Abstract:

Background: Opioid overdose is an increasing cause of mortality among young and middle-aged adults. Conventional reports including incidence alone do not fully convey what is meant to society by the loss of so many young individuals. The present work employs Years of Life Lost (YLL), a time-based metric, to give greater weight to deaths occurring among the young. We document a 7-year period in which there were rapid shifts in the demography and geography of fatal opioid overdose in Ohio. Although recent work has examined opioid overdose YLL at the national level, significant geographic variation in mortality burden exists within the US necessitating detailed state and regional analyses.
Objectives: To quantify the burden of premature mortality due to opioid overdose in Ohio, document the role of fentanyl poisoning in contribution to this evolving epidemic, examine geographic and temporal patterns of mortality burden within Ohio and measure the effect of opioid overdose on lifespan in the state.

Methods: A serial cross-sectional analysis was performed for all fatal opioid poisonings (N = 12,782) in the state of Ohio between January 1, 2010 and December 31, 2016. The burden of fatal opioid overdose was calculated in YLL. YLL were mapped with respect to geographic and cultural region. The geographic spread of fentanyl poisoning was also mapped and the shifting contribution of fentanyl poisoning to overall opioid mortality burden was assessed over time. Finally, the negative effect of opioid overdose on average lifespan was calculated for all-cause decedents in the year 2016.

Results: Opioid overdose resulted in 508,451 total YLL. In the year 2016 alone, there were 136,679 YLL attributable to opioid poisoning. Fentanyl related YLL rose from 7.5% of all YLL due to opioid overdose in 2010 to 69.0% in 2016. In the same year, opioid overdose lowered the average lifespan of all-cause decedents by 0.97 years. Although the vast majority of decedents were White (91%), YLL increased annually in all racial groups and the rate of change was greater for Blacks (387% change) than for Whites (245% change). Burden was not equally distributed within the state. Two distinct geographical clusters of excess mortality were identified.

Conclusions: Fatal opioid overdose accounted for over half a million YLL in Ohio during the 7-year study period. Opioid overdose mortality rose annually. Fentanyl involved overdoses accounted for an increasing proportion of excess mortality. This study contributes to the growing epidemiologic research regarding the opioid epidemic. Our study documents the recent emergence of fentanyl poisoning as a growing source of excess mortality over an increasing geographic area in the state of Ohio. Implications of the present work are many. Our results may be used to guide resource allocation and inform further research. Mortality burden expressed in YLL should be serially assessed in order to surveil the geographic spread of fentanyl and other opioid poisonings, identify community profiles and potential protective factors and evaluate the efficacy of ongoing and future efforts to control the epidemic.