History of SUD linked to increased risk of death from other diseases

Patients hospitalized with a substance use disorder (SUD) are much more likely to die of other medical conditions later in life, a new study has found.

Researchers looked at mortality following a diagnosis of 28 different medical conditions, including heart failure, cancer, diabetes, multiple sclerosis and stroke, and found that patients with a history of alcohol or drug abusers had a significantly increased risk of death after diagnosis of these conditions. . For seven of the medical conditions studied, a prior SUD was associated with a doubling of mortality risk.

“Our study highlights in detail the scale of the problem of high mortality among people with substance use disorders. The study provides evidence that should, ideally, motivate immediate and comprehensive action,” said lead researcher 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, said Medscape Medical News.

The results were published online November 3 in Lancet Psychiatry.

The usual treatment is not enough

The retrospective cohort study relied on hospitalization data from national registries in Czechia between 1994 and 2017. Studies in other countries have yielded similar results, suggesting that the results are not limited to people in Czechia.

The analysis included 121,153 people who had been hospitalized for TUS and 6,742,134 who had not. Of these, 24.2% of those with SUD and 21.2% of those without were subsequently hospitalized with at least one of the 28 medical condition researchers examined.

Those with pre-existing SUD had an increased risk of all-cause mortality after the onset of 26 out of 28 physical health problems compared to those without a history of SUD. 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 impaired thyroid.

People with a history of SUD were more than twice as likely to die from seven of the conditions studied – atrial fibrillation, diseases of the circulatory system, diverticular bowel disease, hypertension, ischemic heart disease, prostate disorders and disorders of the thyroid.

In men with anterior SUD, the largest losses of years of life were observed in people with heart failure with disease onset at age 30 (37.17 years of life lost; 95% CI, 32.26 – 41.88) and cancer with disease onset at age 45 (24.27 years of life lost; 95% CI, 23.82 – 24.72) .

For women with prior SUD, the greatest loss of years of life was seen in people with heart failure with disease onset at age 30 (41.49 years of life lost; 95% CI, 35.72 – 46.06) and heart failure with disease onset at age 45 (25.20 years of life lost; 95% CI, 21.15 – 29.41 ).

The researchers found no increased risk of death in just two conditions studied – multiple sclerosis and Parkinson’s disease.

There were no data on the type or frequency of patients receiving SUD treatment or whether they continued this treatment after discharge. There were also no data on subsequent SUD-related hospitalizations.

Global estimates suggest that more than 283 million people aged 15 or older suffer from alcohol use disorders. About 35.6 million have a drug use disorder.

Data from the World Mental Health Survey show that 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 could be deeper; even when people receive treatment for substance use disorders, there is still a huge gap in mortality following the development of health problems. physics,” Formánek said.

Although the study was not designed to reveal the reasons for the high mortality risk, the researchers say that the negative physical impact of SUD and low screening rates among people with SUD could be factors.

The findings offer several clinical and public health policy implications, the researchers note.

For clinicians, it is essential to be more proactive with patients with SUD, including helping patients access health screenings and prevention programs and treatments for SUD and other medical conditions .

“It seems that ‘usual treatment’ is not enough with this population and special attention is needed,” Formánek said.

“Interesting and Interesting”

In an accompanying editorial, Carsten Hjorthøj, Anne Emilie Stürup and Marie Starzer of the Copenhagen Center for Mental Health Research at the University of Copenhagen, Denmark, note that while the study results are not surprising , “the magnitude of 10 to 40 years of life 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 comment’s authors note that a successful response should be comprehensive, including legislative approaches, early detection, risk reduction and broad efforts to de-stigmatize. South.

“Formánek and his colleagues have clearly demonstrated the problem,” they write. “The international community must lead the way by providing the necessary solutions.”

The study was funded by the National Institute for Health and Care Research Applied Research Collaboration East of England in Cambridge and Peterborough National Health Service Foundation Trust. The study authors and editorial writers reported no relevant financial relationships.

Lancet Psych. Published online November 3, 2022. Full Text, Editorial

Kelli Whitlock Burton is a reporter for Medscape Medical News covering psychiatry and neurology.

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