Accidental and Intentional Drug Poisoning Mortality in Older Adults in Spain: Nationwide Trends, 2001-2022

Objective To estimate time trends in fatal drug poisoning among older adults in Spain during 2001-2022 according to intent, sex, and age group. Patients and Methods Repeated cross-sectional study from January 1, 2001, through December 31, 2022. Fatal drug poisonings included poisoning deaths from psychoactive and therapeutic substances (excluding alcohol) and were classified using International Classification of Diseases, 10th Revision, codes as accidental (X40-X44) or intentional (X60-X64). Age-standardized mortality rates per million person-years were calculated. Time trends were characterized with annual percentage changes (APCs) using Joinpoint regression. Results were stratified by sex, age (65-74, 75-84, and ≥85 years), and intent. Results Among older adults, age-standardized mortality rates from drug poisoning were similar among men (21.7) and women (19.9), increased markedly with age, reaching 63.3 after age 84 years, and were higher for accidental (15.8) than intentional poisoning (4.8). Joinpoint regression shows a 2015 trend change in accidental poisoning rate from strongly upward (APC, 19.6%; 95% CI, 17.2-23.9) to moderately downward (APC, −7.4%; 95% CI, −11.3 to −4.2), whereas intentional poisoning rate rose steadily throughout the study period (APC, 7.3%). Furthermore, it shows substantial differences in time trends between age groups, but not between sexes. Conclusion Drug poisonings among older adults in Spain were predominantly accidental and rose sharply until 2015 before declining, while intentional self-poisoning increased throughout; burden was greatest in adults aged ≥85 years.