title: Mortality among older adults with opioid use disorders in the Veteran's Health Administration, 2000-2011.
abstract: BACKGROUND
  The population of people with opioid use disorders (OUD) is aging. There has been little research on the effects of aging on mortality rates and causes of death in this group. We aimed to compare mortality in older (≥ 50 years of age) adults with OUD to that in younger (<50 years) adults with OUD and older adults with no history of OUD. We also examined risk factors for specific causes of death in older adults with OUD.
  
  
  METHODS
  Using data from the Veteran's Health Administration National Patient Care Database (2000-2011), we compared all-cause and cause-specific mortality rates in older adults with OUD to those in younger adults with OUD and older adults without OUD. We then generated a Cox regression model with specific causes of death treated as competing risks.
  
  
  RESULTS
  Older adults with OUD were more likely to die from any cause than younger adults with OUD. The drug-related mortality rate did not decline with age. HIV-related and liver-related deaths were higher among older OUD compared to same-age peers without OUD. There were very few clinically important predictors of specific causes of death.
  
  
  CONCLUSIONS
  Considerable drug-related mortality in people with OUD suggests a need for greater access to overdose prevention and opioid substitution therapy across the lifespan. Elevated risk of liver-related death in older adults may be addressed through antiviral therapy for hepatitis C virus infection. There is an urgent need to explore models of care that address the complex health needs of older adults with OUD.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia; Alpert Medical School, Brown University, Providence, RI, USA. Electronic address: s.larney@unsw.edu.au.
authors.forename: Sarah
authors.initials: S
authors.lastname: Larney
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA.
authors.forename: Amy S B
authors.initials: AS
authors.lastname: Bohnert
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA.
authors.forename: Dara
authors.initials: D
authors.lastname: Ganoczy
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ilgen
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hickman
authors.affiliation: Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA.
authors.forename: Fred C
authors.initials: FC
authors.lastname: Blow
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia; School of Population and global Health, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000473:pathology* / Q000523:psychology; D062787:Drug Overdose / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000401:mortality* / Q000523:psychology; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000639:trends*; D014728:Veterans / Q000523:psychology; D058014:Veterans Health / Q000639:trends*; D055815:Young Adult
keywords: Aging; Mortality; Opioid dependence; Veterans