Title of Thesis: RISK OF UNINTENTIONAL OPIOID-INVOLVED DEATH AMONG DECEDENTS OF INDUSTRIES WITH A HIGH RISK OF NON-FATAL WORK-RELATED INJURY, GEORGIA 2014 

Thesis Chair: Dr. Heather Bradley

INTRODUCTION: The opioid epidemic continues to be a major public health issue across the United States, and from 2010 – 2018 the rate of opioid overdose death in the state of Georgia has increased more than 70%, with the driving force of the epidemic in the state until 2013 being prescription opioids. Although in recent years illicit opioids such as heroin and fentanyl have become more of a driving force, the rate of overdose attributed to prescription opioids has held steady. The literature has demonstrated nationally that certain occupations that have an increased risk of injury also have a higher risk of opioid-involved death. Occupational data for the state of Georgia has never been analyzed for a potential relationship with opioid-involved death but could be a valuable resource for identifying populations at an increased risk of opioid-involved death and informing public health action and intervention. 

AIM: To determine the risk of opioid-involved death compared to other causes of death for decedents previously working in industries with a high risk of non-fatal work-related injury. 

METHODS: Death certificate data for 2014 was obtained from the Office of Vital Records at the Georgia Department of Public Health and SAS Enterprise Guide 7.1 was used to clean and manage and analyze the data. The dataset analyzed contained records for all residents in the state of Georgia who died during the calendar year 2014. Opioid-involved death is the dependent variable of interest and deaths were identified using the international classification of diseases, 10th revision and deaths identified as intentional (suicides and assault) were excluded. The independent variable of interest was industries with a high risk of non-fatal work-related injury and were identified using the Georgia Occupational Health Surveillance Report, 2008 – 2012. Covariates sex, age at death, marital status, and maximum education level obtained at death were coded as categorical variables and analyzed for possible confounding and effect modification of the relationship between occupational type and opioid-involved death. The independent and dependent variables of interest were coded as dichotomous variables and analyzed along with predictors using multivariate logistic regression.

RESULTS: Decedents previously working in industries with a high risk of non-fatal work-related injury had an increased odds of opioid-related death compared to decedents with other causes of death (OR = 1.10, 95% CI: [0.97, 1.26]) however this association was not statistically significant. Marital status and education level were determined to be confounders with sex acting as an effect modifier. After adjusting for these confounders, male decedents in industries with a high risk of non-fatal work-related injury were found to have an increased odds of opioid-involved death that was 25% higher than (OR = 1.25, 95% CI: [1.06, 1.48]) among males employed in industries without a risk of opioid-involved. Conversely, females in industries with a high risk of non-fatal work-related injury had no associated increased odds of opioid-involved death compared to females who previously worked in all other industries. Additionally, those who were married had 33% decreased odds of opioid-involved death (OR = 0.67, 95% CI: [0.59, 0.77]) compared to those who were not married, and those with a high school diploma had 24% greater odds (OR = 1.24, 95% CI: [1.06, 1.46]) of opioid-involved death compared to those with a college degree. 

DISCUSSION: The results of this study support the previous literature that males are more at risk than females and that there is an increased risk of opioid-involved death for those in industries with a high-risk of non-fatal work-related injury. This indicates a relationship between occupational injury and opioid overdose and indicates that prevention efforts may be made more efficient by targeting specific industries or occupations. More research should also be done to better understand the role of sex in this relationship to determine why males appear to have higher odds of opioid overdose death compared to females. A more thorough understanding of the role occupational health plays in the opioid epidemic could be valuable for improving public health interventions to more efficiently combat the opioid epidemic in Georgia and the United States.