted that, by 2014, the United States and Canada had the highest per capita opioid consumption in the world. Deaths related to opioid use have increased dramatically in both countries, rising most quickly among adults aged 25 to 44 years in the United States.

Even as opioid prescribing and overdose has become one of the leading public health problems in North America, few studies have measured the burden of opioid addiction. The authors cite one study in 2010 which reported that, in North America, opioid dependence was responsible for nearly 1 million disability-adjusted life-years annually. The study also found that more than half of disability-adjusted years were attributed to years of life lost (YLL).

YLL is calculated by using standard 5-year life expectancy tables developed by the World Health Organization. They multiply the number of deaths by the standard life expectancy and then adjust for the average age at death within each 5-year group.
Methods

The Gomes study protocol included the use of the CDC Multiple Cause of Death online database to retrieve mortality and population estimates within the United States. This database captures cause of death data from death certificates of U.S. residents and includes both primary cause of death and up to 20 additional causes of death.

Opioid-related deaths were defined as those in which a prescription (i.e., oxycodone, hydrocodone) or illicit opioid (i.e., heroin, fentanyl) contributed to an individual’s cause of death as determined by death certificates. They compared the percentage of deaths attributable to opioids and the associated person YLL by age group.

The burden of opioid-related deaths was quantified two ways:

Proportion of all deaths in each age group that were opioid-related, calculated using age-specific, all-causes-of-death estimates as the denominator
YLL due to opioid-related deaths, calculated using standard 5-year life expectancy by the World Health Organization

Results

Over the 15-year study period, 335,123 opioid-related deaths in the United States met the inclusion criteria.

The increase in opioid-related deaths from 2001 to 2016 was 345%, from 9,489 in 2001 to 42,245 in 2016.

Other results included:

33.3 opioid-related deaths per million in 2001, compared to 130.7 deaths per million in 2016
By 2016, men accounted for 67.5% of all opioid-related deaths (n=28,496)
Median age at death was 40
Largest increase was observed among those aged 25-34 years (from 4.2% in 2001 to 20.0% in 2016); followed by those aged 15-24 years (increase from 2.9% to 12.4%)
In 2016, 18.4% (7,762 out of 42,245) of all opioid-related deaths in the U.S. occurred among those 55 and older

Burden of early loss of life from opioid overdose:

Opioid-related deaths were responsible for 1,681,359 YLL or 5.2 YLL per 1,000 population in the United States in 2016
When stratified by age, those aged 25-34 and 35-44 had the highest burden from opioid-related deaths (12.9 YLL per 1,000 population and 9.9 YLL per 1,000 population, respectively)
The burden of opioid-related death was higher among men (1,125,711 YLL; 7.0 YLL per 1,000 population) compared with women (555,648 YLL; 3.4 YLL per 1,000)
Among men aged 25-34, total YLL represented nearly one-quarter of all YLL in the U.S. in 2016 (411,805 of 1,681,359 or 24.5%)

Discussion

This study revealed that 1 in 65 deaths in the United States in 2016 was opioid-related. This represents an enormous toll in the years of life lost. This premature loss of life from opioid-related deaths exceeded those attributed to hypertension, HIV/AIDS, and pneumonia, and it amounted to one-tenth of the YLL due to cancer.

The premature loss of life was highest among adults aged 25-34 years, with 1 in 5 deaths related to opioids. Also, the increase in the proportion of deaths over the 15-year period attributed to opioids among adolescents and adults is alarming. This highlights the need for targeted programs and policies that focus on improved addiction care and harm reduction measures, particularly aimed at younger populations.

Richard L. Wynn, BS Pharm, PhD, is professor of pharmacology at the Baltimore College of Dental Surgery, Dental School, University of Maryland Baltimore.