Roberts, Emmert;
Strang, John;
Taylor, Eve;
Crummy, Jamie;
Lowden, Tim;
Amasiatu, Chioma;
Eastwood, Brian;
(2025)
Prediction of individualised 6-month mortality risk in opioid use disorder.
The British Journal of Psychiatry
pp. 1-8.
10.1192/bjp.2025.10313.
(In press).
Preview |
Text
Taylor_div-class-title-prediction-of-individualised-6-month-mortality-risk-in-opioid-use-disorder-div.pdf Download (226kB) | Preview |
Abstract
Background: People with opioid use disorder (OUD) have substantially higher standardised mortality rates compared with the general population. However, lack of individualised prognostic information presents challenges in personalisation of addiction treatment delivery. // Aims: To develop and validate the first prognostic models to estimate 6-month all-cause and drug-related mortality risk for people diagnosed with OUD using indicators recorded at baseline assessment in addiction services in England. // Method: Thirteen candidate prognostic variables, including sociodemographic, injecting status and health and mental health factors, were identified from nationally linked addiction treatment, hospital admission and death records from 1 April 2013 to 1 April 2022. Multivariable Cox regression models were developed with a fractional polynomial approach for continuous variables, and missing data were addressed using multiple imputation by chained equations. Validation was undertaken using bootstrapping methods. Discrimination was assessed using Harrel’s C and D statistics alongside examination of observed-to-predicted event rates and calibration curve slopes. // Results: Data were available for 236 064 people with OUD, with 2427 deaths due to any cause, including 1289 due to drug-related causes. Both final models demonstrated good optimism-adjusted discrimination and calibration, with all-cause and drug-related models, respectively, demonstrating Harrell’s C statistics of 0.73 (95% CI 0.71–0.75) and 0.74 (95% CI 0.72–0.76), D-statistics of 1.01 (95% CI 0.95–1.08) and 1.07 (95% CI 0.98–1.16) and calibration slopes of 1.01 (95% CI 0.95–1.08) and 1.01 (95% CI 0.94–1.10). // Conclusions: We developed and internally validated Roberts’ OUD mortality risk, with the first models to accurately quantify individualised absolute 6-month mortality risks in people with OUD presenting to addiction services. Independent validation is warranted to ensure these models have the optimal utility to assist wider future policy, commissioning and clinical decision-making.
| Type: | Article |
|---|---|
| Title: | Prediction of individualised 6-month mortality risk in opioid use disorder |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1192/bjp.2025.10313 |
| Publisher version: | https://doi.org/10.1192/bjp.2025.10313 |
| Language: | English |
| Additional information: | Copyright © The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited. |
| Keywords: | Mortality; risk prediction; opioid use disorder; prognosis; epidemiology |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Behavioural Science and Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10211268 |
Archive Staff Only
 |
View Item |
