Survival After Opioid-Related Hospitalization and the Impact of Socioeconomic Status (SES) on Survival: A Population-Based Study

Although some studies examined long-term survival following an opioid nonfatal overdose, none assessed whether survival after a nonfatal overdose is linked to socioeconomic status (SES). The objective of this study was to investigate survival rates after opioid-related hospitalizations and the relationship between SES and survival. We used national hospitalization data linked to mortality data to follow patients discharged alive after opioid-related hospitalization in Canada (except Québec) from April 1, 2001, to December 31, 2011, for a minimum of 1 year. SES was measured by quintile of median household income of patient’s area of residence at the Forward Sortation Area. The primary outcome was all-cause mortality, while the secondary outcome was opioid-related mortality, with other causes as a competing risk. Cox proportional hazard models assessed the association between SES and survival, adjusting for age, sex, and comorbidities. Among 49,890 patients, more than 30% reside in areas of the lowest income quintile and 8.2% in the highest. Over a median follow-up period of 4.9 years, 19.9% died (1.7% of opioid-related causes and 18.2% of other causes). All-cause mortality was not associated with income quintile. The hazard ratio (HR) for all-cause mortality between the highest and lowest income quintiles was 0.97 (95% CI 0.90–1.05, p = 0.52) in the crude model, and 0.99 (95% CI 0.92–1.07, p = 0.83) in the adjusted model. Similarly, opioid-related mortality was not associated with income quintile. Patients face high mortality rates following opioid-related hospitalizations, with 90% of deaths due to non-opioid causes, often overlooked in opioid epidemic statistics. Despite over 30% of the sample living in the lowest income quintile, SES does not appear to be associated with survival. However, this may reflect limitations in area-level SES measurement. Future research should explore other factors influencing survival, such as the availability and accessibility of addiction and community-based services and the effectiveness of seamless long-term care.