title: Injury-Related Mortality Over 12 Years in a Cohort of Patients with Alcohol Use Disorders: Higher Mortality Among Young People and Women.
abstract: BACKGROUND
  The goal of this study was to estimate excess death due to external causes among 18- to 64-year-olds with alcohol use disorder (AUD) who were treated at public outpatient treatment centers, and the time elapsed from treatment initiation to death.
  
  
  METHODS
  We conducted a retrospective longitudinal study among 7,012 outpatients aged 18 to 64 years who began treatment for AUD between 1997 and 2007. Deaths due to external causes (intentional and unintentional injuries) were monitored until the end of 2008. Person-years (PY) of follow-up and crude mortality rates (CMRs) were calculated for all study variables, for each sex, and for 2 age groups (18 to 34 and 35 to 64 years). Standardized mortality ratios (SMRs) were estimated by age group and sex. Survival was analyzed using the Kaplan-Meier method and Cox regression.
  
  
  RESULTS
  We recorded 114 deaths due to external causes. The CMR was 2.7 per 1,000 PY (95% confidence interval [CI]: 2.2 to 3.2), with significant gender differences only among younger individuals (CMR for males = 3.9 per 1,000 PY [95% CI: 2.2 to 5.5] and CMR for females = 2.8 per 1,000 PY [95% CI: 0.1 to 5.6]). Unintentional injury was the most common cause of death (n = 65), of which acute poisoning (n = 25; 38.5%) and traffic accidents (n = 15; 23.1%) were the most prevalent. Suicide accounted for 91.8% (n = 49) of deaths from intentional injuries. The excess of mortality between the AUD group and the general population (SMR) was 9.5 higher than in the general population (95% CI: 7.9 to 11.4), with significant differences between genders (SMR = 6.1 [95% CI: 4.9 to 7.5] in males and SMR = 20.4 [95% CI: 13.9 to 29.9] in females). Approximately 35% of deaths among individuals aged <35 years and 60% among women occurred within a year of initiating treatment.
  
  
  CONCLUSIONS
  This study highlights the importance of excess of mortality among people with AUD and patients' vulnerability during the initial years of treatment. Preventing premature deaths due to external causes among women and younger patients with AUD is a priority.
authors.affiliation: Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain.|Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Guitart
authors.affiliation: Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain.|Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.|CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.|Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autónoma de Barcelona, Bellaterra, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Espelt
authors.affiliation: Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain.|Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Castellano
authors.affiliation: Agència de Salut Pública de Catalunya (ASPCAT), Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Suelves
authors.affiliation: Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain.|Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.|CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Joan R
authors.initials: JR
authors.lastname: Villalbí
authors.affiliation: Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain.|Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Brugal
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D019973:Alcohol-Related Disorders / Q000150:complications / Q000401:mortality*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology; D014947:Wounds and Injuries / Q000209:etiology / Q000401:mortality*; D055815:Young Adult
keywords: Alcohol-Related Disorders; Causes of Death; Excess Mortality; Premature Mortality