title: Mortality from respiratory diseases associated with opium use: a population-based cohort study.
abstract: Recent studies have suggested that opium use may increase mortality from cancer and cardiovascular diseases. However, no comprehensive study of opium use and mortality from respiratory diseases has been published. We aimed to study the association between opium use and mortality from respiratory disease using prospectively collected data.
  
  
  
  We used data from the Golestan Cohort Study, a prospective cohort study in northeastern Iran, with detailed, validated data on opium use and several other exposures. A total of 50 045 adults were enrolled from 2004 to 2008, and followed annually until June 2015, with a follow-up success rate of 99%. We used Cox proportional hazard regression models to evaluate the association between opium use and outcomes of interest.
  
  
  
  During the follow-up period, 331 deaths from respiratory disease were reported (85 due to respiratory malignancies and 246 due to non-malignant aetiologies). Opium use was associated with an increased risk of death from any respiratory disease (adjusted HR 95% CI 3.13 (2.42 to 4.04)). The association was dose-dependent with a HR of 3.84 (2.61 to 5.67) for the highest quintile of cumulative opium use versus never use (Ptrend<0.001). The HRs (95% CI) for the associations between opium use and malignant and non-malignant causes of respiratory mortality were 1.96 (1.18 to 3.25) and 3.71 (2.76 to 4.96), respectively.
  
  
  
  Long-term opium use is associated with increased mortality from both malignant and non-malignant respiratory diseases.
authors.affiliation: Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Atieh
authors.initials: A
authors.lastname: Rahmati
authors.affiliation: Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ramin
authors.initials: R
authors.lastname: Shakeri
authors.affiliation: Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hooman
authors.initials: H
authors.lastname: Khademi
authors.affiliation: Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Poutschi
authors.affiliation: Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Akram
authors.initials: A
authors.lastname: Pourshams
authors.affiliation: Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.|Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.
authors.forename: Arash
authors.initials: A
authors.lastname: Etemadi
authors.affiliation: Golestan Research Center of Gastroenterology& Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: Masoud
authors.initials: M
authors.lastname: Khoshnia
authors.affiliation: Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Amir Ali
authors.initials: AA
authors.lastname: Sohrabpour
authors.affiliation: Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Aliasgari
authors.affiliation: Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Elham
authors.initials: E
authors.lastname: Jafari
authors.affiliation: Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.|American Cancer Society, Atlanta, Georgia, USA.
authors.forename: Farhad
authors.initials: F
authors.lastname: Islami
authors.affiliation: Golestan Research Center of Gastroenterology& Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: Shahryar
authors.initials: S
authors.lastname: Semnani
authors.affiliation: Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.|Golestan Research Center of Gastroenterology& Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran.
authors.forename: Abdolsamad
authors.initials: A
authors.lastname: Gharravi
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.
authors.forename: Christian C
authors.initials: CC
authors.lastname: Abnet
authors.affiliation: Departments of Oncology and Public Health and Primary Care University of Cambridge, Cambridge, UK.
authors.forename: Paul D P
authors.initials: PDP
authors.lastname: Pharoah
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Brennan
authors.affiliation: The Tisch Cancer Institute and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA.
authors.forename: Sanford M
authors.initials: SM
authors.lastname: Dawsey
authors.affiliation: Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Reza
authors.initials: R
authors.lastname: Malekzadeh
authors.affiliation: Digestive Oncology Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.|Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland, USA.
authors.forename: Farin
authors.initials: F
authors.lastname: Kamangar
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D015331:Cohort Studies; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008175:Lung Neoplasms / Q000401:mortality; D008297:Male; D009892:Opium / Q000009:adverse effects*; D011446:Prospective Studies; D012120:Respiration Disorders / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000701:Analgesics, Opioid; D009892:Opium
keywords: Clinical Epidemiology; Lung Cancer; Tobacco and the lung