Opioid-related mortality after occupational injury in Washington State: accounting for preinjury opioid use

Authors

Leslie I. Boden, Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA lboden@bu.edu.
Abay Asfaw, National Institute for Occupational Safety and Health, Washington, District of Columbia, USA.
Paul K. O'Leary, Office of Retirement and Disability Policy, U.S. Social Security Administration, Washington, District of Columbia, USA.
Yorghos Tripodis, Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA.
Andrew Busey, NERA Economic Consulting, Boston, Massachusetts, USA.
Katie M. Applebaum, Department of Environmental and Occupational Health, The George Washington University, Washington, District of Columbia, USA.
Matthew P. Fox, Departments of Epidemiology and Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.

Document Type

Journal Article

Publication Date

9-26-2024

Journal

Occupational and environmental medicine

DOI

10.1136/oemed-2024-109606

Keywords

Epidemiology; Mortality; Occupational Health

Abstract

OBJECTIVES: To estimate the impact of occupational injury and illness on opioid-related mortality while accounting for confounding by preinjury opioid use. METHODS: We employed a retrospective cohort study design using Washington State workers' compensation data for 1994-2000 injuries linked to US Social Security Administration earnings and mortality data and National Death Index (NDI) cause of death data from 1994 to 2018. We categorised injuries as lost-time versus medical-only, where the former involved more than 3 days off work or permanent disability. We determined death status and cause of death from NDI records. We modelled separate Fine and Gray subdistribution hazard ratios (sHRs) and 95% CIs for injured men and women for opioid-related and all drug-related mortality through 2018. We used quantitative bias analysis to account for unmeasured confounding by preinjury opioid use. RESULTS: The hazard of opioid-related mortality was elevated for workers with lost-time relative to medical-only injuries: sHR for men: 1.53, 95% CI 1.41 to 1.66; for women: 1.31, 95% CI 1.16 to 1.48. Accounting for preinjury opioid use, effect sizes were reduced but remained elevated: sHR for men was 1.43, 95% simulation interval (SI) 1.20 to 1.69; for women: 1.27, 95% SI 1.10 to 1.45. CONCLUSIONS: Occupational injuries and illnesses severe enough to require more than 3 days off work are associated with an increase in the hazard of opioid-related mortality. The estimated increase is reduced when we account for preinjury opioid use, but it remains substantial. Reducing work-related injuries and postinjury opioid prescribing and improving employment and income security may decrease opioid-related mortality.

APA Citation

Boden, Leslie I.; Asfaw, Abay; O'Leary, Paul K.; Tripodis, Yorghos; Busey, Andrew; Applebaum, Katie M.; and Fox, Matthew P., "Opioid-related mortality after occupational injury in Washington State: accounting for preinjury opioid use" (2024). GW Authored Works. Paper 5586.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/5586

Department

Environmental and Occupational Health