Socioeconomic correlates of incident and fatal opioid overdose among Swedish people with opioid use disorder

Background Opioid overdose (OD) and opioid OD death are major health threats to people with opioid use disorder (OUD). Socioeconomic factors are underexplored potential determinants of opioid OD. In this study, we assessed socioeconomic and other factors and their associations with incident and fatal opioid OD, in a cohort consisting of 22,079 individuals with OUD. Methods We performed a retrospective, longitudinal study based on Swedish national register data for the period January 2005-December 2017. We used Cox proportional hazard models to investigate the risk of incident and fatal opioid OD as a function of several individual, parental and neighborhood covariates. Results Univariate analysis showed that several covariates were associated with incident and fatal opioid OD. In the multivariate analysis, incident opioid OD was associated with educational attainment (Hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.94-0.97), having received social welfare (HR 1.31; 95% CI 1.22-1.39), and criminal conviction (HR 1.53; 95% CI 1.42-1.65). Fatal opioid OD was also associated with criminal conviction (HR 1.93; 95% CI 1.61-2.32). Conclusion Individuals with low education and receipt of social welfare had higher risks of incident opioid OD and individuals with criminal conviction were identified as a risk group for both incident and fatal opioid OD. Our findings should raise attention among health prevention policy makers in general, and among decision-makers within the criminal justice system and social services in particular.

Automated summary

The study found that individuals with low education and receipt of social welfare were at higher risks of incident opioid overdose, while individuals with criminal conviction were more likely to experience fatal opioid overdose.