Work Disability and Fatal Opioid Overdose Risk in the United States: A Cohort Study

Despite long-term rising national rates of opioid-involved overdose deaths, little is known about the risks for US adults with work disability.

A prospective cohort study was performed with a nationally representative sample of adults, ages 20-61 years, from the 2008 American Community Survey (N = 2,403,000) followed through 2019 for overdose death involving opioids. Rates of fatal opioid overdose were calculated for adults with and without work disability followed by adjusted overdose hazards from stepwise Cox models controlling for age, sex, and race/ethnicity; marital status, education, residence, and region; and adding employment and income. Adjusted opioid overdose hazards of disability status were also stratified by age groups, sex, race/ethnicity, and by hearing, visual, cognitive, mobility, self-care, independent living skills, and unspecified impairments.

Approximately 4% had work disability. Annual fatal opioid overdose rates per 100,000 persons were 44.1 (95%CI = 40.1-48.3) for adults with work disability and 9.4 (95%CI = 9.1-9.8) for those without work disability. After controlling for age, sex, and race/ethnicity, the adjusted hazards of opioid overdose with disability were 5.92 (95%CI = 5.34-6.56), decreasing to 3.52 (95%CI = 3.14-3.93) after further controlling for marital status, residence, and education, and decreasing to 1.82 (95%CI = 1.62-2.05) after further controlling for employment and income, compared to adults without disability. In fully adjusted models, the association of work disability with opioid overdose was stronger for females (2.44, 95%CI = 2.03-2.93) than for males (1.40, 95%CI = 1.20-1.64), older (1.93, 95%CI = 1.65-2.26) than younger (1.31, 95%CI = 1.07-1.61) adults, and Hispanic (2.80, 95%CI = 1.69-4.63) than White non-Hispanic (1.75, 95%CI = 1.54-1.99) adults.

Relative to US adults without work disability, adults with work disability were at increased risk of fatal opioid overdose, including especially women, older adults, and Hispanic adults. New clinical and health policy initiatives may be needed to help protect US adults with work disability from the risks of fatal opioid overdose.