Mortality risk among individuals treated for alcohol use disorders: results of a longitudinal study from 1978 to 2016 in Northern Italy

OBJECTIVE: The aim of this study was to examine the mortality trends and causes of death in Northern Italy in a cohort of a population of individuals treated for alcohol use disorder (AUD) over a 38-year follow-up period (1978-2016). MATERIALS AND METHODS: 6,198 patients attending eighteen centres for addiction treatment (CATs) for AUD were recruited. RESULTS: During the follow-up period, 19.5% of the whole cohort died. The crude mortality rates (CMRs) were elevated (21.34 x 1000 person-years [PY]), higher for men and increasing with age group. The CMRs were higher for all cancers, followed by digestive system diseases, diseases of the circulatory system, transport accidents, and suicide. The standardised mortality ratios (SMRs) were at least three times higher for women and for men, and they were more elevated in younger patients and have been falling since 2009. Multivariate analysis confirmed that the mortality risk was higher for males and increased with age and decreased over time. The patients' main characteristics changed over time and, along with a greater presence of women and non-natives, fewer marginalised people and more socially integrated people turned to CATs. CONCLUSIONS: The mortality risk in treated AUD is confirmed to be higher when compared with the general population, although it is decreasing. In addition, there is enough epidemiological data to assert that, independent of age and gender, the major causes of death in AUD patients are cancers, gastrointestinal disease, cardiovascular disease (CVD), and injuries.