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Original research
Opioid-related mortality after occupational injury in Washington State: accounting for preinjury opioid use
  1. Leslie I Boden1,
  2. Abay Asfaw2,
  3. Paul K O'Leary3,
  4. Yorghos Tripodis4,
  5. Andrew Busey5,
  6. Katie M Applebaum6,
  7. Matthew P Fox7
  1. 1Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
  2. 2National Institute for Occupational Safety and Health, Washington, District of Columbia, USA
  3. 3Office of Retirement and Disability Policy, U.S. Social Security Administration, Washington, District of Columbia, USA
  4. 4Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
  5. 5NERA Economic Consulting, Boston, Massachusetts, USA
  6. 6Department of Environmental and Occupational Health, The George Washington University, Washington, District of Columbia, USA
  7. 7Departments of Epidemiology and Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Professor Leslie I Boden; lboden{at}bu.edu

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.

  • Epidemiology
  • Occupational Health
  • Mortality

Data availability statement

Data may be obtained from a third party and are not publicly available. Individually identifiable information is not available from the US Social Security Administration. It may be possible to obtain data from the Washington State Department of Labor and Industries with appropriate data-sharing agreements and assurances of confidentiality as approved by the Washington State Institutional Review Board. National Death Index data are available on approval by the NDI.

https://doi.org/10.1136/oemed-2024-109606

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Individually identifiable information is not available from the US Social Security Administration. It may be possible to obtain data from the Washington State Department of Labor and Industries with appropriate data-sharing agreements and assurances of confidentiality as approved by the Washington State Institutional Review Board. National Death Index data are available on approval by the NDI.

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    Footnotes

    • Contributors LIB is the guarantor of the study. LIB, PKO'L, KMA, YT and MPF conceived and designed the study. AA, PKO'L, YT and AB performed data analysis and interpretation. LIB drafted the manuscript. All authors participated in revising the work critically for important intellectual content, provided final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The National Institute for Occupational Safety and Health (grants R21 OH010555 and R01 OH011511) supported this work.

    • Disclaimer Guidelines: This study has followed the STROBE guidelines.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.