title: Associations between substance use disorder sub-groups, life expectancy and all-cause mortality in a large British specialist mental healthcare service.
abstract: BACKGROUND
  People with substance use disorders (SUDs) have increased risk of mortality but risk in sub-groups is poorly understood.
  
  
  METHODS
  SUD cases, aged 15 years or older, were identified in the South London and Maudsley Case Register which contains over 150,000 specialist mental healthcare and addictions service users linked to regular national mortality tracing. Standardized mortality ratios (SMRs) for the period 2007-2009 were calculated based on expected numbers of deaths for England and Wales in 2008 then stratified by gender, age, ethnicity, and type of substance use disorder. Life expectancies at birth were estimated.
  
  
  RESULTS
  We detected 10,927 cases with a primary substance use disorder diagnosis prior to 2010, who were active to South London and Maudsley NHS Foundation Trust services between 2007 and 2009. Alcohol and opioid use disorders were the most common disorders (45.4% and 44.2% of the SUD cohort respectively) and were associated with increased mortality (SMRs 4.04 and 4.85 respectively). Subgroups at particularly high risk were women with opioid use disorder (SMR 7.32) and those under the age of 45 years with alcohol use disorder (SMR 9.25). SMRs associated with alcohol and opioid use disorders diminished with age. Life expectancies of individuals with alcohol and opioid use disorders were reduced by 9-17 years compared to national norms.
  
  
  CONCLUSIONS
  Those under 45 years with alcohol use disorder and women with opioid use disorder are at particularly high risk of mortality. More targeted health care is required to address the specific needs of these vulnerable subgroups.
authors: King's College London, Institute of Psychiatry, Section of Epidemiology, UK. richard.hayes@kcl.ac.uk
authors: Richard D
authors: RD
authors: Hayes
authors: Chin-Kuo
authors: CK
authors: Chang
authors: Andrea
authors: A
authors: Fernandes
authors: Matthew
authors: M
authors: Broadbent
authors: William
authors: W
authors: Lee
authors: Matthew
authors: M
authors: Hotopf
authors: Robert
authors: R
authors: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000401:mortality*; D015331:Cohort Studies; D016208:Databases, Factual; D004739:England; D005006:Ethnicity; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008297:Male; D001523:Mental Disorders / Q000401:mortality*; D008605:Mental Health Services; D008875:Middle Aged; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000401:mortality*; D055815:Young Adult